Hispanic Residents Research Articles

Temporal trends in the association of social vulnerability and race/ethnicity with county-level COVID-19 incidence and outcomes in the USA: an ecological analysis

BackgroundThe COVID-19 pandemic adversely affected the socially vulnerable and minority communities in the USA initially, but the temporal trends during the year-long pandemic remain unknown.ObjectiveWe examined the temporal association of...

Chilling Effects: US Immigration Enforcement And Health Care Seeking Among Hispanic Adults.

Aggressive deportation policy enforcement in the US may make undocumented immigrants and those close to them reluctant to seek medical care. With 68percent of undocumented immigrants coming from Mexico or Central America, US deportation policies particularly affect Hispanic residents. To examine how deportation enforcement relates to health care use in the Hispanic population in general, we matched survey data from the 2011-16 Behavioral Risk Factor Surveillance System to measures of Immigration and Customs Enforcement (ICE) activity. Quasi-experimental analyses demonstrated that Hispanic respondents were less likely to report having had a regular provider or annual checkup following increased ICE activity in their state. In contrast, these behaviors were unchanged among non-Hispanic adults, a group less likely to be affected by deportation enforcement. Parallel results were found among Hispanic and non-Hispanic adults with diabetes, for whom lapses in care may confer significant health risks.

Race, ethnicity, poverty and the social determinants of the coronavirus divide: U.S. county-level disparities and risk factors

BackgroundCommunities with more Black or Hispanic residents have higher coronavirus rates than communities with more White residents, but relevant community characteristics are underexplored. The purpose of this study was to investigate poverty-, race- and ethnic-based disparities and associated economic, housing, transit, population health and health care characteristics.MethodsSix-month cumulative coronavirus incidence and mortality were examined using adjusted negative binomial models among all U.S. counties (n = 3142). County-level independent variables included percentages in poverty and within racial/ethnic groups (Black, Hispanic, Native American, Asian), and rates of unemployment, lacking a high school diploma, housing cost burden, single parent households, limited English proficiency, diabetes, obesity, smoking, uninsured, preventable hospitalizations, primary care physicians, hospitals, ICU beds and households that were crowded, in multi-unit buildings or without a vehicle.ResultsCounties with higher percentages of Black (IRR = 1.03, 95% CI: 1.02–1.03) or Hispanic (IRR = 1.02, 95% CI: 1.01–1.03) residents had more coronavirus cases. Counties with higher percentages of Black (IRR = 1.02, 95% CI: 1.02–1.03) or Native American (IRR = 1.02, 95% CI: 1.01–1.04) residents had more deaths. Higher rates of lacking a high school diploma was associated with higher counts of cases (IRR = 1.03, 95% CI: 1.01–1.05) and deaths (IRR = 1.04, 95% CI: 1.01–1.07). Higher percentages of multi-unit households were associated with higher (IRR = 1.02, 95% CI: 1.01–1.04) and unemployment with lower (IRR = 0.96, 95% CI: 0.94–0.98) incidence. Higher percentages of individuals with limited English proficiency (IRR = 1.09, 95% CI: 1.04–1.14) and households without a vehicle (IRR = 1.04, 95% CI: 1.01–1.07) were associated with more deaths.ConclusionsThese results document differential pandemic impact in counties with more residents who are Black, Hispanic or Native American, highlighting the roles of residential racial segregation and other forms of discrimination. Factors including economic opportunities, occupational risk, public transit and housing conditions should be addressed in pandemic-related public health strategies to mitigate disparities across counties for the current pandemic and future population health events.

Landscape of Centralized Otolaryngology Research Efforts Grant Recipients Over the Past Decade.

To investigate the demographics of CORE grant recipients (Centralized Otolaryngology Research Efforts) over the last decade and evaluate disparity among recipients as compared with otolaryngology overall. To assess whether procurement of a grant predicts pursuit of an academic career. Analysis of grant recipients' bibliometrics. Academic medical center. The list of recipients of grants from 2010 to 2019 was obtained from the website of the American Academy of Otolaryngology-Head and Neck Surgery. Demographics of recipients were collected through an internet search, including gender, race, residency program, and h-index. Recipients from 2010 were searched to determine current academic faculty rank. Univariate and multivariate analyses were used to compare these factors with otolaryngology overall. The distribution of gender among recipients over the last decade remained nearly constant, with no significant difference versus residents in otolaryngology (P > .05). However, there were significantly more female recipients when adjusted for gender differences in the field overall (P < .01). Asians were relatively overrepresented, while Black and Hispanic residents were underrepresented (P < .01). Many recipients (52.6%) trained at institutions recognized as the best training programs with reputations for quality research output. The h-index of recipients decreased over the last decade (P < .01). The h-index of duplicate winners was significantly higher than those of nonduplicate winners (P < .01). After adjusting for gender and rank, recipients were significantly more likely to hold academic positions (P < .01). CORE grants are favorably distributed as related to gender and racial disparities, and recipients frequently go on to achieve high levels of academic success.

Life Expectancy At The US-Mexico Border: Evidence Of Disparities By Place, Race, And Ethnicity.

The mortality experience for the cluster of US counties in the US-Mexico border region has not been well described. We calculated 2016-18 life expectancy for the border region (counties within 100 kilometers of the border), making key comparisons to the US overall and to nonborder counties in border states. Life expectancy from birth for the border region was 81.1 years, which was greater than for the US and for the nonborder counties of border states. However, the disparity in life expectancy between racial/ethnic subgroups in the border region was also greater, within a range of more than thirteen years. Although White, Black, and Asian residents of the border region could expect to live significantly longer than residents of the US and nonborder counties of border states, Hispanic and American Indian residents could not. Understanding the mortality experience via life expectancy can help public health professionals and leaders prioritize efforts to ensure that all border residents have an equal opportunity to live a long, healthy life.

Invited commentary

The update on workforce diversity in vascular surgery by Dorsey et al1 is an important report defining the strides that we have and have not made in diversifying the physician faces of vascular surgery. The authors compared the number of female, black, and Hispanic medical students and residents in vascular surgery (integrated residency and fellowship), general surgery, and orthopedic surgery over time. Specifically, they evaluated each year from 2013 to 2017 and compared those numbers to a historical period from 1999 to 2005.

A Comparative Approach for Environmental Justice Analysis: Explaining Divergent Societal Distributions of Particulate Matter and Ozone Pollution across U.S. Neighborhoods

Numerous environmental justice (EJ) studies demonstrate that U.S. racial and ethnic minorities experience disparate hazard exposures, but we lack knowledge about how the societal distribution of risk varies between hazard types and how neighborhood-level racial residential segregation influences patterns of environmental injustice. We address those limitations by comparatively analyzing disparities in exposures to fine particulate matter (PM2.5) and ground-level ozone (O3) across census tracts of the contiguous United States and by elucidating the role of local racial residential segregation in structuring environmental injustices based on minority versus White neighborhood composition. Results indicate divergent societal patterns of exposure to the two pollutants. Tracts with higher PM2.5 have greater proportions of Hispanic, Black, and Asian and Pacific Islander residents, whereas tracts with increased O3 have lower proportions of those racialized groups. Additionally, we find that local multigroup racial residential segregation modifies the effect of minority versus White composition on PM2.5 exposures, such that residents of segregated minority neighborhoods breathe air laden with more PM2.5, whereas those in segregated White neighborhoods inhale air with less PM2.5. We find the opposite pattern for O3. Our comparative EJ perspective illuminates how the association between privileged Whiteness and O3 pollution is neither unjust nor equalizes the distribution of risk.

Police use of firearms: Exploring citizen, officer, and incident characteristics in a statewide sample

This paper analyzes the more than 70,000 police use of force incidents in New Jersey from 2012 to 2016 to examine the association of a citizen’ s race and ethnicity with the likelihood of officers pointing a firearm, shooting, and the number of shots discharged. Our study suggests that Black and Hispanic New Jerseyans are not more likely to experience force incidents involving a firearm relative to other citizens who experience police use of force, however this relationship is conditioned on the size of the place the incident occured. Black residents of smaller municipalities are almost twice as likely (OR = 1.70), and Hispanic residents more than twice as likely (OR = 2.30), than white citizens to have an officer pull their service weapon out during a stop. Furthermore, among all use of force incidents where a gun is brandished by police, Black and Hispanic residents are more likely to be shot, and shot numerous times compared to white citizens. While some of the relationship between race and force is mediated by crime type and subject behavior, a relationship between race and force remains. The need for systematic data reporting from smaller agencies and implications for research and policy are discussed.

Associations of Race/Ethnicity and Food Insecurity With COVID-19 Infection Rates Across US Counties

Food insecurity is prevalent among racial/ethnic minority populations in the US. To date, few studies have examined the association between pre-COVID-19 experiences of food insecurity and COVID-19 infection rates through a race/ethnicity lens. To examine the associations of race/ethnicity and past experiences of food insecurity with COVID-19 infection rates and the interactions of race/ethnicity and food insecurity, while controlling for demographic, socioeconomic, risk exposure, and geographic confounders. This cross-sectional study examined the associations of race/ethnicity and food insecurity with cumulative COVID-19 infection rates in 3133 US counties, as of July 21 and December 14, 2020. Data were analyzed from November 2020 through March 2021. Racial/ethnic minority groups who experienced food insecurity. The dependent variable was COVID-19 infections per 1000 residents. The independent variables of interest were race/ethnicity, food insecurity, and their interactions. Among 3133 US counties, the mean (SD) racial/ethnic composition was 9.0% (14.3%) Black residents, 9.6% (13.8%) Hispanic residents, 2.3% (7.3%) American Indian or Alaska Native residents, 1.7% (3.2%) Asian American or Pacific Islander residents, and 76.1% (20.1%) White residents. The mean (SD) proportion of women was 49.9% (2.3%), and the mean (SD) proportion of individuals aged 65 years or older was 19.3% (4.7%). In these counties, large Black and Hispanic populations were associated with increased COVID-19 infection rates in July 2020. An increase of 1 SD in the percentage of Black and Hispanic residents in a county was associated with an increase in infection rates per 1000 residents of 2.99 (95% CI, 2.04 to 3.94; P < .001) and 2.91 (95% CI, 0.39 to 5.43; P = .02), respectively. By December, a large Black population was no longer associated with increased COVID-19 infection rates. However, a 1-SD increase in the percentage of Black residents in counties with high prevalence of food insecurity was associated with an increase in infections per 1000 residents of 0.90 (95% CI, 0.33 to 1.47; P = .003). Similarly, a 1-SD increase in the percentage of American Indian or Alaska Native residents in counties with high levels of food insecurity was associated with an increase in COVID-19 infections per 1000 residents of 0.57 (95% CI, 0.06 to 1.08; P = .03). By contrast, a 1-SD increase in Hispanic populations in a county remained independently associated with a 5.64 (95% CI, 3.54 to 7.75; P < .001) increase in infection rates per 1000 residents in December 2020 vs 2.91 in July 2020. Furthermore, while a 1-SD increase in the proportion of Asian American or Pacific Islander residents was associated with a decrease in infection rates per 1000 residents of -1.39 (95% CI, -2.29 to 0.49; P = .003), the interaction with food insecurity revealed a similar association (interaction coefficient, -1.48; 95% CI, -2.26 to -0.70; P < .001). This study sheds light on the association of race/ethnicity and past experiences of food insecurity with COVID-19 infection rates in the United States. These findings suggest that the channels through which various racial/ethnic minority population concentrations were associated with COVID-19 infection rates were markedly different during the pandemic.

PCN146 Association of Health Related Quality of Life with Breast Cancer Survival Among Hispanic Population Using Medical Expenditure Panel Survey DATA (2006-2015)

Breast cancer is the most commonly diagnosed cancer among women in the United States and it is the leading cause of death among the Hispanic population. Little evidence exists the association of health-related quality of life (HRQoL) by the presence of breast cancer survival among Latina population. This study was to look at the association of the presence of breast cancer survival on HRQoL measure in the US Hispanic population. This was a cross-sectional study analyzing data from the 2006-2015 Medical Expenditure Panel Survey (MEPS). The target population was comprised of Hispanic community-dwelling residents with breast cancer in the US. Two multivariate regression models were used to predict HRQoL measure by the presence of breast cancer survival among Hispanic population. A total 207 breast cancer survivors met the study inclusion criteria, and the estimated population size was 1.200,337 breast cancer survivors. In the multiple regression analysis on the SF-12 PCS scores, age, census region, poverty level, perceived health status, BMI, and employment were associated with SF-12 PCS scores. The multiple regression analysis on the SF-12 MCS scores presented that age, census region, insurance type, perceived mental health status, and CCI were associated with SF-12 MCS scores. This study presents data on the HRQoL of Hispanic breast cancer survivors in the U.S. It builds on previous research that examines the HRQoL as expressed through the SF-12 PCS and SF-12 MCS surveys, rather than other types of measurement. This study may also be used as a guide in the implementation of clinical interventions and plans for survivorship care in improving the HRQoL of Hispanic breast cancer survivors.

COVID-19 Cases and Death in Nursing Homes: The Role of Racial and Ethnic Composition of Facilities and Their Communities

ObjectivesTo examine the extent to which the racial and ethnic composition of nursing homes (NHs) and their communities affects the likelihood of COVID-19 cases and death in NHs, and whether and how the relationship between NH characteristics and COVID-19 cases and death varies with the racial and ethnic composition of the community in which an NH is located. Methods and DesignCenters for Medicare & Medicare Services Nursing Home COVID-19 data were linked with other NH- or community-level data (eg, Certification and Survey Provider Enhanced Reporting, Minimum Data Set, Nursing Home Compare, and the American Community Survey). Setting and Participants: NHs with more than 30 occupied beds (N=13,123) with weekly reported NH COVID-19 records between the weeks of June 7, 2020, and August 23, 2020. Measurements and model: Weekly indicators of any new COVID-19 cases and any new deaths (outcome variables) were regressed on the percentage of black and Hispanic residents in an NH, stratified by the percentage of blacks and Hispanics in the community in which the NH was located. A set of linear probability models with NH random effects and robust standard errors were estimated, accounting for other covariates. ResultsThe racial and ethnic composition of NHs and their communities were both associated with the likelihood of having COVID-19 cases and death in NHs. The racial and ethnic composition of the community played an independent role in the likelihood of COVID-19 cases and death in NHs, even after accounting for the COVID-19 infection rate in the community (ie, daily cases per 1000 people in the county). Moreover, the racial and ethnic composition of a community modified the relationship between NH characteristics (eg, staffing) and the likelihoods of COVID-19 cases and death. Conclusions and ImplicationsTo curb the COVID-19 outbreaks in NHs and protect vulnerable populations, efforts may be especially needed in communities with a higher concentration of racial and ethnic minorities. Efforts may also be needed to reduce structural racism and address social risk factors to improve quality of care and population health in communities of color.

Factors associated with Health-Related Quality of Life in Hispanic population with mental disorders using medical expenditure panel survey 2013-2017

There is a lack of U.S. population-based research surrounding the marked decrease in health-related quality of life (HRQoL) caused by the morbidity of mental disorders in the U.S. Hispanic demographic. This cross-sectional study utilized data from the 2013-2017 Medical Expenditure Panel Survey (MEPS) to identify Hispanic community-dwelling residents with mental disorders in the U.S. The independent variable was the presence of mental disorders, and the dependent variable was HRQoL. HRQoL was measured with the Short Form 12 (SF-12) Physical Health Composite Scale (PCS) and Mental Health Composite Scale (MCS). A total of 34,434 patients met the inclusion criteria, representing about 38,683,299 Hispanic individuals. Of this group, those older than 18 were stratified by the presence of mental disorders. The two groups were those with mental disorders: 4,122 individuals representing a sample size of 4,789,634; and those without mental disorders: 30,312 individuals representing a sample size of 33,893,665. Based on our study, Hispanic patients with mental disorders were associated with lower HRQoL scores. SF-12 PCS scores (95% CI) were 45.3 (44.5, 46.1) for those with mental disorders and 50.8 (50.5, 51.0) for those without mental disorders. SF-12 MCS scores (95% CI) were 42.6 (42, 43.3) in patients with mental disorders and 52.6 (52.3, 52.8) in patients without mental disorders. These differences in scores denote the impact of mental health disorders on HRQoL scores in the Hispanic demographic and mark the way for further research on identifying means of improving such scores for Hispanic patients.

Neighborhood Inequities in Tobacco Retailer Density and the Presence of Tobacco-Selling Pharmacies and Tobacco Shops

Studies document inequitable tobacco retailer density by neighborhood sociodemographics, but these findings may not be robust to different density measures. Policies to reduce density may be less equitable depending on how the presence of store types differs by neighborhood characteristics. We built a 2018 list of probable tobacco retailers in the United States and calculated four measures of density for all census tracts (N = 71,495), including total count, and number of retailers per 1,000 people, square mile, and kilometers of roadway. We fit multivariable regression models testing associations between each density measure and tract-level sociodemographics. We fit logistic regression models testing associations between sociodemographics and the presence of a tobacco-selling pharmacy or tobacco shop. Across all measures, tracts with a greater percentage of residents living below 150% of the federal poverty level (FPL) had higher density. A higher percentage of Black residents, Hispanic or Latino residents, and vacant housing was inconsistently associated with density across measures. Neighborhoods with a greater percentage of Black residents had a lower odds of having a pharmacy (adjusted odds ratio [aOR] = 0.96, 95% confidence interval [CI; 0.95, 0.97]) and tobacco shop (aOR = 0.87, CI [0.86, 0.89]), while those with a greater percentage of residents living below 150% FPL had greater odds of having a tobacco shop (aOR = 1.18, CI [1.16, 1.20]). Researchers and policymakers should consider how various measures of retailer density may capture different aspects of the environment. Furthermore, there may be an inequitable impact of retailer-specific policies on tobacco availability.

Decomposing Racial and Ethnic Disparities in Nursing Home Influenza Vaccination

ObjectivesQuantify how observable characteristics contribute to influenza vaccination disparities among White, Black, and Hispanic nursing home (NH) residents. DesignRetrospective cohort. Setting and ParticipantsShort- and long-stay U.S. NH residents aged ≥65 years. MethodsWe linked Minimum Data Set (MDS) and Medicare data to LTCFocUS and other facility data. We included residents with 6-month continuous enrollment in Medicare and an MDS assessment between October 1, 2013, and March 31, 2014. Residents were classified as short-stay (<100 days in NH) or long-stay (≥100 days in NH). We fit multivariable logistic regression models to assess the relationships between 27 resident and NH-level characteristics and receipt of influenza vaccination. Using nonlinear Oaxaca-Blinder decomposition, we decomposed the disparity in influenza vaccination between White versus Black and White versus Hispanic NH residents. Analyses were repeated separately for short- and long-stay residents. ResultsOur study included 630,373 short-stay and 1,029,593 long-stay residents. Proportions vaccinated against influenza included 67.2% of White, 55.1% of Black, and 54.5% of Hispanic individuals among short-stay residents and 84.2%, 76.7%, and 80.8%, respectively among long-stay residents. Across 4 comparisons, the crude disparity in influenza vaccination ranged from 3.4 to 12.7 percentage points. By equalizing 27 prespecified characteristics, these disparities could be reduced 37.7% to 59.2%. Living in a predominantly White facility and proxies for NH quality were important contributors across all analyses. Characteristics unmeasured in our data (eg, NH staff attitudes and beliefs) may have also contributed significantly to the disparity. Conclusions and ImplicationsThe racial/ethnic disparity in influenza vaccination was most dramatic among short-stay residents. Intervening on factors associated with NH quality would likely reduce these disparities; however, future qualitative research is essential to explore potential contributors that were unmeasured in our data and to understand the degree to which these factors contribute to the overall disparity in influenza vaccination.

Description of the fecal microbiota of siblings from Costa Rica with and without affective and psychotic disorders

• Individuals affected of serious mental disorders have significantly increased LPS producing Pseudomonas and reduced butyrate producing Ruminococcaceae . • Bacterial taxa associated with healthy phenotype, such as B arnesiella and Rumicococcaceae were depleted in individuals affected with psychosis. • Significant alternations were found in the pathways associated with amino acid metabolism in affected individuals in comparison to the unaffected. The pathogenesis of mental disorders remains poorly understood and there are enormous challenges in the development of biomarkers and more effective therapeutic options. A total of 13 pairs of 26 siblings discordant for mental disorders, affected and unaffected, were subjected to Best Estimate Diagnosis process and clinical assessments with respect to their diagnosis, current mental health status and disability, resilience, medication, lifestyle and diet. All participants were of Hispanic ethnicity and residents of the San José Greater Metropolitan Area. Many of the pairs of siblings shared households. Affected individuals displayed major depression, bipolar affective disorder, psychosis non-otherwise specified or schizoaffective disorder. In a subsequent analysis the affected individuals were further divided according to whether they exhibited psychotic features or not. Fecal samples were collected for the analysis of the gut microbiota using 16S rRNA gene amplicon sequencing and imputed metagenomics that were compared within the sibling pairs. Based on beta-diversity analysis, the use of levothyroxine and irbesartan was identified and thus used as confounders. Decreased bacterial richness was observed among the affected participants. The relative abundances of several bacterial taxa showed significant differences, including families Peptostreptococcaceae, Ruminococcaceae, Porphyromonadaceae , and genera Pseudomonas, Barnesiella, Odoribacter, Paludibacter, Lactococcus, Clostridium, Acidaminococcus and Haemophilus. The proportion of Proteobacteria ( Pseudomonas ) was significantly increased in the affected individuals, while the bacterial taxa associated to healthy phenotype, such as Barnesiella and Ruminococcaceae, were depleted in individuals affected with psychosis in comparison to those without psychosis. Based on prediction functions of the gut microbiota, significant alternations were found in the pathways associated with amino acid metabolism in affected individuals in comparison to the unaffected. Our findings suggest the changes in gut microbiota composition and functionality are associated with mental health, its diagnostics, and therapeutics.

County-Level Socioeconomic and Political Predictors of Distancing for COVID-19

IntroductionIn response to the COVID-19 pandemic, governments have implemented social distancing measures to slow viral transmission. This work aims to determine the extent to which socioeconomic and political conditions have shaped community-level distancing behaviors during the COVID-19 pandemic, especially how these dynamics have evolved over time.MethodsThis study used daily data on physical distancing from 15‒17 million cell phone users in 3,037 U.S. counties. County-level changes in the average distance traveled per person were estimated relative to prepandemic weeks as a proxy for physical distancing. Pooled ordinary least squares regressions estimated the association between physical distancing and a variety of county-level demographic, socioeconomic, and political characteristics by week from March 9, 2020 to January 17, 2021. Data were collected until January 2021, at which point the analyses were finalized.ResultsLower per capita income and greater Republican orientation were associated with significantly reduced physical distancing throughout nearly all the study period. These associations persisted after adjusting for a variety of county-level demographic and socioeconomic characteristics. Other county-level characteristics, such as the shares of Black and Hispanic residents, were associated with reduced distancing at various points during the study period.ConclusionsThese results highlight the importance of dynamic socioeconomic and political gradients in preventive behavior and imply the need for nimble policy responses.

The Unequal Burden of COVID-19 Deaths in Counties With High Proportions of Black and Hispanic Residents.

Understanding the current burden of coronavirus disease 2019 (COVID-19) deaths in vulnerable populations will help inform efforts by policymakers to address disparities in COVID-19 outcomes. The objective of this study was to examine the association between COVID-19 deaths and the county-level proportions of non-Hispanic Black and Hispanic residents. A retrospective study using COVID-19 mortality data from USA Facts linked to data from the US Census Bureau, the Health Resources & Services Administration Area Health Resources file, and the US Census Bureau. Negative binomial regression was used to estimate the association between the total county COVID-19 deaths during consecutive 30-day intervals and the proportion of non-Hispanic Blacks and Hispanic residents after adjusting for resident demographics, comorbidity burden, rurality, social determinants of health, and health care resources. In April, counties (n=179) with >40% Blacks had 6-fold higher death rates than counties (n=1521) with <2% Blacks [incident rate ratio (IRR)=6.58, 95% confidence interval (CI): 3.29-13.2, P<0.001]. These counties had higher death rates until October, but were no different than referent counties in November. In April, death rates in counties with >40% Hispanic residents were similar to death rates in counties with <2% Hispanic residents. Death rates in these counties peaked in August (IRR=3.14, 95% CI: 1.69-5.82, P<0.001) but were also no different than referent counties in November. These effects were robust after adjusting for county-level characteristics. Before August, death rates differed little by insurance status, but since then, counties with >15% uninsurance rates had up to 2-fold higher mortality rates (IRR=1.97, 95% CI: 1.19-3.27, P<0.001) than counties with <5% uninsurance rates. Counties with high concentrations of non-Hispanic Blacks were disproportionately affected by COVID-19 throughout most of the pandemic, but other social determinants of health such as health insurance are now playing a more prominent role than race and ethnicity.

Urban forest response to Hurricane Irma: The role of landscape characteristics and sociodemographic context

While often considered “open grown,” urban trees are often found in relatively close proximity to neighboring trees, buildings, and other elements of urban infrastructure. These spatial arrangements may provide wind protection during severe weather events such as hurricanes. Beyond this very local scale, urban tree abundance and condition are often influenced by the greater sociodemographic context of the neighborhood or community where they are found. In an effort to assess the impact of these external factors on wind firmness after Hurricane Irma impacted Florida in 2017, we revisited three urban areas that had previously been inventoried using sample plots prior to the storm. At each plot we assessed storm damage and characterized surrounding protective elements (i.e., buildings and other trees) using a combination of ground-based and aerial approaches. This was then paired with block group level sociodemographic data derived from the United States Census. Logistic regression results confirmed previous research, showing that partial and whole tree failure were significantly more likely with a larger stem diameter (p = 0.001) and perceived/previously documented lower wind firmness (p = 0.004). However, our results disagreed with previous studies linking species diversity and resilience, showing tree failure was significantly more likely with higher Shannon Diversity Index (p = 0.008). A comparative geographically weighted logistic regression model also found that the higher proportions of African American residents and Hispanic residents, and the median age of residents were significant predictors of less likely tree failure in 30 %, 36 %, and 20 % of plots, respectively. However, this evidence was weak, compared to that of tree- and plot-level effects. Despite being a key predictor of interest, we did not see any significant protective effect from neighboring trees or structures.

Urban environments and COVID-19 in three Eastern states of the United States.

The United States has the highest numbers of confirmed cases and deaths during the novel coronavirus disease 2019 (COVID-19) pandemic. Previous studies reported that urban residents are more vulnerable to the spread and mortality of COVID-19 than rural residents. However, the pathways through which urban environments affect COVID-19 spread and mortality are unclear. We collected daily data on the number of confirmed cases and deaths of COVID-19 from Mar. 01 to Nov. 16, 2020 for all 91 counties in New York, New Jersey, and Connecticut in the United States. We calculated the COVID-19 incidence %, daily reproduction number, and mortality %, then estimated the associations with urban environment indicators using regression models. COVID-19 outcomes were generally highest in areas with high population density, and this pattern was evident in the early period of epidemic. Among the area-level demographic variables, the percentage of Black or Hispanic residents showed the strongest positive association with COVID-19 outcomes. Higher risk of COVID-19 outcomes was also associated with higher percentage of overcrowded households, uninsured people, and income inequality. The percent elderly, sex ratio (the ratio of males to females), and greenness were negatively associated with risk of COVID-19 outcomes. The results of this study could indicate where resources are most needed.

Neighborhoods with Greater Prevalence of Minority Residents Have Lower Continuous Positive Airway Pressure Adherence.

Rationale: Limited data suggest racial disparities in continuous positive airway pressure (CPAP) adherence exist.Objectives: To assess whether CPAP adherence varies by neighborhood racial composition at a national scale.Methods: Telemonitoring data from a CPAP manufacturer database were used to assess adherence in adult patients initiating CPAP therapy between November 2015 and October 2018. Mapping ZIP code to ZIP code tabulation areas, age- and sex-adjusted CPAP adherence data at a neighborhood level was computed as a function of neighborhood racial composition. Secondary analyses adjusted for neighborhood education and poverty.Measurements and Main Results: Among 787,236 patients living in 26,180 ZIP code tabulation areas, the prevalence of CPAP adherence was 1.3% (95% confidence interval [CI], 1.0-1.6%) lower in neighborhoods with high (⩾25%) versus low (<1%) percentages of Black residents and 1.2% (95% CI, 0.9-1.5%) lower in neighborhoods with high versus low percentages of Hispanic residents (P < 0.001 for both), even after adjusting for neighborhood differences in poverty and education. Mean CPAP usage was similar across neighborhoods for the first 2 days, but by 90 days, differences in CPAP usage increased to 22 minutes (95% CI, 18-27 min) between neighborhoods with high versus low percentages of Black residents and 22 minutes (95% CI 17-27 min) between neighborhoods with high versus low percentages of Hispanic residents (P < 0.001 for both).Conclusions: CPAP adherence is lower in neighborhoods with greater proportions of Black and Hispanic residents, independent of education or poverty. These differences lead to a lower likelihood of meeting insurance coverage requirements for CPAP therapy, potentially exacerbating sleep health disparities.