Neighborhood Investment Research Articles

Gentrification creates social class disparities in belonging.

Gentrification impacts nearly every major city in the United States, posing a potential threat to lower social class residents' sense of belonging in their neighborhoods. In one survey and three preregistered experiments, we investigated how gentrification affects the belonging of residents across the social class spectrum and how to invest in working-class neighborhoods without undermining lower social class residents' sense of belonging. Studies 1-3 (Ns = 141, 1,085, and 510, respectively) provided correlational and experimental evidence that lower social class residents feel less belonging than higher social class residents in gentrifying neighborhoods. Study 3 showed that this belonging disparity was mediated by lower social class individuals perceiving themselves to be less similar to and less trusting of other residents and higher social class individuals feeling the amenities would better suit them in the gentrifying neighborhood. Nevertheless, neighborhood investment does not always threaten lower social class individuals' sense of belonging. Study 4 (N = 402) showed that lower social class individuals anticipated greater belonging and were more supportive when neighborhood investment was community driven (i.e., prioritized the needs of existing residents) than capital driven (i.e., prioritized economic growth). We discuss implications for equitable urban policy and future directions for a social psychology of gentrification. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Neighborhood Walkability Is Associated With Lower Burden of Cardiovascular Risk Factors Among Cancer Patients

BackgroundModifiable cardiovascular risk factors constitute a significant cause of cardiovascular disease and mortality among patients with cancer. Recent studies suggest a potential link between neighborhood walkability and favorable cardiovascular risk factor profiles in the general population. ObjectivesThis study aimed to investigate whether neighborhood walkability is correlated with favorable cardiovascular risk factor profiles among patients with a history of cancer. MethodsWe conducted a cross-sectional study using data from the Houston Methodist Learning Health System Outpatient Registry (2016-2022) comprising 1,171,768 adults aged 18 years and older. Neighborhood walkability was determined using the 2019 Walk Score and divided into 4 categories. Patients with a history of cancer were identified through International Classification of Diseases-10th Revision-Clinical Modification codes (C00-C96). We examined the prevalence and association between modifiable cardiovascular risk factors (hypertension, diabetes, smoking, dyslipidemia, and obesity) and neighborhood walkability categories in cancer patients. ResultsThe study included 121,109 patients with a history of cancer; 56.7% were female patients, and 68.8% were non-Hispanic Whites, with a mean age of 67.3 years. The prevalence of modifiable cardiovascular risk factors was lower among participants residing in the most walkable neighborhoods compared with those in the least walkable neighborhoods (76.7% and 86.0%, respectively). Patients with a history of cancer living in very walkable neighborhoods were 16% less likely to have any risk factor compared with car-dependent–all errands neighborhoods (adjusted OR: 0.84, 95% CI: 0.78-0.92). Sensitivity analyses considering the timing of events yielded similar results. ConclusionsOur findings demonstrate an association between neighborhood walkability and the burden of modifiable cardiovascular risk factors among patients with a medical history of cancer. Investments in walkable neighborhoods may present a viable opportunity for mitigating the growing burden of modifiable cardiovascular risk factors among patients with a history of cancer.

Racial and Ethnic Representation in Local Government

Does the presence of underrepresented racial/ethnic groups in a legislative body differentially impact outcomes for members of those groups? We study close elections between White and non-White candidates for California city council and the corresponding impact on housing values, a summary statistic for neighborhood investment. We find electing non-White rather than White candidates generates differential home value gains in majority non-White neighborhoods. This result, which is not explained by correlations between candidate race and political affiliation or neighborhood racial composition and income, suggests that increased representation can reduce racial disparities. Our results strengthen with increased city-level segregation and council member pivotality. (JEL D72, J15, R23)

Do Publicly Funded Neighborhood Investments Impact Individual-Level Health-Related Outcomes? A Longitudinal Study of Two Neighborhoods in Pittsburgh, PA from 2011 to 2018

Research examining the relationship between a neighborhood’s built environment and resident health has largely either used a static, cross-sectional research design or focused on the neighborhood in its entirety, making it difficult to understand the relationship between specific dynamic neighborhood characteristics and individual well-being. We use longitudinal data from the Pittsburgh Research on Neighborhood Change and Health (PHRESH) studies to assess the relationship between publicly funded neighborhood investments between 2011 and 2018 and five health-related outcomes: food insecurity, stress, perceived neighborhood safety, neighborhood satisfaction, and dietary quality. We additionally determine whether the distance between an individual’s place of residence and the investment affects the magnitude of associations. Using individual and year fixed effects models, we find that when measured at the neighborhood level, an increase by one standard deviation (SD) in investments (about $130 million) is associated with decreased food insecurity (−0.294 SD), increased safety (0.231 SD), and increased neighborhood satisfaction (0.201 SD) among adults who remain in the study for at least two waves of data collection. We also analyze specific investment types and find that commercial investments are largely driving the changes in food insecurity, safety, and neighborhood satisfaction, while business and residential investments are correlated with the decrease in stress.

From vacancy to verdancy? The impact of land options on the timing of vacant lot investment

AbstractLand vacancy is a persistent phenomenon leading to various socioeconomic issues in postindustrial cities. We examine the relationship between the timing of vacant lot investment and land options and compare two investment options using a quasi‐experimental design: housing investment that develops vacant lots into housing, and greening investment that converts vacant lots into gardens and reserves redevelopment options. By compiling a unique lot‐level time‐to‐event dataset based on a large‐scale vacant lot greening program in Philadelphia, we address the questions of whether and how introducing the option of greening investment to vacant lots can expedite initial investment and reduce vacancy. With the greening option, initial investment on vacant lots becomes less irreversible, thus reducing time in vacancy by 50% and elevating the hazard rate of investment by 80%. We test for the presence of the real options channel, identifying a decelerating (accelerating) effect of price uncertainty (price growth rate) on the timing of housing investment and insignificant effects of the factors on the timing of greening investment. Our findings suggest that vacant lot greening as an anti‐blight strategy is more effective to expedite investment in neighborhoods with elevated uncertainty, subdued growth rate, moderately lower income, and heightened vacancy.

Perspectives of community members on community-based participatory research: A systematic literature review

ABSTRACT Anchor institutions are a part of a complex urban governance regime influencing policy, investment and programming in urban neighborhoods. Anchor land-grant educational institutions are questioning their role in conducting impactful research in and with the community. We find growing evidence of interest in community-based participatory research (CBPR) by universities and funders. Utilizing a systematic literature review we analyze peer-reviewed scholarship on CBPR. While the number of CBPR publications has been on the rise since 2005 and the term CBPR among others is used most frequently across the fields, the trend in the social sciences is lagging. About half of the CBPR literature provides community perspectives, and less than a third was coauthored with community partners. We find community perspectives and voices are more limited in the social sciences. We attribute this phenomenon to funding limitations and the potential for bias in the peer-review process of relevant journals.

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.

Urban projects, stigmatization, and territorial disputes in the Independencia neighborhood of Monterrey, Nuevo León, México

The city of Monterrey has become a space of great inequalities and increasingly notorious socio-spatial phenomena. Its different problems have been used by the government and the private sector to justify interventions in working-class neighborhoods, as is the case of the “Independencia” neighborhood. This article looks to analyze the aspects that turn this neighborhood into a disputed space and identify how this is reflected in the territory through the (in)action of public and private actors. It uses a qualitative methodology supported by interviews, informal talks, and non-participant observations that were made in 2019 and 2020. The paper shows how abandonment and a lack of government investment in working-class neighborhoods is part of an urban revaluation process that seeks to attract private investment to these sectors and end the presence of those "others" who are considered a threat to the urban order.

The metropolitan and neighborhood geographies of REIT- and private equity–owned single-family rentals

ABSTRACT After the U.S. foreclosure crisis, institutional investors purchased thousands of homes and converted them into rental properties. Past research links these entities to a number of negative outcomes, including rent increases and eviction filings. This paper examines a larger variety of investors, including private equity firms and contract sellers. Using a national dataset of real estate transactions from 2010 to mid-2017, we examine the inter- and intra-metropolitan geography of institutional investors. Consistent with prior research, we find that large publicly traded entities purchased homes in growing Sunbelt metros, yet some specific firms target weaker-market metros. Large, publicly traded firms have concentrated investment in higher-value neighborhoods with larger shares of white residents. In contrast, private equity firms and contract sellers tend to invest in relatively lower-value neighborhoods with larger shares of Black residents. Results suggest different potential implications for these diverse actors’ investments, from crowding out prospective homebuyers to racial targeting.

Community Investments and Diet-Related Outcomes: A Longitudinal Study of Residents of Two Urban Neighborhoods

Investments in historically oppressed neighborhoods through food retail, housing, and commercial development are hypothesized to improve residents' health, nutrition, and perceptions of their neighborhood as a place to live. Although place-based development (e.g., housing, retail, business assistance) is happening in many communities, there is little evidence of the long-term correlates of multiple investments such as health and nutrition among residents. A quasi-experimental longitudinal study was conducted using a cohort of randomly sampled households in two low-income, predominantly African American neighborhoods in Pittsburgh, PA, with surveys assessing residents' food insecurity, perception of their neighborhood as a place to live, perception of access to healthy foods, and dietary outcomes in 2011 and seven years later (2018), with an interim assessment in 2014. Analyses conducted in 2022 compared changes among residents of one neighborhood which had 2.6 times the investments over a 7-year period with changes among residents of a socio-demographically similar neighborhood that received fewer investments. It was found that residents in the neighborhood receiving substantial investments demonstrated statistically significant improvements in neighborhood satisfaction (12.6% improvement compared with a 2.2% decrease) and perceived access to healthy food (52% improvement compared with 18.2% improvement), and marginally significant change in food security (14% compared with 4.8% improvement) compared with residents in the neighborhood receiving fewer investments. Multiple place-based investments in neighborhoods can potentially induce positive change for residents in health and nutrition outcomes.

Exposure to Neighborhood Racialized Economic Segregation and Reinjury and Violence Perpetration Among Survivors of Violent Injuries

Much is unknown about how individual and neighborhood factors converge in the association with risk for violent reinjury and violence perpetration. To investigate the association of exposure to neighborhood racialized economic segregation with reinjury and use of violence against others among survivors of violent penetrating injury. This retrospective cohort study was performed using data obtained from hospital, police, and state vital records. The study was performed at Boston Medical Center, an urban, level I trauma center that is the largest safety-net hospital and busiest trauma center in New England. The cohort included all patients treated for a nonfatal violent penetrating injury from 2013 to 2018. Patients with no Boston metropolitan area home address were excluded. Individuals were followed up through 2021. Data were analyzed from February to August 2022. American Community Survey data were used to measure neighborhood deprivation using the racialized economic Index of Concentration at the Extremes (ICE) for patient residential address upon hospital discharge. ICE was measured on a scale from -1 (most deprived) to 1 (most privileged). Primary outcomes were violent reinjury and police-reported perpetration of violence within 3 years of an index injury. Of 1843 survivors of violence (median [IQR] age, 27 [22-37] years; 1557 men [84.5%]; 351 Hispanic [19.5%], 1271 non-Hispanic Black [70.5%], and 149 non-Hispanic White [8.3%] among 1804 patients with race and ethnicity data), the cohort was skewed toward residing in neighborhoods with higher racialized economic segregation (median [IQR] ICE = -0.15 [-0.22 to 0.07]) compared with the state overall (ICE = 0.27). There were police encounters for violence perpetration among 161 individuals (8.7%) and violent reinjuries among 214 individuals (11.6%) within 3 years after surviving a violent penetrating injury. For each 0.1-unit increase in neighborhood deprivation, there was a 13% (hazard ratio [HR], 1.13; 95% CI, 1.03 to 1.25; P = .01) increase in risk of violence perpetration but no difference in risk for violent reinjury (HR, 1.03; 95% CI, 0.96 to 1.11; P = .38). The greatest occurrence for each outcome was within the first year after index injury; for example, incidents of violence perpetration occurred among 48 of 614 patients (7.8%) at year 1 vs 10 of 542 patients (1.8%) at year 3 in tertile 3 of neighborhood deprivation. This study found that living in a more economically deprived and socially marginalized area was associated with increased risk of using violence against others. The finding suggests that interventions may need to include investments in neighborhoods with the highest levels of violence to help reduce downstream transmission of violence.

Change in environmental justice scores in historically redlined communities compared to non-redlined communities: A case study of Richmond, Virginia

Historical redlining discouraged investment in low-income and Black neighborhoods through racially-based residential security maps, making it difficult for these groups to build generational wealth. Further, historically redlined communities experience worse health and environmental outcomes than non-redlined communities. I hypothesized that the change in environmental quality from 2015 to 2021 is significantly different between historically redlined and non-redlined communities in Richmond, Virginia. I also examined if a disparity in environmental quality still exists between Richmond's historically redlined and non-redlined communities in 2021. To achieve this goal, Environmental Justice (EJ) scores for Particulate Matter 2.5 Concentration (PM2.5), Ozone Concentration, and Wastewater Discharge Levels were assessed at the Census Block Group level and retrieved from the EPA's EJSCREEN database. My analysis showed that Wastewater Discharge EJ scores improved in historically redlined areas but worsened in non-redlined communities. However, redlined communities' EJ scores for PM2.5 declined relative to non-redlined communities; there was no significant difference in the change of Ozone EJ scores between historically redlined and non-redlined communities. Notably, the higher 2021 EJ scores (indicating higher risk) for the above indices indicate a persistent disparity in environmental risk between redlined and non-redlined communities. Policy solutions should be explored to mitigate higher environmental risk in historically redlined communities.

Abstract PD1-04: Neighborhood Deprivation Index and Survival in Breast Cancer in the United States

Abstract Introduction: Socioeconomic status (SES) of the individual and neighborhood plays an important role in patients’ (pts) access to the health system and eventually in the outcomes of their disease. Owing to the inequalities in opportunities, education, income, and developmental infrastructures, the area with deprived individual and neighborhood SES may be associated with a poor prognosis of certain malignancies and worse outcomes. We analyzed the association between Neighborhood Deprivation Index (NDI) and survival of early-stage breast cancer (BC). Methods: The NDI created by the National Cancer Institute includes variables from dimensions, such as, wealth and income, education, occupation, and housing conditions which have been used for our analysis. We analyzed the impact of NDI in quintiles (qn). We queried the SEER database from 2010-2016 for all early-stage BC pts and studied the overall survival (OS) and disease-specific survival (DSS) of BC in association with NDI. Cox multivariate regression modeling was performed to measure the association between NDI and OS/DSS. Kruskal-Wallis test was used for comparison for continuous and Chi-Square test was used for categorical variables. All analyses were adjusted for age, race, grade, insurance, surgery (SX), radiation (RN), and chemotherapy (CT). Statistics were performed using SAS. Results: Out of the 88,572 early-stage BC pts, 27.4 % (n= 24,307) were in the most deprivation (MD) qn, 26.5% (n= 23,447) were in the average deprivation (AD) qn, 17% (n= 15,035) were in the above average deprivation (AA) qn, 15.6% (n= 13,838) were in the least deprivation (LD) qn and 13.5% (n= 11,945) were in the below average deprivation (BA) qn. The median age of pts in the LD qn was 59 and MD qn was 61 yrs, p< 0.001. There was a predominance of racial minorities in the MD and AA qn with Blacks being 13-15% and Hispanics being 15% compared to only 8% Blacks and 6% Hispanics in the LD qn (p< 0.001). There was a higher percentage of uninsured pts in the MD qn compared to LD qn (2.2% vs 1.7%, p< 0.001). There were more rural areas in MD qn compared to LD qn (25.9% vs only 0.7%, p< 0.001). There were more pts with grade III disease in MD qn compared to LD qn (34% vs 31.9%, p< 0.001). 96.1% pts underwent SX in MD qn vs 97.1 % had SX in LD qn, p< 0.001. Similarly, 49.7% underwent RN in MD qn vs 56.5% had RN in the LD qn, p< 0.001. Greater percentage of pts received CT in MD qn compared to LD qn (44.6% vs 42.1%, p< 0.001). There was a higher percentage of more aggressive cancers such as triple-negative breast cancer (TNBC) and HER2 positive (HER2+) in MD qn compared to LD qn (14.5%, 17.7% vs 11.7%, 16.5% respectively, p< 0.001). In multivariate analysis, in the overall cohort, those who live in AA qn and MD qn have inferior OS and DSS when compared to those who live in LD qn (OS in AA: Hazard Ratio (HR) 1.3, 95% CI: 1.2-1.4; OS in MD: HR 1.2, 95% CI: 1.1-1.3; DSS in AA: HR 1.3, 95% CI: 1.2-1.5; DSS in MD: HR 1.2, 95% CI: 1.1-1.4, all p< 0.001). Similar results in OS and DSS were observed in hormone receptor-positive HER2 negative (HR+) and HER2+ subtypes, but not in TNBC (Table 1). The 5-year OS rates and DSS rates were also comparatively low in AA qn and MD qn compared to LD qn (OS: AA- 84%, MD- 85%, LD- 98%; DSS: AA- 91%, MD- 92%, LD- 95%, all p< 0.001). Conclusion: Early-stage BC pts from areas with worse NDI have poor OS and DSS, after accounting for the demographic, clinicopathological, treatment-related factors. Investments in poor-resource neighborhoods and policies focusing on improving the SES of areas with high deprivation need to be implemented to reduce health care disparities and improve breast cancer outcomes. Table: Overall Survival and Disease Specific Survival Citation Format: Arya Mariam Roy, Anthony George, Kristopher Attwood, Shipra Gandhi. Neighborhood Deprivation Index and Survival in Breast Cancer in the United States [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD1-04.

Neighborhood Walkability, Historical Redlining, and Childhood Obesity in Denver, Colorado.

Childhood obesity is a precursor to future health complications. In adults, neighborhood walkability is inversely associated with obesity prevalence. Recently, it has been shown that current urban walkability has been influenced by historical discriminatory neighborhood disinvestment. However, the relationship between this systemic racism and obesity has not been extensively studied. The objective of this study was to evaluate the association of neighborhood walkability and redlining, a historical practice of denying home loans to communities of color, with childhood obesity. We evaluated neighborhood walkability and walkable destinations for 250 participants of the Healthy Start cohort, based in the Denver metropolitan region. Eligible participants attended an examination between ages 4 and 8. Walkable destinations and redlining geolocations were determined based on residential addresses, and a weighting system for destination types was developed. Sidewalks and trails in Denver were included in the network analyst tool in ArcMap to calculate the precise walkable environment for each child. We implemented linear regression models to estimate associations between neighborhood characteristics and child body mass index (BMI) z-scores and fat mass percent. There was a significant association between child BMI and redlining (β: 1.36, 95% CI: 0.106, 2.620). We did not find an association between walkability measures and childhood obesity outcomes. We propose that cities such as Denver pursue built environment policies, such as inclusionary zoning and direct investments in neighborhoods that have been historically neglected, to reduce the childhood health impacts of segregated poverty, and suggest further studies on the influences that redlining and urban built environment factors have on childhood obesity.

АНАЛІЗ ІНВЕСТИЦІЙНОЇ ДІЯЛЬНОСТІ У СФЕРІ РОЗВИТКУ ТРАНСПОРТНО-ЛОГІСТИЧНОЇ ІНФРАСТРУКТУРИ УКРАЇНИ

The article examines the potential and modern conditions of the functioning of the transport and logistics infrastructure of Ukraine. The state and trends of investment activity in the field of development of the transport and logistics infrastructure of Ukraine have been described in terms of its components – land (vehicle) infrastructure, railway infrastructure, water, and aviation infrastructure. An analysis and assessment of the transport and logistics potential of countries have been carried out based on the ranking of the World Bank's International Logistics Efficiency Index. Aspects of the manifestation of the Corona crisis and military aggression of the Russian Federation in the transport and logistics sphere have been studied. An assessment of the subjective and objective factors of the low development of the transport and logistics infrastructure and the attraction of investments has been carried out. The consequences of the military aggression of the Russian Federation on the studied sector of the economy have been outlined and substantiated. The state and potential opportunities of the transport and logistics sphere in Ukraine in the conditions of the war economy and the possibility of attracting investments have been characterized. The directions of state programs in the field of development of transport and logistics infrastructure, sources, and amounts of funding have been substantiated. The implementation of measures related to the implementation of the program "On the National Transport Strategy of Ukraine" during 2019–2022 has been summarized. The systemic problems of low investment activity in the transport and logistics sphere have been analyzed. The main approaches of state policy to stimulating the processes of investment attraction in the industry have been noted based on the creation of a favorable investment climate for private investors were noted; formation of legislative prerequisites for the implementation of concession agreements; promotion of projects of common interest for the EU and Ukraine based on financial instruments (Neighborhood Investment Facility –- NIF, Connecting Europe Facilities (CEF)), which can be adaptive for economic recovery in the post-war period; to contribute to the introduction of a transport safety management system in accordance with European CADaS standards, etc.

The Nonimpact of Opportunity Zones on Home and Business Lending

Opportunity Zones (OZs) promised to stimulate investment in over 8,500 “distressed” neighborhoods. Have OZs increased neighborhood investment and, if so, what types of neighborhoods have benefitted? This study uses a difference-in-differences (DID) design to compare small business and residential lending outcomes in designated OZs with areas that were eligible but not designated. Census tracts are stratified by pretreatment social and economic indicators of distress to search for heterogeneity in effects by neighborhood type. An event study framework is used to check the parallel trends assumption and census tracts are then matched to improve the counterfactual. Finally, an adjusted interrupted time series (AITS) analysis is introduced to further evaluate differences in outcome indicator levels and trends between target and control neighborhoods pre and post OZ. DID and AITS estimates suggest that OZs have had no statistically significant effects on business or residential loan growth. Heterogeneity modeling confirms a noneffect across neighborhood distress type. In conclusion, study limitations and future extensions for both policy and research are discussed.

Changes in neighborhood disadvantage over 18 years contributes to racial disparities in later‐life cognition

AbstractBackgroundNeighborhood disadvantage (NDis) is a well‐studied contextual and local indicator of Black‐White health disparities, including cognitive health. Trajectories of NDis are less commonly studied but may be important for understanding how investment and disinvestment in neighborhoods with predominately Black residents may contribute to disparities in cognitive aging. This study characterizes 18‐year trajectories of NDis and examines whether trajectories of NDis mediate Black‐White disparities in cognitive function.MethodThis study of 480 non‐Hispanic Black (NHB) and White (NHW) older adults (Mage = 63.9; 55% Black) were drawn from the Michigan Cognitive Aging Project (MCAP), a regionally‐representative, prospective longitudinal study of older adults in the Detroit metropolitan area. Participants’ current addresses were geocoded and linked to historical neighborhood data from the National Neighborhood Data Archive (NaNDA). Yearly measures of NDis from 2000 to 2017 reflect a composite of four indicators of disadvantage (proportions of: female headed families with children; households with public assistance; families below the federal poverty level; adults unemployed). First, a latent class growth analysis (LCGA) was used to determine distinct types of 18‐year NDis trajectories across 1,344 census tracts in the six counties represented in the sample. Next, path analysis was used to quantify the extent to which the identified classes of NDis trajectory mediated the association between race and global cognition, which was operationalized as a composite of five cognitive domain factor scores (i.e., episodic memory, executive function, processing speed, language, and visuospatial ability). Mediation models adjusted for age, sex/gender, and education.ResultLCGA indicated three classes of NDis trajectories: persistently high disadvantage (PHD: 9%), high and increasing disadvantage (HID; 16%), and persistently low disadvantage (PLD; 75%). NHB participants were more likely to live in PHD or HID neighborhoods, which were each associated with worse global cognition. NDis trajectories explained 12% of the Black‐White disparity in global cognition. HID was a stronger mediator of cognitive disparities than PHD.ConclusionDisinvestment in neighborhoods may contribute to racial disparities in global cognition among adults transitioning to late life. This study highlights the value of examining risk and resilience factors at the neighborhood level in research on ADRD inequalities.

Abstract 13513: Favorable Neighborhood Walkability is Associated With Lower Burden of CV Risk Factors Among Patients Within an Integrated Health System: Houston Methodist CVD Learning Health System Registry

Background: Optimizing modifiable cardiovascular risk factors is critical to achieving AHA’s 2020 Strategic Impact Goals. Neighborhood and urban factors with a supportive walkable environment can enhance physical activity and hence impact CVH across a wide range of populations. We assessed whether a more walkable environment is associated with CV risk factor burden irrespective of CVD burden among a large diverse population within an integrated health system. Methods: Cross-sectional study using data from 1.01 million patients aged 18+ years in the Houston Methodist Cardiovascular Disease Learning Health System Registry (2016-2021). Individuals lacking NW (177,674) & BMI <18.5 kg/m 2 (27,065) were excluded. Neighborhood walkability (NW) was defined using 2019 Walk Score. Patients were assigned to 1 of 4 NW categories ( Figure ). Study participants were classified as poor (>3 CV risk factors), average (1-2 CV risk factors) or optimal (0 CV risk factors). Results: We included 901,860 patients (mean age 51.88, female 59%, NHB 15%, and 16% Hispanics), most of these (86%) resided in the 2 least walkable neighborhoods. Age-adjusted prevalence of CV risk factors was significantly lower among participants in most favorable walkable neighborhoods irrespective of CVD status ( Figure ). In adjusted analysis, favorable NW (somewhat/very walkable) vs unfavorable NW (car dependent) was associated with 2-fold odds for optimal vs poor CVD risk (OR 2.07 95%CI: 2.01-2.12) among those without CVD. Similar results were found in those with CVD (OR 1.58 95% CI:1.41-1.77). Conclusions: Our findings demonstrate favorable association between neighborhood walkability and the CVD risk factors burden in large population of about 1 million individuals. These robust findings support multilevel health system stakeholder engagements and investments in walkable neighborhoods as a viable tool for mitigating growing burden of modifiable CV risk factors.

Association of area-level mortgage discrimination and guideline-concordant non–small cell lung cancer care in the United States.

3 Background: Disparities in receipt of care for non-small cell lung cancer (NSCLC) are well described. Discriminatory mortgage lending, which limits access to home ownership in specific neighborhoods overall and disproportionately for racialized groups, is a marker of systemic racism and lower levels of neighborhood investment. This may, in turn, decrease access to high quality care. We used the mortgage denial rate as a measure of housing discrimination and investigated its association with guideline-concordant NSCLC care. Methods: Mortgage denial rates were estimated at the zip code tabulation areas (ZCTAs) level using the Home Mortgage Disclosure Act (HMDA) database (2014-2019). Mortgage denial rates represent the proportion of denied home loans to total loans and were categorized into quartiles. Individuals ≥ 18 years diagnosed with NSCLC 2014-2019 were identified from the National Cancer Database and combined with HMDA. Multivariable logistic regression models examined associations between mortgage discrimination and receipt of guideline-concordant care, including surgery, chemotherapy, and chemoradiation. A multivariable Cox proportional hazard model examined the association between mortgage discrimination and time to chemotherapy initiation. Results: Cohort included 450,614 patients newly diagnosed with NSCLC resided in 33,120 ZCTAs. Individuals residing in ZCTAs with higher mortgage denial rates were more likely to be aged 45-64 years, male, non-Hispanic White, with private health insurance coverage and income < $40,000/year. 69% of all patients received guideline-concordant care. Likelihood of guideline-concordant care was lower in neighborhoods with higher mortgage denial rates, adjusting for age and sex (Table). This disparity was present in all care subgroups. Time to chemotherapy initiation was longer for patients in neighborhoods with higher mortgage denial rates. Conclusions: Mortgage discrimination is adversely associated with receipt of guideline-concordant NSCLC care. Our examination of institutional practices leading to barriers in access to resources highlights the critical need to understand the pathways through which area-level mortgage denials impact receipt of equitable cancer care.[Table: see text]

Historical Redlining and Contemporary Federal Place-Based Policy: A Case of Compensatory or Compounding Neighborhood Inequality?

In the 1930s, the federal Home Owners' Loan Corporation (HOLC) created maps of American cities that were used to restrict investment in minority neighborhoods, leaving a durable mark on redlined neighborhoods. Since the 1990s, place-based policies are one tool the federal government has used to reinvest in disadvantaged neighborhoods. Do these programs target historically redlined neighborhoods—and to what effect? In this article, we combine data on federal place-based initiatives from 1990 to 2015 and historical HOLC maps to answer these questions. Results indicate that formerly redlined areas received substantially more funding than areas graded more favorably, indicating concentrated investment in neighborhoods that had experienced disinvestment. Federal place-based funding was associated with increased property values in formerly redlined areas, but also reductions in the share of Black homeowners, suggesting racial disparities in who benefits from rising property values. We conclude by discussing the potential and the challenges of place-based policy to address urban inequality.