Higher Proportion Of Black Residents Research Articles

The Impact of the COVID-19 Pandemic on Staffing Levels in Philadelphia Nursing Homes: Disparities Based on the Racial Composition of Geographical Areas.

Research to assess and inform health policy is an essential component of the policymaking process to advance equity in public health practice. This study investigated health disparities during the COVID-19 pandemic (2020-2022) in older adult institutional settings in Philadelphia, PA, to inform policy initiatives, interventions, and infrastructure development. We first explored the changing patterns of nursing staffing levels (total direct care staff and registered nurses [RNs]) measured by hours per resident per day (HPRD) before and after COVID-19. Our findings revealed that HPRD levels consistently fell below the Centers for Medicare and Medicaid Services recommended standards from 2018 to 2022, with notable declines observed starting from 2021. Results from multilevel modeling showed significant declines in HPRD for total direct care nursing staff in nursing homes located in zip codes with a high proportion of Black residents (≥40%). In contrast, HPRD for RNs significantly declined in nursing homes located in zip codes with a lower proportion of Black residents (<40%). Moreover, higher reported direct care HPRD and RN HPRD were associated with any reported COVID-19 cases only within zip codes with a low proportion of Black residents. These findings indicate the need for additional policies to address these observed patterns in staffing levels. Our study provides a foundation for future policy reviews utilizing a conceptual framework that is health equity-centric for local and state health departments program and units intended for institutional care settings for older adults.

Maintaining disorder: estimating the association between policing and psychiatric hospitalization among youth in New York City by neighborhood racial composition, 2006-2014.

To assess whether neighborhood-level measures of policing are spatio-temporally associated with psychiatric hospialization among adolescents and young adults in New York City, and whether this association varies by neighborhood racial composition. We derived population-based measures of policing from the New York City Police Department (NYPD), psychiatric hospitalization from Statewide Planning and Research Cooperative System (SPARCS) data, and socio-demographic data from the American Community Survey (ACS), aggregated by month and ZIP Code Tabulation Area (ZCTA) from 2006 to 2014. Multi-level negative binomial regression models assessed hospitalization-time of youth aged 10-24 as the dependent variable and the rate of policing events as the primary independent variable, adjusting for neighborhood poverty, unemployment, and educational attainment. Multiplicative interaction was assessed between policing and tertiles of the percentage of Black residents. A total of 11,900,192 policing incidents and 2,118,481 person-days of hospitalization were aggregated to 19,440 ZCTA-months. After adjusting for neighborhood-level sociodemographic characteristics, an increase in one policing incident per 1,000 residents was associated with a 0.3% increase in the rate of youth psychiatric hospitalization time (IRR 1.003 [1.001-1.005]). Neighborhood racial composition modified this effect; not only was the rate of psychiatric hospitalization and policing higher in neighborhoods with a higher proportion of Black residents, but the association between these was also significantly higher in neighorhoods with a larger share of Black residents compared with predominantly non-Black neighborhoods. Neighborhoods experiencing higher rates of policing during the study period experienced higher burdens of psychiatric hospitalization among adolescent and young adult residents. This association was larger in neighborhoods of color which have been disproportionately targeted by "hot spot" and order-maintenance policing practices and policies.

Factors Associated With the Ability of US Nursing Homes to Accept Residents With Severe Obesity

ObjectivesSevere obesity in nursing home (NH) residents is associated with specialized care needs, limited mobility, and challenges in daily living. The COVID-19 pandemic strained NH resources and exacerbated staffing shortages. This study aimed to assess the ability of US NHs to accept and care for residents with severe obesity post-COVID, as well as associated NH factors. DesignCross-sectional nationwide survey of NH administrators (2021-2022). Setting and Participants290 NHs from a national sample (n = 224) and a targeted sample in Massachusetts and New Jersey (n = 66). MethodsA survey designed to assess how NHs approach admitting and caring for people with severe obesity before and after COVID was fielded from 2021 to 2022. Responses were linked to facility information from the Certification and Survey Provider Enhanced Reports, Minimum Data Set, Nursing Home Compare, Area Health Resources File, and US Diabetes Surveillance System. Multivariable logistic regression was used to assess the effect of organizational and survey response variables. ResultsOf the 2503 surveys sent to US NHs, 1923 were sent to the national NH stratified sample, and 580 were sent to the MA/NJ sample. Overall, 12% (301 of 2503) of NHs surveyed responded. The response rates were similar between the 2 samples. Of 290 NHs with complete data, 34% reported being unlikely to accept residents with severe obesity after COVID-19, compared with 25% before the pandemic (P < .001). The main barriers to acceptance were staffing shortages and difficulties meeting equipment and space needs. NHs with higher proportions of Black residents were more likely to admit individuals with severe obesity. Conclusions and ImplicationsThe decline in acceptance of residents with severe obesity during and after COVID-19 highlights potential challenges that this population faces in accessing care. Our results also raise concerns that an intersection of disparities may exist in Black patients with severe obesity.

Toxic air pollution and concentrated social deprivation are associated with low birthweight and preterm Birth in Louisiana * *K T and G S provide scientific support to communities engaged in environmental advocacy, including litigation, through their work at the Tulane Environmental Law Clinic. They receive no compensation for this work outside of employment. M W declares that she has nothing

Previous studies indicate that pollution exposure can increase risks of adverse birth outcomes, but Black communities are underrepresented in this research, and the potential moderating role of neighborhood context has not been explored. These issues are especially relevant in Louisiana, which has a high proportion of Black residents, an entrenched history of structural racism, the most pounds of toxic industrial emissions annually, and among the nation’s highest rates of low birthweight (LBW), preterm birth (PTB), and infant mortality. We investigated whether air pollution and social polarization by race and income (measured via the index of concentration at the extremes [ICE]) were associated with LBW and PTB among Louisiana census tracts (n = 1101) using spatial lag models. Data sources included 2011–2020 birth records, U.S. Census Bureau 2017 demographic data, and 2017 respiratory hazard (RH) from the U.S. Environmental Protection Agency. Both RH and ICE were associated with LBW (z = 4.4, P < 0.0001; z = −27.0, P < 0.0001) and PTB (z = 2.3, P = 0.019; z = −16.7, P < 0.0001), with no interaction. Severely polluted tracts had 36% higher and 25% higher risks of LBW and PTB, respectively, versus unpolluted tracts. On average, 2166 low birthweight and 3583 preterm births annually were attributable to pollution exposure. Tracts with concentrated social deprivation (i.e. low ICE scores) had 53% higher and 34% higher risks of LBW and PTB, respectively, versus intermediate or mixed tracts. On average, 1171 low birthweight and 1739 preterm births annually were attributable to concentrated deprivation. Our ecological study found that a majority of adverse birth outcomes in Louisiana (i.e. 67% of LBW and PTB combined) are linked to air pollution exposure or disadvantage resulting from social polarization. These findings can inform research, policy, and advocacy to improve health equity in marginalized communities.

Access to housing credit and marriage: evidence from redlining maps

AbstractThis study evaluates the impact of a policy popularly known as “redlining” on marriage. This policy led to the creation of a series of maps that guided banks in their lending, where some areas were favored and others were discriminated against. Given the quasi-randomness of mortgage discrimination, this policy allows us to make inferences regarding whether housing credit constraints affect marriage. Furthermore, it also provides insight into whether unequal access to housing credit played a role in the contemporary racial marriage gap. This policy allows us to make these inferences due to the fact that neighborhood blocks that were more heavily discriminated against had higher proportions of Black residents. The study uses a spatial differences in discontinuities design to show that the maps led to a reduction in marriage in discriminated areas. These effects are shown to not be due to sorting. They can also be ascribed to the housing credit mechanism per se, rather than competing second-order mechanisms that result from individuals being denied mortgages. These second-order effects can include, for instance, neighborhood decline effects found in other redlining work.

Disproportionate Rates of COVID-19 Among Black Canadian Communities: Lessons from a Cross-Sectional Study in the First Year of the Pandemic.

Racialized communities, including Black Canadians, have disproportionately higher COVID-19 cases. We examined the extent to which SARS-CoV-2 infection has affected the Black Canadian community and the factors associated with the infection. We conducted a cross-sectional survey in an area of Ontario (northwest Toronto/Peel Region) with a high proportion of Black residents along with 2 areas that have lower proportions of Black residents (Oakville and London, Ontario). SARS-CoV-2 IgG antibodies were determined using the EUROIMMUN assay. The study was conducted between August 15, 2020, and December 15, 2020. Among 387 evaluable subjects, the majority, 273 (70.5%), were enrolled from northwest Toronto and adjoining suburban areas of Peel, Ontario. The seropositivity values for Oakville and London were comparable (3.3% (2/60; 95% CI 0.4-11.5) and 3.9% (2/51; 95% CI 0.5-13.5), respectively). Relative to these areas, the seropositivity was higher for the northwest Toronto/Peel area at 12.1% (33/273), relative risk (RR) 3.35 (1.22-9.25). Persons 19 years of age or less had the highest seropositivity (10/50; 20.0%, 95% CI 10.3-33.7%), RR 2.27 (1.23-3.59). There was a trend for an interaction effect between race and location of residence as this relates to the relative risk of seropositivity. During the early phases of the pandemic, the seropositivity within a COVID-19 high-prevalence zone was threefold greater than lower prevalence areas of Ontario. Black individuals were among those with the highest seroprevalence of SARS-CoV-2.

Exploring the Presence and Type of Premium Cigar Retailers With Neighborhood Sociodemographic Correlates in the United States, 2019-2021.

Little is known about the location and store type of premium cigar retailers in the United States. Different store types may expose people to secondhand smoke (eg, cigar bar or lounge) and may also have age restrictions (eg, tobacco shops) that could reduce youth exposure to products and marketing. We obtained a national retailer dataset from the Premium Cigar Association (PCA) from 2019 to 2021. We coded store type using nine categories and used generalized estimating equations to examine associations between census tract sociodemographic characteristics and PCA store type. Of the 1279 PCA retailers, the majority were cigar stores (39%), followed by tobacco shops (26%), cigar bars or lounges (20%), and beer, wine, or liquor stores (15%). Overall, there were no statistically significant associations between tract-level sociodemographic characteristics and the odds that a retailer was a specific store type versus another store type. However, PCA retailers located in tracts with a higher percentage of non-Hispanic Black residents were associated with 1.12 times the odds of being a cigar bar or lounge versus another type (95% CI, 1.02 to 1.22). The majority of PCA retailers are specialty cigar stores or cigar bars or lounges, and few are more traditional tobacco retailers, such as convenience stores. We document a higher odds of a store being a cigar bar or lounge for retailers located in neighborhoods with a higher proportion of Black residents, which may contribute to inequities in tobacco-related disease and disability because of potentially greater secondhand smoke exposure. Specialized retailers account for most premium cigar stores. One in five PCA retailers was a cigar bar or lounge, which raises public health concerns around exposure to secondhand smoke for patrons and employees. Local jurisdictions should examine zoning ordinances in tandem with sociodemographic characteristics to ensure inequities in the location of cigar bars or lounges are not produced or sustained given the potential harms associated with secondhand smoke exposure.

Social and Environmental Stressors of Urban Oil and Gas Facilities in Los Angeles County, California, 2020.

Objectives. To examine patterns of cumulative environmental injustice with respect to operations of urban oil and gas development in Los Angeles County, California. Methods. Using CalEnviroScreen (CES) 4.0, oil and gas data permit records, and US census data, we examined the association between CES score (grouped into equal quintiles, with the lowest representing low cumulative burden) and oil and gas development (presence or absence of an oil and gas production well) within 1 kilometer of a census block centroid. Results. Among census blocks in the highest quintile of CES score, we observed 94% increased odds of being within 1 kilometer of a well compared with census blocks in the lowest quintile of CES score (odds ratio = 1.94; 95% confidence interval = 1.83, 2.10). In our multivariable model, the proportion of Black residents and higher quintiles of CES score were also associated with increased odds of a nearby oil and gas well. Conclusions. These findings suggest that oil and gas facilities are operating in neighborhoods already cumulatively burdened and with higher proportions of Black residents. (Am J Public Health. 2023;113(11):1182-1190. https://doi.org/10.2105/AJPH.2023.307360).

Measuring the Digital Divide: A Neighborhood-Level Analysis of Racial Inequality in Internet Speed during the COVID-19 Pandemic

Since the beginning of the COVID-19 pandemic, internet access has been vital to ensuring individuals can work from home, attend online school and maintain contact with loved ones. While research has already shown that inequalities exist regarding who has access to the internet, less research has used actual internet speed test data to examine neighborhood inequalities in internet access, and even less research has explored trends related to this during the COVID-19 pandemic. Using a dataset containing over 100 million internet speed tests in the United States, we analyze neighborhood-level variation in internet speed. We find that neighborhoods with higher proportions of Black residents tend to have better download speeds but worse upload speeds. Notably, upload speeds are especially important for video communication, which massively proliferated during the pandemic. Further, upload speeds in Black neighborhoods have consistently fallen relative to white neighborhoods during the pandemic. This trend has substantial implications for racial inequality in the digital age.

Neighborhood factors and triple negative breast cancer: The role of cumulative exposure to area-level risk factors.

Despite similar incidence rates among Black and White women, breast cancer mortality rates are 40% higher among Black women. More than half of the racial difference in breast cancer mortality can be attributed to triple negative breast cancer (TNBC), an aggressive subtype of invasive breast cancer that disproportionately affects Black women. Recent research has implicated neighborhood conditions in the etiology of TNBC. This study investigated the relationship between cumulative neighborhood-level exposures and TNBC risk. This single-institution retrospective study was conducted on a cohort of 3316 breast cancer cases from New Castle County, Delaware (from 2012 to 2020), an area of the country with elevated TNBC rates. Cases were stratified into TNBC and "Non-TNBC" diagnosis and geocoded by residential address. Neighborhood exposures included census tract-level measures of unhealthy alcohol use, metabolic dysfunction, breastfeeding, and environmental hazards. An overall cumulative risk score was calculated based on tract-level exposures. Univariate analyses showed each tract-level exposure was associated with greater TNBC odds. In multivariate analyses that controlled for patient-level race and age, tract-level exposures were not associated with TNBC odds. However, in a second multivariate model that included patient-level variables and considered tract-level risk factors as a cumulative exposure risk score, each one unit increase in cumulative exposure was significantly associated with a 10% increase in TNBC odds. Higher cumulative exposure risk scores were found in census tracts with relatively high proportions of Black residents. Cumulative exposure to neighborhood-level risk factors that disproportionately affect Black communities was associated with greater TNBC risk.

Neighborhood-level COVID vaccination and booster disparities: A population-level analysis across California

ObjectivesTo describe vaccine and booster uptake by neighborhood-level factors in California. MethodsWe examined trends in COVID-19 vaccination up to September 21, 2021, and boosters up to March 29, 2022 using data from the California Department of Public Health. Quasi-Poisson regression was used to model the association between neighborhood-level factors and fully vaccinated and boosted among ZIP codes. Sub-analyses on booster rates were compared among the 10 census regions. ResultsIn a minimally adjusted model, a higher proportion of Black residents was associated with lower vaccination (HR = 0.97; 95%CI: 0.96–0.98). However, in a fully adjusted model, proportion of Black, Hispanic/Latinx, and Asian residents were associated with higher vaccination rates (HR = 1.02; 95%CI: 1.01–1.03 for all). The strongest predictor of low vaccine coverage was disability (HR = 0.89; 95%CI: 0.86–0.91). Similar trends persisted for booster doses. Factors associated with booster coverage varied by region. ConclusionsExamining neighborhood-level factors associated with COVID-19 vaccination and booster rates uncovered significant variation within the large and geographically and demographically diverse state of California. Equity-based approaches to vaccination must ensure a robust consideration of multiple social determinants of health.

Relationships Between Patient Race and Residential Race Context With Missed Human Immunodeficiency Virus Care Visits in the United States, 2010-2015.

Racial inequities exist in retention in human immunodeficiency virus (HIV) care and multilevel analyses are needed to contextualize and address these differences. Leveraging data from a multisite clinical cohort of people with HIV (PWH), we assessed the relationships between patient race and residential characteristics with missed HIV care visits. Medical record and patient-reported outcome (PRO; including mental health and substance-use measures) data were drawn from 7 participating Center for AIDS Research Network of Integrated Clinical Systems (CNICS) sites including N = 20 807 PWH from January 2010 through December 2015. Generalized estimating equations were used to account for nesting within individuals and within census tracts in multivariable models assessing the relationship between race and missed HIV care visits, controlling for individual demographic and health characteristics and census tract characteristics. Black PWH resided in more disadvantaged census tracts, on average. Black PWH residing in census tracts with higher proportion of Black residents were more likely to miss an HIV care visit. Non-Black PWH were less likely to miss a visit regardless of where they lived. These relationships were attenuated when PRO data were included. Residential racial segregation and disadvantage may create inequities between Black PWH and non-Black PWH in retention in HIV care. Multilevel approaches are needed to retain PWH in HIV care, accounting for community, healthcare setting, and individual needs and resources.

Trends in 1-Year Recurrent Ischemic Stroke in the US Medicare Fee-for-Service Population.

There have been important advances in secondary stroke prevention and a focus on healthcare delivery over the past decades. Yet, data on US trends in recurrent stroke are limited. We examined national and regional patterns in 1-year recurrence among Medicare beneficiaries hospitalized for ischemic stroke from 2001 to 2017. This cohort study included all fee-for-service Medicare beneficiaries aged ≥65 years who were discharged alive with a principal diagnosis of ischemic stroke from 2001 to 2017. Follow-up was up to 1 year through 2018. Cox models were used to assess temporal trends in 1-year recurrent ischemic stroke, adjusting for demographic and clinical characteristics. We mapped recurrence rates and identified persistently high-recurrence counties as those with rates in the highest sextile for stroke recurrence in ≥5 of the following periods: 2001-2003, 2004-2006, 2007-2009, 2010-2012, 2013-2015, and 2016-2017. There were 3 638 346 unique beneficiaries discharged with stroke (mean age 79.0±8.1 years, 55.2% women, 85.3% White). The national 1-year recurrent stroke rate decreased from 11.3% in 2001-2003 to 7.6% in 2016-2017 (relative reduction, 33.5% [95% CI, 32.5%-34.5%]). There was a 2.3% (95% CI, 2.2%-2.4%) adjusted annual decrease in recurrence from 2001 to 2017 that included reductions in all age, sex, and race subgroups. County-level recurrence rates ranged from 5.5% to 14.0% in 2001-2003 and from 0.2% to 8.9% in 2016-2017. There were 76 counties, concentrated in the South-Central United States, that had the highest recurrence throughout the study. These counties had populations with a higher proportion of Black residents and uninsured adults, greater wealth inequity, poorer general health, and reduced preventive testing rates as compared with other counties. Recurrent ischemic strokes decreased over time overall and across demographic subgroups; however, there were geographic areas with persistently higher recurrence rates. These findings can inform secondary prevention intervention opportunities for high-risk populations and communities.

Associations between ambient PM2.5 – components and age-specific mortality risk in the United States

Long-term exposure to fine particulate matter (PM 2.5 ) has been associated with premature mortality, but less work has examined associations with multiple PM 2.5 components. In this study we assess the relationship between specific PM 2.5 components (black carbon (BC), organic matter (OM), sulfate (SO 4 ), nitrate (NO 3 ), ammonium (NH 4 ), soil, and seasalt) and mean age-specific mortality risk (ASMR) between 2010 and 2015 at the census tract (CT) level from the US Small-Area Life Expectancy Estimates Project using multilevel models that control for a rich set of socioeconomic factors (SES) and weather conditions. We observed that ASMR and PM-components varied substantially across the US CTs. CTs accounted for the majority of the total variability in ASMR (∼75-95%). Much of the variation in ASMR observed at the state and county level were explained by SES (∼70-90%) and PM 2.5 -component concentrations (∼ 20-50%). Underprivileged CTs (CTs with a high proportion of Black residents, residents living in poverty, foreign-born residents, residents with no college education) had higher PM 2.5 and PM 2.5 -component concentrations. We observed significant associations between PM 2.5 -components, OM, SO 4 , soil and seasalt, in fully adjusted models with ASMR for most age groups > 25 years and older, with the highest associations observed for OM and ASMR across most age groups. The strongest associations between PM 2.5 -components and ASMR were observed for older residents (65-74 years of age). The associations detected were highest in underprivileged CTs. Our findings support that the impact of PM 2.5 on the risk of mortality, likely varies by particle composition.

Do social determinants of health impact access to neurosurgical care in the United States? A workforce perspective.

This study attempts to use neurosurgical workforce distribution to uncover the social determinants of health that are associated with disparate access to neurosurgical care. Data were compiled from public sources and aggregated at the county level. Socioeconomic data were provided by the Brookings Institute. Racial and ethnicity data were gathered from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research. Physician density was retrieved from the Health Resources and Services Administration Area Health Resources Files. Catchment areas were constructed based on the 628 counties with neurosurgical coverage, with counties lacking neurosurgical coverage being integrated with the nearest covered county based on distances from the National Bureau of Economic Research's County Distance Database. Catchment areas form a mutually exclusive and collectively exhaustive breakdown of the entire US population and licensed neurosurgeons. Socioeconomic factors, race, and ethnicity were chosen as independent variables for analysis. Characteristics for each catchment area were calculated as the population-weighted average across all contained counties. Linear regression analysis modeled two outcomes of interest: neurosurgeon density per capita and average distance to neurosurgical care. Coefficient estimates (CEs) and 95% confidence intervals were calculated and scaled by 1 SD to allow for comparison between variables. Catchment areas with higher poverty (CE = 0.64, 95% CI 0.34-0.93) and higher prime age employment (CE = 0.58, 95% CI 0.40-0.76) were significantly associated with greater neurosurgeon density. Among categories of race and ethnicity, catchment areas with higher proportions of Black residents (CE = 0.21, 95% CI 0.06-0.35) were associated with greater neurosurgeon density. Meanwhile, catchment areas with higher proportions of Hispanic residents displayed lower neurosurgeon density (CE = -0.17, 95% CI -0.30 to -0.03). Residents of catchment areas with higher housing vacancy rates (CE = 2.37, 95% CI 1.31-3.43), higher proportions of Native American residents (CE = 4.97, 95% CI 3.99-5.95), and higher proportions of Hispanic residents (CE = 2.31, 95% CI 1.26-3.37) must travel farther, on average, to receive neurosurgical care, whereas people living in areas with a lower income (CE = -2.28, 95% CI -4.48 to -0.09) or higher proportion of Black residents (CE = -3.81, 95% CI -4.93 to -2.68) travel a shorter distance. Multiple factors demonstrate a significant correlation with neurosurgical workforce distribution in the US, most notably with Hispanic and Native American populations being associated with greater distances to care. Additionally, higher proportions of Hispanic residents correlated with fewer neurosurgeons per capita. These findings highlight the interwoven associations among socioeconomics, race, ethnicity, and access to neurosurgical care nationwide.

Facility Characteristics Associated With Intensity of Care of Nursing Homes and Hospital Referral Regions.

Intensity of care, such as hospital transfers and tube feeding of residents with advanced dementia varies by nursing home (NH) within and across regions. Little work has been done to understand how these 2 levels of influence relate. This study's objectives are to identify facility factors associated with NHs providing high-intensity care to residents with advanced dementia and determine whether these factors differ within and across hospital referral regions (HRRs). Cross-sectional analysis. 1449 NHs. Nationwide 2016-2017 Minimum Data Set was used to categorize NHs and HRRs into 4 levels of care intensity based on rates of hospital transfers and tube feeding among residents with advanced dementia: low-intensity NH in a low-intensity HRR, high-intensity NH in a low-intensity HRR, low-intensity NH in a high-intensity HRR, and a high-intensity NH in a high-intensity HRR. In high-intensity HRRs, high-vs low-intensity NHs were more likely to be urban, lack a dementia unit, have a nurse practitioner or physician (NP or PA) on staff, and have a higher proportion of residents who were male, aged <65years, Black, had pressure ulcers, and shorter hospice stays. In low-intensity HRRs, higher proportion of Black residents was the only characteristic associated with being a high-intensity NH. These findings suggest that within high-intensity HRRs, there are potentially modifiable factors that could be targeted to reduce burdensome care in advanced dementia, including having a dementia unit, palliative care training for NPs and PAs, and increased use of hospice care.

Association of Residential Racial and Ethnic Segregation With Legal Intervention Injuries in California

The continued harm of Black individuals in the US by law enforcement officers calls for reform of both law enforcement officers and structural racism embedded in communities. To examine the association between county characteristics and racial and ethnic disparities in legal intervention injuries. This retrospective, cross-sectional study was conducted among 27 671 patients presenting to California hospitals from January 1, 2016, to December 31, 2019, with legal intervention injuries (defined as any injury sustained as a result of an encounter with any law enforcement officer) as identified by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Legal intervention injuries were classified by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision external cause of injury code Y35. Expected injury counts were calculated for each county by multiplying statewide median rates of injury per capita for each age-racial and ethnic group, and then observed to expected injury ratios were measured. The association between county injury ratio, percentage of Black individuals, and residential segregation (measured using an index of dissimilarity) was modeled, stratifying by race and ethnicity. A total of 27 671 patients (24 159 male patients [87.3%]; 1734 Asian and Pacific Islander [6.3%], 5049 Black [18.2%], 11 250 Hispanic [40.7%], and 9638 White [34.8%]; mean [SD] age, 34.2 [12.5] years) presented with legal intervention injuries in California from 2016 to 2019. Observed to expected injury ratios ranged from 0 to 7 for Black residents and from 0 to 5 for White residents. High observed to expected injury ratios for Black residents (408 observed vs 60 expected; ratio = 7) were clustered around San Francisco Bay Area counties and corresponded with a higher proportion of Black residents. High observed to expected injury ratios for White residents (57 observed vs 11 expected; ratio = 5) clustered around rural northern California counties and corresponded with higher mean percentage of residents with income below the federal poverty level and fewer urban areas. This study suggests that residential segregation may be associated with increased legal intervention injury rates for Black residents of California counties with a large percentage of Black residents. Reform efforts to address racial and ethnic disparities in these injuries should carefully consider and address the legacy of discriminatory policies that has led to segregated communities in California and the United States.

Tract level associations between historical residential redlining and contemporary fatal encounters with police

How does structural racism influence where people are killed during encounters with police? We analyzed geo-located incidents of fatal encounters with police that occurred between 2000 and 2020 in Census tracts that received a classification by the Home Owners Loan Corporation (HOLC) during the 1930's. Statistical models show that incidents of fatal encounters with police in formerly redlined areas are 66% more likely than in zones that received the most favorable “A” rating. These differences remain even when tract historical and contemporary racial compositions, along with contemporary economic conditions, are taken into account. The effects of contemporary racial composition and economic conditions overshadow the effect of zone classifications only in areas with high proportions of Black residents or residents in poverty (>60% or >30% respectively). These findings provide evidence of structural biases in policing rooted in historical segregation policies.

Facility Characteristics Associated With Intensity of Care of Nursing Home Residents With Advanced Dementia

Profound variations in care intensity of nursing home (NH) residents with advanced dementia exist for NHs within and across hospital referral regions (HRRs). Little is known about how these levels of influence relate. Nationwide 2016-2017 Minimum DataSet was used to categorize NHs and HRRs into 4 levels of care intensity based on hospital transfer and tube-feeding rates among residents with advanced dementia: low intensity NH in low intensity HRR; high intensity NH in low intensity HRR; low intensity NH in high intensity HRR; and high intensity NH in high intensity HRR. We used multinomial logistic regression to identify NH characteristics associated with belonging to each of 4-levels of intensity as compared to low intensity NH in low intensity HRRs (reference). We found high intensity NHs in high intensity HRRs were more likely to be in an urbanized area, not have an dementia unit, have an NP/PA on staff, have a higher proportion of residents who were male, age <65, of Black race, and had pressure ulcers, and relatively fewer days on hospice. Whereas in low intensity HRRs, higher proportion of Black residents was the only characteristic associated with being a high intensity NH. These findings suggest potentially modifiable factors within high intensity HRRs that could be targeted to reduce burdensome care, including having a dementia unit, palliative care training for NP/PAs, or increased use of hospice care. This study underscores the critical need to better understand the role race plays in the intensity of care of NH residents with dementia.

An Exploratory Study of Environmental Stress in Four High Violent Crime Cities: What Sets Them Apart?

Understanding the social contexts of violent crime remains controversial in the literature. In the current study, we examine common social contexts in four cities (Houston, TX, Baltimore, MD, Jackson, MS, Wilmington, DE). Data were examined in two studies. In the first, each city was compared to national county-level data on health outcomes. In the second, communities within the four cities were examined for correlates of crime. Results suggest that some common social contexts emerge: high STD rates, air pollution, single-parent homes, insufficient food resources and sleep, residential segregation, housing cost burdens, comparatively few older adults and comparatively more females, were common among the four high-violence cities. By contrast, all four cities unexpectedly had uncommonly low suicide rates compared to the national average. At the community level, unemployment, community stress, median household income, and population density all correlated with criminal outcomes. High-violence cities tended to have higher proportions of Black residents, however community level evaluations suggested that class-related issues, not race per se, was correlated with violent crime.