National Establishment Time Series Research Articles

Banking on the Neighborhood? Inequalities in Older Adults' Access to Local Banking and Neighborhood Perceptions.

Access to local banking represents an understudied dimension of neighborhood-based inequalities that could significantly influence older adults' perceptions of their neighborhood spaces in ways that matter for disparities in well-being. We evaluate disparities in banking access and then examine how local banking access informs older adults' perceptions of neighborhood collective efficacy and danger, above and beyond other neighborhood socioeconomic characteristics. We use nationally representative data from older adults in the United States who were interviewed at Round 3 of the National Social Life, Health, and Aging Project, linked with data on banks in respondents' residential and surrounding census tracts from the National Establishment Time-Series database, in a series of bivariate and multivariable regression analyses. White older adults and those with higher levels of education have significantly greater local banking access than Black and Hispanic older adults and those with lower levels of education. Higher rates of local banking institutions are associated with significantly lower perceptions of neighborhood danger, but not with perceived collective efficacy. This finding emerges when accounting for neighborhood concentrated disadvantage and physical disorder. Local banks may represent neighborhood investment and the broader economic vitality of a community, as well as the ability of communities to meet older adults' everyday needs in ways that enhance older residents' feelings of safety. Increasing access to local financial institutions may help attenuate neighborhood-based contributors to inequalities in health and well-being among the older adult population.

ASSOCIATIONS BETWEEN NEIGHBORHOOD SOCIAL DESTINATIONS AND GPS-DERIVED COMMUNITY MOBILITY OF OLDER ADULTS

Abstract Neighborhood social destinations may encourage greater out-of-home travel (i.e., community mobility) and support independent functioning in later life. We examined associations between quantity of destinations that promote social interactions (e.g., arts/recreation, restaurants, stores, civic/religious institutions) and objective, GPS-derived community mobility. Participants were 146 adults ≥65 years old (Mean=77.0±6.5 years, 68% women) at baseline of a randomized trial to improve walking coordination. Participants carried a GPS device that passively collected real-time location data for 5-7 days. Spatial extent of community mobility was quantified using median standard deviational ellipse area (SDEa, km2) and maximum distance from home (mDOH, km). Duration of community mobility was characterized using percentage of time spent out-of-home (pTOH). Community mobility measures were stratified into tertiles due to positive skew. We used National Establishment Time Series (NETS) classifications to derive a total social destination count at the Census tract-level (Mean=48.9±35.7 social destinations per tract). Ordinal logistic regressions were adjusted for demographics (age, gender, race, education), device, season, and number of comorbidities and were clustered on Census tract. Each 1-SD greater destination count was associated with 46% greater odds of being in a higher tertile of pTOH (OR=1.46, 95% CI: 1.08-1.97, p=.014). Number of social destinations was not associated with SDEa or mDOH (all p’s>.05). Nearby social destinations may encourage greater duration, but not necessarily spatial extent, of community travel. Future work utilizing GPS can objectively measure activity in community social spaces to assess its benefits for cognitive and mental health in later life.

NEIGHBORHOOD AFFLUENCE AND RISK OF INCIDENT DEMENTIA: ROLE OF PHYSICAL ACTIVITY DESTINATIONS

Abstract Neighborhood affluence encompasses the degree of high educational, occupational, and wealth concentration within residential communities. Highly affluent neighborhoods may reduce dementia risk in part by providing amenities that promote physical activity. We examined associations between neighborhood affluence, and specifically the quantity of nearby physical activity (PA) destinations (e.g., gyms), with incident dementia. Participants were 2,942 adults ≥65 years old from the Cardiovascular Health Cognition Study. Baseline neighborhood measures included 1) a 1990 Census-derived affluence index (percent with college education, percent with professional/managerial occupation, median home value) and 2) the count of PA destinations from the 1990 National Establishment Time Series (NETS) database that fell within a 1-km Euclidean buffer around the home. A total of 469 dementia cases (240 Alzheimer’s, 208 mixed/vascular, 21 other) were clinically adjudicated from neurological/neuropsychological examinations (Mean=5.3±1.8 follow-up years). In Cox proportional hazards models adjusted for clinic site and individual demographics (age, gender, race, marital status), each 1-SD higher neighborhood affluence was associated with 15% reduced hazard of all-cause dementia (HR=0.85, 95%CI: 0.77-0.94), largely driven by mixed/vascular subtype (HR=0.73, 95%CI: 0.64-0.86), but not Alzheimer’s subtype (HR=0.93, 95%CI: 0.81-1.07). Further, participants with ≥2 (versus no) nearby PA destinations had 37% reduced hazard of specifically mixed/vascular dementia (HR=0.63, 95%CI: 0.41-0.99). After also adjusting for individual health, income, and education, neighborhood affluence remained protective against mixed/vascular dementia (HR=0.77, 95%CI: 0.65-0.90), but number of PA destinations was no longer associated. Neighborhood affluence may reduce dementia risk via improved vascular health and operate through additional mechanisms beyond nearby PA amenities.

ACCESS TO LOCAL ESTABLISHMENTS AND NEIGHBORHOOD PERCEPTIONS: A FOCUS ON THE ROLE OF LOCAL BANKING

Abstract As an increasing number of older adults are aging-in-place, individuals’ perceptions of their neighborhood environments have emerged as significant social-contextual issues for healthy aging. Prior studies have focused on how neighborhood characteristics shape perceptions of residential neighborhoods. Far less research has focused on the role of local banking, despite the intersections between local banking establishments and a host of key community social and economic resources, particularly for the older adult population. We use nationally representative data from older adults interviewed at Rounds 2 and 3 of the National Social Life, Health, and Aging Project (N=4,589) linked with the National Establishment Time Series database to examine neighborhood perceptions as a function of local banking establishment density. We find that older adults who live in areas with higher rates of banking establishments report significantly higher levels of neighborhood safety, even when adjusting for a host of individual and neighborhood characteristics. Importantly, other types of establishments also shape perceived neighborhood safety, however, the significance of certain associations only emerges when we adjust for the presence of local banking. We suggest that local banks may be a lynchpin in catalyzing the broader socioeconomic vitality of a place, supporting older residents’ favorable perceptions of neighborhood safety. We discuss the implications of our findings for inequality in aging in light of unequal access to local banking across social groups, potentially increasing the vulnerability of older adults who are less likely to adopt mobile banking solutions and who are more likely to be susceptible to financial exploitation.

NEIGHBORHOOD HEALTH CARE FACILITIES AND INCIDENT DEMENTIA: RESULTS FROM THE EINSTEIN AGING STUDY

Abstract Though access to health care is associated with improved chronic health outcomes, data on dementia risk are limited. From the Ecological Model of Aging, limited access to health care facilities may be associated with increased likelihood of developing dementia through poor management of comorbidities. The current study aims to investigate the association between the density of neighborhood health care facilities and incident dementia. Participants were community-dwelling older adults, systematically recruited from Bronx, NY (N=1,461, mean age=78.4; mean follow-ups=4.6 years; 68% non-Hispanic White, 26% non-Hispanic Black). Density of health care facilities in each participant’s Census Tract was derived from the National Establishment Time-Series data. We used Cox proportional hazards models using age as the time scale and adjusted for sex, race, education, income, and neighborhood deprivation. Incident dementia developed in 10% of the sample. Older adults living in the areas with lower density of health care facilities, compared to those living areas with a higher density of health care facilities, were at increased risk for incident dementia (HR=1.79, 95% CI=[1.12, 2.87] for lowest vs. highest tertile; HR=1.65, 95% CI=[1.02, 2.66] for intermediate vs. highest tertile). Further controlling for cardiovascular and other comorbidities did not change the pattern of results. The current results suggest that unequal distribution of health care facilities across geographic locations may help account for cognitive health disparities among older adults. Future studies will need to identify behavioral and individual-level mechanisms (e.g., healthcare use, better treatment before disease occurs) in the association between neighborhood health care facilities and dementia.

DO NEARBY PHYSICAL ACTIVITY DESTINATIONS ENCOURAGE PEOPLE TO BE F.I.T.T.?

Abstract Neighborhood amenities may reduce barriers to engaging in physical activity (PA). However, it is unclear whether proximity to these amenities will indeed promote increased PA. This study examined whether living near PA destinations was associated with greater self-reported PA. The sample included Cardiovascular Health Study participants (N=3,922; mean age=75.3 years) from visit 5 (1992-1993). Quantity of PA destinations (e.g., gyms) within a one-kilometer Euclidean buffer of each participant’s home address was provided by the National Establishment Time-Series database. PA over the previous two weeks was self-reported via the Minnesota Leisure Time Activity Questionnaire. The exposure was dichotomized into having at least one PA destination (vs. none) within one kilometer of participants’ homes. Outcomes were based on the FITT components of PA outlined by the American College of Sports Medicine: Frequency (activities per week), Intensity (MET-minutes per week), Time (minutes per day), and Type (number of different activities, i.e., variety). Outcomes were modeled separately as five-level ordinal variables considering PA guidelines. Using ordinal logistic regression models adjusting for age, sex, health status, smoking, and body mass index, we found that living within one kilometer of at least one PA destination was associated with significantly increased odds of engaging in higher levels of all four PA components (odds ratios: 1.17-1.20, all Ps < 0.01). After adjusting for social factors (race, education, income), associations were attenuated and no longer significant. When evaluating barriers to PA, social determinants of health should be considered, in addition to proximity of PA destinations.

Does rail transit access affect firm dynamics? Analysis of firm births and closures in Maryland, USA

Firm birth and firm closure are two interrelated dynamics relevant to measuring economic growth, yet most studies focus on firm birth only. Public transportation infrastructure may facilitate firm birth, but it may also avert firm closure through improved accessibility that can consequently lead to increased local density hence agglomeration economies. This study analyzes firm births and firm closures using the National Establishment Time Series (NETS) panel data from Maryland from 1991 to 2009. By examining both birth and closure patterns, this study estimates the likelihood of firm retention for areas in proximity to passenger rail stations of multiple levels of maturity, while controlling for a number of potentially confounding factors. Positive and statistically significant relationships are found between proximity to the passenger rail stations and the rates of firm births in Maryland, regardless of differences in the level of maturity of stations. From 1991 to 2009, areas within close proximity to passenger rail stations in Maryland experienced a wide range of rates of growth in firm density, depending on the year of station opening. The results suggest that well after the introduction of rail stations, areas near passenger rail stations gain belated economic benefits shown by higher likelihood of firm retention around the mature rail stations opened before 1990. In comparison, areas near the less mature stations that opened after 1990 had predominantly lower likelihood of firm retention. Planners and policymakers should be proactive in directing development near rail stations by adopting a variety of measures and policies that support or are at least consistent with transit-oriented development (TOD).

Climate-related disaster impact on health care infrastructure in the USA

PurposeResearch on postdisaster health care accessibility and availability has largely focused on the short-term impacts of isolated disasters on specific health care services. We examined the distribution of health care facilities and climate-related weather disasters across counties in the United States across a 15-year period. MethodsLinking longitudinal data on disasters, health care, and demographic and socioeconomic characteristics, we created an annual panel dataset of counties in the United States from 2000 to 2014 (N = 3108). National Establishment Time Series data measured change in health care facilities, categorized into drug stores, hospitals, and ambulatory care. Using data from Spatial Hazards and Events Losses Database for the United States, we classified county-level disasters as moderate and severe. We used autoregressive linear models to estimate the per-capita number of health care establishments in 2014 associated with the total number of moderate and severe disasters (2000–2013), after adjustment for health care establishments, total population, and poverty in 2000. ResultsEach additional moderate disaster was associated with a significant increase in hospital infrastructure (0.14, 95% confidence interval [CI]: 0.02 to 0.25) while an increase in severe disasters was associated with a significant decrease in hospital infrastructure (−0.28, 95% CI: −0.45 to −0.12). Similar relationships were found with ambulatory care facilities (2.49, 95% CI: 0.89 to 4.09 and −5.78, 95% CI: −8.13 to −3.43, respectively). The association between disasters and drug store facilities was not statistically significant. ConclusionsGiven the increasing number and severity of climate-related disasters, the loss of health care facilities following severe disasters may lead to poor health outcomes, especially among vulnerable populations.

A longitudinal assessment of racial and ethnic inequities in food environment exposure and retail market concentration.

This paper assesses trends in food environment and market concentration and racial and ethnic inequities in food environment exposure and food retail market concentration at the US census tract level from 2000 to 2019. Establishment-level data from the National Establishment Time Series were used to measure food environment exposure and food retail market concentration. We linked that dataset to race, ethnicity and social vulnerability information from the American Community Survey and the Agency for Toxic Substances and Disease Registry. A geospatial hot-spot analysis was conducted to identify relatively low and high healthy food access clusters based on the modified Retail Food Environment Index (mRFEI). The associations were assessed using two-way fixed effects regression models. Census tracts spanning all US states. 69 904 US census tracts. The geospatial analysis revealed clear patterns of areas with high and low mRFEI values. Our empirical findings point to disparities in food environment exposure and market concentration by race. The analysis shows that Asian Americans are likelier to live in neighbourhoods with a low food environment exposure and low retail market concentration. These adverse effects are more pronounced in metro areas. The robustness analysis for the social vulnerability index confirms these results. US food policies must address disparities in neighbourhood food environments and foster a healthy, profitable, equitable and sustainable food system. Our findings may inform equity-oriented neighbourhood, land use and food systems planning. Identifying priority areas for investment and policy interventions is essential for equity-oriented neighbourhood planning.

National trends and disparities in retail food environments in the USA between 1990 and 2014.

To describe national disparities in retail food environments by neighbourhood composition (race/ethnicity and socio-economic status) across time and space. We examined built food environments (retail outlets) between 1990 and 2014 for census tracts in the contiguous USA (n 71 547). We measured retail food environment as counts of all food stores, all unhealthy food sources (including fast food, convenience stores, bakeries and ice cream) and healthy food stores (including supermarkets, fruit and vegetable markets) from National Establishment Time Series business data. Changes in food environment were mapped to display spatial patterns. Multi-level Poisson models, clustered by tract, estimated time trends in counts of food stores with a land area offset and independent variables population density, racial composition (categorised as predominantly one race/ethnicity (>60 %) or mixed), and inflation-adjusted income tertile. The contiguous USA between 1990 and 2014. All census tracts (n 71 547). All food stores and unhealthy food sources increased, while the subcategory healthy food remained relatively stable. In models adjusting for population density, predominantly non-Hispanic Black, Hispanic, Asian and mixed tracts had significantly more destinations of all food categories than predominantly non-Hispanic White tracts. This disparity increased over time, predominantly driven by larger increases in unhealthy food sources for tracts which were not predominantly non-Hispanic White. Income and food store access were inversely related, although disparities narrowed over time. Our findings illustrate a national food landscape with both persistent and shifting spatial patterns in the availability of establishments across neighbourhoods with different racial/ethnic and socio-economic compositions.

Spatial and cross-sectoral relationships in business entry dynamics around a highway corridor

Inter-business networks are important components of business dynamics and spatial clusters. Extensive literature proclaims the existence of a variety of networks and benefits of diversity within. However, the literature falls short to exhibit the subsistence of connections between economic activities which invariably contribute towards entry decisions of business establishments. In this paper, using National Establishment Time Series (NETS) database, we analyse establishments entering the region around U.S.-400, largely in Kansas, across a period of 20 years (1992–2011). The establishments are categorised into 20 industrial sectors based on their economic activities. Using spatial econometric models and partial least squares regression, yearly relationships (attraction/impedance) among these categories are estimated. The results provide evidence that relationships amidst pre-existing and new-entrants are indeed significant in business entry. This can be critical in understanding and rationale of freight vehicle flows and guide towards corridor utilisation aspects. The inferred relationships could be used to understand how alterations in one sector may perturb other sectors and to inform about upgrading regional attraction, retention and growth-related policies.

Urban-rural differences in tobacco product availability in food retailers, United States, 2017.

Tobacco use prevalence is higher in rural compared to urban settings, possibly due to differences in tobacco availability, including the option to purchase food and other essential items in stores that do not sell tobacco (tobacco-free food retailers). The goal of this research is to determine whether tobacco-free food retailer availability varies by urbanicity/rurality. Using the 2017 National Establishment Time-Series database, we identified food retailers across all census tracts containing food retailers in the United States (n = 66,053). We used multivariable logistic and linear regression models to test whether tobacco-free food retailer availability varied across 4-levels of census tract urbanicity/rurality (urban, suburban, large town, and small town/rural) for 2 outcomes: (1) the presence of at least 1 tobacco-free food retailer and (2) the percent of all food retailers that were tobacco-free. Compared to urban core census tracts, suburban census tracts had a lower odds (aOR = 0.77, 95% CI = 0.73, 0.81) of having at least 1 tobacco-free food retailer, while small town/rural census tracts had greater odds (aOR = 1.23, 95% CI = 1.15, 1.32). Suburban census tracts (B = -2.29, P < .001) and large town census tracts (B = -1.90, P < .001) also had a lower percentage of tobacco-free food retailers compared to urban census tracts. Compared to urban cores, tobacco-free food retailers were less prevalent in suburban and large town areas, though similarly or slightly more available in rural areas. Future research should assess whether these differences depend on varying store types.

Sociodemographic Disparities in Tobacco Retailer Density in the United States, 2000-2017.

Studies find differences in tobacco retailer density according to neighborhood sociodemographic characteristics, raising issues of social justice, but not all research is consistent. This study examined associations between tobacco retailer density and neighborhood sociodemographic characteristics in the United States at four timepoints (2000, 2007, 2012, and 2017) and investigated if associations remained stable over time. Data on tobacco retailers came from the National Establishment Time-Series Database. Adjusted log-linear models examined the relationship between retailer density and census tract sociodemographic characteristics (% non-Hispanic Black [Black], % Hispanic, % vacant housing units, median household income), controlling for percentage of youth, urbanicity, and US region. To examine whether the relationship between density and sociodemographic characteristics changed over time, additional models were estimated with interaction terms between each sociodemographic characteristic and year. Tobacco retailer density ranged from 1.22 to 1.44 retailers/1000 persons from 2000 to 2017. There were significant, positive relationships between tobacco retailer density and the percentage of Black (standardized exp(b) = 1.05 [95% CI: 1.04% to 1.07%]) and Hispanic (standardized exp(b) = 1.06 [95% CI: 1.05% to 1.08%]) residents and the percentage of vacant housing units (standardized exp(b) =1.08 [95% CI: 1.07% to 1.10%]) in a census tract. Retailer density was negatively associated with income (standardized exp(b) = 0.84 [95% CI: 0.82% to 0.86%]). From 2000 to 2017, the relationship between retailer density and income and vacant housing units became weaker. Despite the weakening of some associations, there are sociodemographic disparities in tobacco retailer density from 2000 to 2017, which research has shown may contribute to inequities in smoking. This study examines associations between tobacco retailer density and neighborhood sociodemographic characteristics in the United States at four timepoints from 2000 to 2017. Although some associations weakened, there are sociodemographic disparities in tobacco retailer density over the study period. Research suggests that sociodemographic disparities in retailer density may contribute to inequities in smoking. Findings from this study may help identify which communities should be prioritized for policy intervention and regulation.

Weather-Related Disaster in a Diverse Cohort of Aging Adults

As climate change contributes to increasing frequency and intensity of weather-related disasters, it is critical to define characteristics that increase risk of poor health outcomes during and after events. Given the aging of the United States (US) population and over-representation of older adults in disaster-prone areas, disaster-related impacts on older adults present a growing public health challenge. We linked data from the REGARDS study, a cohort of 30,107 Black and White adults (mean age 65 years at baseline, 2003-2007), with community data from the National Establishment Time Series database and longitudinal weather-related disaster data from the Spatial Hazard Events and Losses Database for the US. We calculated disaster exposure for each year for the county in which the respondents lived from 2003 – 2015: 84% of county-years showed at least some impacts, including 16% of counties experiencing medium impacts ($10- $50 property damage per capita or 2 fatalities) and 12% severe (greater than $50 per capital or 3 fatalities); this mirrors that of the continental US (77% some impact, 15% medium, 13% severe). REGARDS participants exposed to moderate or severe disasters were more likely to be Black and low socioeconomic status compared to those who were not exposed. For community characteristics, higher disaster exposure was associated with a greater density of resources including ambulatory care, food stores, social services, and destinations for daily living. Our approach showcases how disaster preparedness systems need better data about specific individual-and community-level factors that increase risk among older adults to better serve communities.

Trends in the Number and Type of Tobacco Product Retailers, United States, 2000-2017.

Tobacco product retailers provide access to tobacco products and exposure to tobacco marketing. Without a national tobacco retailer licensing system in the United States, there are no estimates of national trends in tobacco retailer numbers and store type over time. We developed a protocol to identify likely tobacco retailers across the United States between 2000 and 2017 using industry codes and retailer names in the annual National Establishment Time Series (NETS) database. We calculated annual counts of tobacco retailers in seven store-type categories and annual numbers of tobacco retailers that opened and closed. We estimate that there were 317 492 tobacco product retailers in 2000; the number grew to 412 536 in 2009 before falling to 356 074 in 2017, for a net 12% increase overall. Gas/convenience stores and grocery stores accounted for more than two thirds of all retailers. On average, new openings accounted for 8.0% of the total retailers, whereas 7.3% of retailers closed or stopped selling tobacco each year, with stronger market volatility following the Great Recession. Since 2011, there was a disproportionate reduction in tobacco-selling pharmacies and an increase in both tobacco-specialty shops and tobacco-selling discount stores. During two decades when smoking declined, tobacco retailer availability increased in the United States. The economic climate, corporate and public policies, and new tobacco products may all contribute to trends in tobacco retailer availability. State and local jurisdictions considering tobacco retailer policies may find retailer trend information useful for forecasting or evaluating potential policy impacts. This study provides historic data tracking tobacco retailers in the United States between 2000 and 2017, documenting trends that unfolded as the general economic market contracted and grew, with greater regulation of the tobacco retailer environment. These data provide a context for better understanding future changes in the tobacco retailer market. In addition, the protocol established in this study could be applied in any US-based location without tobacco retailer licensing to allow identification of stores and tracking of trends.

Association of neighborhood physical activity opportunities with incident cardiovascular disease in the Cardiovascular Health Study.

We determined associations of cumulative exposures to neighborhood physical activity opportunities with risk of incident cardiovascular disease (CVD). We included 3595 participants from the Cardiovascular Health Study recruited between 1989 and 1993 (mean age=73; 60% women; 11% black). Neighborhood environment measures were calculated using Geographic Information Systems (GIS) and annual information from the National Establishment Time Series database, including the density of (1) walking destinations and (2) physical activity/recreational facilities in a 1- and 5-km radius around the respondent's home. Incident CVD was defined as the development of myocardial infarction, stroke, or cardiovascular death and associations with time to incident CVD were estimated using Cox proportional hazards models. A total of 1986 incident CVD cases occurred over a median follow-up of 11.2 years. After adjusting for baseline and time-varying individual and neighborhood-level confounding, a one standard deviation increase in walking destinations and physical activity/recreational facilities within 5km of home was associated with a respective 7% (95% confidence interval (CI)=0.87-0.99) and 12% (95% CI=0.73-1.0) decreased risk of incident CVD. No significant associations were noted within a 1-km radius. Efforts to improve the availability of physical activity resources in neighborhoods may be an important strategy for lowering CVD.

Land use diversity and park use in New York City.

Neighborhood parks and mixed-use land development are both understood to be important independent contributors to physical activity levels. It has been hypothesized that mixed-use land development could increase park use as a result of mixed-use neighborhoods being consistently activated throughout the day, but the results of previous research on this question have been inconsistent and the mediational role of neighborhood activation has not been tested. This study leverages data from Google Places Popular Times and the National Establishment Time Series to directly test the mediational role of the daily temporal distribution of neighborhood activation, to construct a novel measure of commercial activity diversity, and to help disentangle built-environment density from commercial diversity. Park use data was measured from 10,004 systematic observations of 20 neighborhood parks in New York City in the spring and summer of 2017. The hypothesis that commercial activity diversity is positively associated with park use was not supported in any models. However, a positive relationship between built-environment density and park use was found, which may help to explain prior inconsistent findings.

An organizational ecology approach to new food marts in New York City neighbourhoods

ABSTRACT Global forces have disrupted local businesses across cities, but neighbourhood convenience stores and small grocery stores have proven to be resilient in the face of economic and institutional pressures. In this paper, we integrate urban retail and organizational ecology perspectives and examine small independently-owned convenience and grocery stores, colloquially referred to as food marts, as organizational populations that develop and persist in neighbourhoods across multiple decades. Drawing on data from the National Establishment Time Series database and the Decennial Census, we argue that a nonlinear relationship exists between the number of existing food marts and the emergence of new food marts. Furthermore, we examine how conditions such as the presence of chain stores, neighbourhood socio-economic conditions and ethno-racial composition affect the likelihood that new food marts will emerge in neighbourhoods. Our results show that the emergence of new food marts in neighbourhoods is strongly influenced by the existing number of similar firm types. In other words, we find that competition among new food marts strongly predicts the extent to which small food marts remain in neighbourhoods. The value our study is that we look beyond the individual firm and ask whether the entire population is at risk, for example when chain stores are present.

Patterns in Geographic Access to Health Care Facilities Across Neighborhoods in the United States Based on Data From the National Establishment Time-Series Between 2000 and 2014

The association between proximity to health care facilities and improved disease management and population health has been documented, but little is known about small-area health care environments and how the presence of health care facilities has changed over time during recent health system and policy change. To examine geographic access to health care facilities across neighborhoods in the United States over a 15-year period. Using longitudinal business data from the National Establishment Time-Series, this cross-sectional study examined the presence of and change in ambulatory care facilities and pharmacies and drugstores in census tracts (CTs) throughout the continental United States between 2000 and 2014. Between January and April 2019, multinomial logistic regression was used to estimate associations between health care facility presence and neighborhood sociodemographic characteristics over time. Change in health care facility presence was measured as never present, lost, gained, or always present between 2000 and 2014. Neighborhood sociodemographic characteristics (ie, CTs) and their change over time were measured from US Census reports (2000 and 2010) and the American Community Survey (2008-2012). Among 72 246 included CTs, the percentage of non-US-born residents, residents 75 years or older, poverty status, and population density increased, and 8.1% of CTs showed a change in the racial/ethnic composition of an area from predominantly non-Hispanic (NH) white to other racial/ethnic composition categories between 2000 and 2010. The presence of ambulatory care facilities increased from a mean (SD) of 7.7 (15.9) per CT in 2000 to 13.0 (22.9) per CT in 2014, and the presence of pharmacies and drugstores increased from a mean (SD) of 0.6 (1.0) per CT in 2000 to 0.9 (1.4) per CT in 2014. Census tracts with predominantly NH black individuals (adjusted odds ratio [aOR], 2.37; 95% CI, 2.03-2.77), Hispanic/Latino individuals (aOR 1.30; 95% CI, 1.00-1.69), and racially/ethnically mixed individuals (aOR, 1.53; 95% CI, 1.33-1.77) in 2000 had higher odds of losing health care facilities between 2000 and 2014 compared with CTs with predominantly NH white individuals, after controlling for other neighborhood characteristics. Census tracts of geographic areas with higher levels of poverty in 2000 also had higher odds of losing health care facilities between 2000 and 2014 (aOR, 1.12; 95% CI, 1.05-1.19). Differential change was found in the presence of health care facilities across neighborhoods over time, indicating the need to monitor and address the spatial distribution of health care resources within the context of population health disparities.

Incentives and Firm Migration: An Interstate Comparison Approach

The authors model how state business incentives influence interstate relocation patterns of manufacturers using a panel (2000-2011) of 32 states. The National Establishment Time Series database and the Panel Database on Incentives and Taxes are used to study relocation by manufacturing establishments based on differences between the origin and destination states. The authors find that traditional factors associated with business climate, such as taxation and subsidies, statistically influence manufacturing interstate relocation. Further analysis shows that policy changes (e.g., increasing incentives and reducing taxes) to induce manufacturers to relocate may need to be infeasibly large or used in combination to evoke an economically meaningful increase in relocations.