Neighborhood Socioeconomic Disadvantage Research Articles

THE NEIGHBORHOOD CONTEXT AND ALL-CAUSE MORTALITY AMONG OLDER ADULTS IN PUERTO RICO

Abstract The neighborhood contexts in which older adults live are increasingly being recognized for their role in influencing disease processes and risk of death among the U.S. population. However, few studies have focused on neighborhood impacts among older populations residing in Puerto Rico– a U.S. territory –who are especially vulnerable to the effects of the environment as they “age in place” in the context of a budget crisis, the great recession, the debt crisis, and Hurricanes Irma and María. The combination of these events can obstruct access to neighborhood resources, services, and contexts considered necessary for promoting healthy aging. Thus, it is warranted to understand the effects of place on mortality in Puerto Rico, whose social and economic contexts differ from the U.S. and are more similar to that of other Latin American and Hispanic-Caribbean countries. We used 2000 U.S. Census data at the block-group level linked to the 2002 Puerto Rican Elderly Health Conditions Project with mortality follow-up to 2021 to examine neighborhood characteristics that are conceptualized as influencing mortality (e.g., residents without a high school degree; households receiving public assistance income; residents living below the poverty level; unemployed residents; residential stability; age structure). Multilevel mixed-effects parametric survival models with a Weibull distribution were estimated. Overall, results show that neighborhood socioeconomic disadvantage is associated with an increased risk of mortality among older Puerto Ricans. This suggests that older Puerto Ricans clustered in disadvantaged communities are more likely to experience a cumulative burden of social disadvantages that adversely impacts their longevity.

Race, Sex, and Neighborhood Socioeconomic Disparities in Ablation of Ventricular Tachycardia Within a National Medicare Cohort.

Background Ventricular tachycardia (VT) ablation significantly improves our ability to control VT, yet little is known about whether disparities exist in delivery of this technology. Methods and Results Using a national 100% Medicare inpatient data set of beneficiaries admitted with VT from January 1, 2014, through November 30, 2014, multivariable logistic regression techniques were used to examine the sociodemographic and clinical characteristics associated with receiving ablation. Census block group-level neighborhood socioeconomic disadvantage was measured for each patient by the Area Deprivation Index, a composite measure of socioeconomic disadvantage consisting of education, income, housing, and employment factors. Among 131 645 patients admitted with VT, 2190 (1.66%) received ablation. After adjustment for comorbidities, hospital characteristics, and sociodemographics, female sex (odds ratio [OR], 0.75 [95% CI, 0.67-0.84]), identifying as Black race (OR, 0.75 [95% CI, 0.62-0.90] compared with identifying as White race), and living in a highly socioeconomically disadvantaged neighborhood (national Area Deprivation Index percentile of >85%) (OR, 0.81 [95% CI, 0.69-0.95] versus Area Deprivation Index ≤85%) were associated with significantly lower odds of receiving ablation. Conclusions Female patients, patients identifying as Black race, and patients living in the most disadvantaged neighborhoods are 19% to 25% less likely to receive ablation during hospitalization with VT. The cause of and solutions for these disparities require further investigation.

Geospatial analysis of patients' social determinants of health for health systems science and disparity research.

Geospatial analysis of patients' social determinants of health for health systems science and disparity research.

Neighborhood socioeconomic disadvantage does not predict outcomes or cost after elective shoulder arthroplasty.

There is growing evidence that the variation in value of shoulder arthroplasty may be mediated by factors external to surgery. We sought to determine if neighborhood-level socioeconomic deprivation is associated with postoperative outcomes and cost among patients undergoing elective shoulder arthroplasty. We identified 380 patients undergoing elective total shoulder arthroplasty (anatomic or reverse) between 2015 and 2018 in our institutional registry with minimum 2-year follow-up. Each patient's home address was mapped to the area deprivation index in order to determine the level of socioeconomic disadvantage. The area deprivation index is a validated composite measure of 17 census variables encompassing income, education, employment, and housing conditions. Patients were categorized into 3 groups based on socioeconomic disadvantage (least disadvantaged [deciles 1-3], middle group [4-6], and most disadvantaged [7-10]). Bivariate analysis was performed to determine associations between the level of socioeconomic deprivation with hospitalization time-driven activity-based costs and 2-year postoperative American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and pain intensity scores. Overall 19% of patients were categorized as most disadvantaged. These patients were found to have equivalent preoperative pain intensity (P=.51), SANE (P=.50), and ASES (P=.72) scores compared to the middle and least disadvantaged groups, as well as similar outcome improvement at 2 years postoperatively (ASES): least disadvantaged group [35.7-84.3], middle group [35.1-82.4], and most disadvantaged group [37.1-84.0] [P=.56]; SANE: least disadvantaged group [31.8-87.1], middle group [30.8-84.8], and most disadvantaged group [34.2-85.1] [P=.42]; and pain: least disadvantaged group [6.0-0.97], middle group [6-0.97], and most disadvantaged group [5.6-0.80] [P=.88]. No differences in hospitalization costs were noted between groups (P=.77). Patients undergoing elective shoulder arthroplasty residing in the most disadvantaged neighborhoods demonstrate equivalent preoperative and postoperative outcomes as others, without incurring higher costs. These findings support continued efforts to provide equitable access to orthopedic care across the socioeconomic spectrum.

The intersection of neighborhood and race in urban adolescent health risk behaviors.

Racial variability in associations of neighborhood socioeconomic disadvantage and neighborhood disorder with adolescent health risk behaviors remains under-researched, which this study examined over 1 year among racially diverse adolescents. High school students (N = 345; 18% Asian, 44% Black, 16% Multiracial, 22% White) completed surveys assessing neighborhood socioeconomic disadvantage and neighborhood disorder, and health risk behaviors (lifetime alcohol, cannabis, and cigarette use, number of sexual partners) at baseline (Year 1) and 1-year follow-up (Year 2). Asian, Black, and Multiracial adolescents were more likely to endorse health risk behaviors in Year 2 compared to White adolescents living in similarly disadvantaged neighborhoods at Year 1. Associations of neighborhood disorder with health risk behavior did not differ by race. Neighborhood socioeconomic disadvantage (but not neighborhood disorder) may predispose Asian, Black, and Multiracial adolescents to health risk behaviors. Findings may inform interventions to address racial disparities in adolescent health risk behaviors.

Abstract 11993: Area Deprivation Index and Risk of Poly-Vascular Disease: Insights From Houston Methodist Cardiovascular Disease Learning Health System Registry

Introduction: Poly-vascular disease (PVD), defined as presence of atherosclerotic disease in >1 vascular territory, typically coronary artery disease (CAD), peripheral arterial disease (PAD), or cerebrovascular disease, is associated with worse CV prognosis. The impact of social vulnerability among this very high-risk subgroup has not been well studied. We aim to leverage readily available measures of neighborhood-level social vulnerability (area deprivation index, ADI) associated with increasing burden of overall and premature (<65 years) PVD in a large integrated healthcare system. Methods: Cross-sectional study using data from 1.12M patients aged 18+ years in Houston Methodist CVD Learning Health System Registry (2016-2022). Patients were ranked by ADI quintiles (Q1-Q5) as validated index of neighborhood socioeconomic disadvantage built from 17 metrics at census tract level quantified using Geographic Information Systems. CAD, PAD, and stroke were identified using ICD 10-CM codes. Results: We included a total of 1.1M adults with ADI ranking. Overall, prevalence of CAD, PAD and stroke was 5.7%, 1.7% and 3.2% respectively with 1.4% & 0.3% having vascular disease in 2 and 3 vascular beds respectively. Age-adjusted prevalence of any & premature PVD was higher with worse ADI groups ( Table ). Overall, 35% and 41% of patients with premature 2-3 PVD were in the highest 4-5 th ADI quintile (most deprived neighborhood) compared to 28% with premature single vascular CVD. After adjusting for age, sex, race/ethnicity, CV risk factors, adults in the highest ADI quintile had odds of 1.18(1.11-1.26) of PVD in 2 territories & 1.33(1.15-1.54) in 3 vascular beds compared to ADI quintile 1 (least deprived neighborhood). Conclusion: Readily available neighborhood social deprivation such as ADI is strongly associated with worsening poly-vascular CVD. It can be used to inform comprehensive preventive and management strategies for this vulnerable population at health system level.

Population-Based Impact of Rurality and Neighborhood-Level Socioeconomic Disadvantage on Pediatric Cancer Mortality in Washington State.

Childhood cancer-related mortality differs by socioeconomic factors, but the impact of residential location, including rurality and neighborhood-level socioeconomic disadvantage, is not well-characterized. This retrospective cohort study linked Washington State cancer registry data (1992-2013) to state birth (1974-2013) and death records (1992-2013) to identify residents <20 years diagnosed with cancer (n = 4,306). Census-based rural-urban commuting area codes and Area Deprivation Index (ADI) defined rural residence and neighborhood socioeconomic disadvantage at time of cancer diagnosis, respectively. Neighborhoods in the highest state ADI quintile were classified as the most disadvantaged. Kaplan-Meier estimates and Cox hazards models, adjusted for key characteristics, were used to compare mortality by rural and ADI classification. Five-year overall survival for children from non-rural low ADI neighborhoods (referent) was 80.9%±0.8%, versus 66.4%±2.9% from non-rural high ADI neighborhoods, 69.4%±3.8% from rural low ADI neighborhoods, and 66.9%±3.8% from rural high ADI neighborhoods (P < 0.01 for each comparison versus referent). Compared with the referent group, children from comparator neighborhoods had a greater mortality risk: Rural low ADI [hazard ratio (HR), 1.50; 95% confidence interval (CI), 1.12-2.02], rural high ADI (HR, 1.53; 95% CI, 1.16-2.01), and non-rural high ADI (HR, 1.64; 95% CI, 1.32-2.04). Associations of ADI and rurality with mortality varied in sub-analyses by cancer type. Children with cancer living in rural and/or socioeconomically disadvantaged neighborhoods at diagnosis experienced greater mortality relative to those without either factor. Future investigation is needed to examine how rurality and poverty potentially impact healthcare utilization and health-related outcomes in pediatric oncology.

Does hospital location matter? Association of neighborhood socioeconomic disadvantage with hospital quality in US metropolitan settings.

An aspect of a hospital's location, such as its degree of socioeconomic disadvantage, could potentially affect quality ratings of the hospital; yet, few studies have granularly explored this relationship in United States (US) metropolitan areas characterized by a wide breadth of socioeconomic disparities across neighborhoods. An understanding of the effect of neighborhood socioeconomic disadvantage on hospital quality of care is informative for targeting resources in poor neighborhoods. We assessed the association of neighborhood socioeconomic disadvantage with hospital quality of care across several areas of quality (including mortality, readmission, safety, patient experience, effectiveness of care, summary and overall star rating) in US metropolitan areas. Hospitals in the most disadvantaged neighborhoods, compared to hospitals in the least disadvantaged neighborhoods, had worse mortality scores, readmission scores, safety of care scores, patient experience of care scores, effectiveness of care scores, summary scores and overall star rating. Timeliness of care and efficient use of imaging scores were not strongly associated with neighborhood socioeconomic disadvantage; although, future studies are needed to validate this finding. Policymakers could target innovative strategies for improving neighborhood socioeconomic conditions in more disadvantaged areas, as this may improve hospital quality.

The Association between Breast Cancer Related Lymphedema and Area Deprivation Index.

Lymphedema affects up to 34% of patients after breast cancer treatment but remains underdiagnosed and undertreated. Here, we use area deprivation index (ADI), a measure of neighborhood socioeconomic disadvantage, to determine how socioeconomic status may affect risk for and diagnosis of breast cancer-related lymphedema. Records of patients who underwent surgical treatment of breast cancer between 2017-2020 were examined. Patients' nine-digit ZIP codes were utilized to determine their deprivation level as a national ADI percentile, and those fitting into the most and least deprived quartiles were compared with evaluate lymphedema risk factors and incidence. A total of 1,333 breast cancer patients were included, 812 (61%) of whom resided within the most disadvantaged ADI quartile nationally, and 521 within the least disadvantaged quartile. The most deprived group had higher rates of diabetes, obesity, and regional breast cancer, and received more extensive surgeries (7.5% modified radical mastectomy vs 1.9%, p < 0.001) and chemotherapy compared with the least disadvantaged quartile. The most disadvantaged cohort were more often at extreme risk of lymphedema utilizing the Risk Assessment Tool Evaluating Lymphedema Risk (9.1% versus 2.5%, p < 0.001); however, the incidence of lymphedema diagnoses was not significantly higher (13% vs 12%, p > 0.9). Logistic regression showed that the most deprived ADI quartile had 44% lower odds of a lymphedema diagnosis in comparison to the least deprived quartile. Residing in more socioeconomically disadvantaged neighborhoods is associated with lower odds of a lymphedema diagnosis, despite higher rates of risk factors for lymphedema, suggesting significant underdiagnosis in this population.

Relationship Between Neighborhood Socioeconomic Disadvantage and Severe Maternal Morbidity and Maternal Mortality.

Rates of severe maternal morbidity and maternal mortality (SMM/MM) in the United States are rising. Disparities in SMM/MM persist by race, ethnicity and geography, and could partially be attributed to social determinants of health. Utilizing data from the largest, statewide referral hospital in Alabama, we investigated the relationship between residence in disadvantaged neighborhoods and SMM/MM. Data on all pregnancies between 2010 and 2020 were included; SMM/MM cases were identified using CDC definitions. Area deprivation index (ADI) available at the census-block group was geographically linked to individual records and categorized using quintile cutoffs; higher ADI score indicated higher socioeconomic disadvantage. Generalized estimating equation models were used to adjust for spatial autocorrelation and ORs were computed to evaluate the relationship between ADI and SMM/MM, adjusted for covariates including age, race, insurance, residence in medically underserved areas/population (MUAP), and urban/rural residence. Overall, 32,909 live-birth deliveries were identified, with a prevalence of 9.8% deliveries with SMM/MM with blood transfusion and 5.3% without blood transfusion, respectively. Increased levels of ADI were associated with increased odds of SMM/MM. Compared to women in the lowest quintile, the adjusted OR for SMM/MM among women in highest quintile was 1.78 (95%CI, 1.22-2.59, P=.0027); increasing age, non-Hispanic Black, government insurance and residence in MUAP were also significantly associated with increased odds of SMM/MM. Our results suggest that residence within disadvantaged neighborhoods may contribute to SMM/MM even after adjusting for patient-level factors. Measures such as ADI can help identify the most vulnerable populations and provide points to intervene.

S1328 Examining Associations Between Arsenic Pollution and Hepatocellular Carcinoma in Texas

Introduction: Alcohol is the major chemical risk factor for hepatocellular carcinoma (HCC) around the world, however other toxins including Arsenic have been shown to promote hepatocarcinogenesis in animals, though the exact mechanism is poorly understood. This ecological study assesses neighborhood-level HCC burden in Texas relative to arsenic exposure. Methods: Using data from the Texas Cancer Registry, we identified a cohort of individuals diagnosed with HCC between 2011 and 2015. The primary exposure of interest is Arsenic pollution as reported in the 2011 National Air Toxics Assessment (NATA) inventory, this national screening assessment by the Environmental Protection Agency (EPA) uses emissions data to estimate health risks from toxic air pollutants. NATA calculates the concentrations of toxic air pollutants at the census tract (neighborhood) level; the inhalation exposure concentrations of Arsenic are in units of micrograms per cubic meter, however, for analysis, exposure concentrations were divided into deciles. Arsenic concentrations, demographic data, and the Area Deprivation Index (composite measure of neighborhood socioeconomic disadvantage that relies on 17 census variables drawn from these categories: poverty, housing, employment, and education) were included in multivariable Poisson-based modeling using negative binomial regression to evaluate the association between Arsenic exposure and HCC incidence in Texas. Results: In a univariable model, the association between Arsenic inhalation exposure concentrations and HCC was not significant (IRR = 1.06 [95% CI, 0.98-1.16]). Whereas, in a multivariable model that included selected demographic and socioeconomic factors, results show that variation in census tract HCC incidence across Texas is significantly associated with the inhalation exposure concentrations of Arsenic. Based on our findings, in a typical Texas census tract, a 10-unit increase in decile classification of Arsenic inhalation exposure concentration increases the risk of HCC incidence by a factor of 1.30, while holding other explanatory variables constant (IRR = 1.30 [95% CI, 1.19-1.42]) (Table). Conclusion: Variation in HCC incidence across Texas’s census tracts is significantly associated with the inhalation exposure concentrations of Arsenic at the census tract level, higher Arsenic concentrations are associated with an increased incidence. This ecological finding needs to be further examined in direct association studies. Table 1. - Relationships between HCC incidence in Texas (2011 to 2015) and inhalation exposure concentrations of Arsenic (2011 estimate). Texas census tracts; N = 5,205 Univariable Models a Multivariable Model b IRR 95% CI p value IRR 95% CI p value Arsenic concentrations c 1.06 0.98-1.16 0.159 1.302 1.194-1.419 0.001 Area Deprivation Index 1.17 1.16-1.20 <0.001 1.618 1.444-1.813 <0.001 % Hispanic or Latino (NH) 1.08 1.07-1.09 <0.001 1.092 1.080-1.105 <0.001 % Non-Hispanic Asians 0.68 0.65-0.71 <0.001 0.892 0.853-0.934 <0.001 % Non-Hispanic African American 1.06 1.05-1.07 <0.001 1.098 1.080-1.116 <0.001 % Others; 2+ races d 0.58 0.54-0.63 <0.001 - % Population ≥ 60 y.o. 1.19 1.15-1.22 <0.001 1.406 1.359-1.455 <0.001 % Population male 1.05 1.00-1.11 0.064 1.171 1.117-1.226 <0.001 % Non-Hispanic White e 0.91 0.90-0.92 <0.001 aUnivariable models where Arsenic exposure concentrations was regressed on the HCC incidence separately. Also, each covariate was regressed on the HCC incidence separately.bMultivariable model where Arsenic concentrations and the covariates (P value ≤ 0.10) were regressed on the HCC incidence simultaneously.cThe 2011 National Air Toxics Assessment (NATA) inhalation exposure concentrations for Arsenic are in units of micrograms per cubic meter; for analysis, concentrations were divided into deciles.dVariable dropped from the multivariable model run because p value > 0.10.eTo avoid model overfitting from multicollinearity among race/ethnicity, Non-Hispanic White excluded from multivariable model.

A FAILURE TO REACH DISADVANTAGED NEIGHBORHOODS: LEGISLATION IS NOT ENOUGH TO EXPAND ACCESS TO MEDICAL FERTILITY PRESERVATION

In 2019, IL made effective HB 2617 which mandated insurers provide coverage for fertility preservation (FP) services when medical treatment may cause iatrogenic infertility.1 IL is the only state nationwide to also extend coverage to publicly-insured recipients. Our study aimed to assess whether legislation mandating insurance coverage for medical fertility preservation (MFP) was associated with a change in the neighborhood socioeconomic disadvantage of patients accessing FP care.

Evaluating pediatric car safety compliance in motor vehicle collisions: Identifying high-risk groups for improper restraint usage

To identify patient factors associated with improper restraint usage and worse trauma outcomes for pediatric patients involved in motor vehicle collisions (MVCs). Retrospective study performed at a Level I pediatric trauma center for patients (≤18yr) evaluated after MVC between 2008 and 2018. The Area Deprivation Index (ADI) was used to measure neighborhood socioeconomic disadvantage (NSD) levels based on the patient's home address. Trauma registry data was correlated to ADI and used to analyze appropriate restraint usage by NSD. Proper restraint practices were defined based on national guidelines and state laws. Demographics and clinical outcomes were also analyzed. Chi-square analysis with Bonferroni corrections was used to assess the association of ADI, race, and ethnicity with proper restraint usage. Among 1152 patients included, approximately 50% were male, the median age was 7 years [IQR 4-10], and 53% were of Hispanic ethnicity. Hispanic patients comprised 73% of children in ADI quintile 5 (greatest NSD), yet only 26% of children in ADI quintile 1 (least NSD). No differences were observed across clinical data and outcomes. Hispanic children <8yr were significantly less likely to be in a car seat/booster seat compared to non-Hispanic children (OR 0.69, 95% CI 0.50-0.95, p=0.025). Furthermore, those with greatest NSD (ADI quintile 5) had the largest proportion of unrestrained patients (21%, see Fig.1). Hispanic children, especially those who require infant or booster seats (<8yr), and children living in areas with greater neighborhood socioeconomic disadvantage demonstrated poorer restraint practices. ADI can successfully identify high-risk groups for targeted injury prevention programs and improved compliance in the most vulnerable neighborhoods. Retrospective Study.

Risk of Psychiatric Disorders Among Refugee Children and Adolescents Living in Disadvantaged Neighborhoods

Refugee children and adolescents are at increased risk of mental health difficulties, but little is known about how the characteristics of the neighborhood in which they resettle may affect vulnerability and resilience. To test whether neighborhood socioeconomic disadvantage is associated with risk of psychiatric disorders among refugee children and adolescents and examine whether the association differs by sex, age at arrival, and family structure. This quasi-experimental register-based cohort study included refugees in Denmark aged 0 to 16 years at the time of resettlement from 1986 to 1998. A refugee dispersal policy implemented during those years assigned housing to refugee families in neighborhoods with varying degrees of socioeconomic disadvantage in a quasi-random (ie, arbitrary) manner conditional on refugee characteristics observed by placement officers. Cox proportional hazard models were used to examine the association between neighborhood disadvantage and risk of psychiatric disorders, adjusting for relevant baseline covariates. A neighborhood disadvantage index combining information on levels of income, education, unemployment, and welfare assistance in the refugees' initial quasi-randomly assigned neighborhood. First-time inpatient or outpatient diagnosis of a psychiatric disorder before age 30 years. Median (IQR) baseline age in the sample of 18 709 refugee children and adolescents was 7.9 (4.7-11.7) years; 8781 participants (46.9%) were female and 9928 (53.1%) were male. During a median (IQR) follow-up period of 16.1 (10.2-20.8) years, 1448 refugees (7.7%) were diagnosed with a psychiatric disorder (incidence rate, 51.2 per 10 000 person-years). An increase of 1 SD in neighborhood disadvantage was associated with an 11% increase in the hazard of a psychiatric disorders (hazard ratio [HR], 1.11; 95% CI, 1.03-1.21). This association did not differ between male and female individuals, refugees who arrived at different ages, or those from single- vs dual-parent households. In secondary analyses using prescribed psychiatric medication as the outcome, a similar association with neighborhood disadvantage was found (HR, 1.08; 95% CI, 1.03-1.14). In this cohort study, neighborhood disadvantage was associated with an increase in risk of psychiatric disorders. The results suggest that placement of refugee families in advantaged neighborhoods and efforts to enhance the neighborhood context in disadvantaged areas may improve mental health among refugee children and adolescents.

Racial Disparities in Neighborhood and Household Socioeconomic Disadvantage Predict Postpartum Weight Retention

Structural racism leads to neighborhood-level socioeconomic disadvantage, which determines adverse birth outcomes. Individual socioeconomic disadvantage is associated with compromised healthy pregnancy outcomes. This study aimed to investigate the pathways by which race, neighborhood socioeconomic disadvantage, and household socioeconomic disadvantage predict subsequent maternal postpartum weight retention. A total of 176 (N=176) racially diverse women were studied from the third trimester to 6 months after delivery. Neighborhood socioeconomic disadvantage was defined by information from the American Community Survey based on women's census tract and self-reports of neighborhood healthy food availability, safety, violence, and walking environment. Household socioeconomic disadvantage included food insecurity, income-to-needs ratio, and maternal education. Pregnancy health risk was operationalized using a summative index that included prepregnancy overweight/obesity, excessive gestational weight gain, and diagnosed hypertensive disorders during pregnancy. Postpartum weight retention was operationalized as a 6-month postpartum weight minus prepregnancy weight. Data were analyzed using structural equation modeling with bootstrapped CIs to estimate indirect effects. One third of participants retained more than 22 lbs. of pregnancy weight gain 6 months after delivery. Increased household socioeconomic disadvantage (β=0.64, p=0.039) and pregnancy health risk (β=0.34, p=0.002) were directly associated with higher postpartum weight retention. Maternal race/ethnicity had an indirect impact on postpartum weight retention through neighborhood socioeconomic disadvantage and household socioeconomic disadvantage. Non-Hispanic Black women had greater neighborhood socioeconomic disadvantage than non-Hispanic White women (White vs Black β= -0.62; p<0.001) and all other women (other vs Black β= -0.22; p=0.013). In addition, Black women had greater household socioeconomic disadvantage than White women (White vs Black β= -0.35; p=0.004), both of which in turn predicted higher postpartum weight retention. To prevent postpartum weight retention, education on behavior change to lose weight is essential, but it must be offered in the context of basic resources, at both the neighborhood and household levels.

Associations between Neighborhood Disadvantage and Dog Walking among Participants in the Dog Aging Project.

Although neighborhood socioeconomic disadvantage is negatively related to overall physical activity, prior studies reveal a complex relationship between disadvantage and particular walking behaviors. While disadvantage is associated with reduced recreational walking through a hypothesized “fear-of-crime” mechanism, the built environment in disadvantaged neighborhoods may encourage utilitarian walking. To date, no study has assessed how disadvantage relates to dog walking, a distinct walking behavior that is neither strictly recreational nor utilitarian but represents a key mechanism through which pet ownership may affect human health. We employ a large (n = 19,732) dataset from the Dog Aging Project to understand how neighborhood disadvantage is associated with dog walking when controlling for individual-, household-, and environmental-level factors. We find that dog owners in more disadvantaged neighborhoods report less on-leash walking activity compared to owners in advantaged neighborhoods and discuss the possibility of a fear-of-crime mechanism underlying this association. These findings improve our understanding of the relationship between neighborhood disadvantage and physical function and highlight the need for public health interventions that encourage dog ownership to consider neighborhood disadvantage.

Radically reframing studies on neurobiology and socioeconomic circumstances: A call for social justice-oriented neuroscience.

Socioeconomic circumstances are associated with symptoms and diagnostic status of nearly all mental health conditions. Given these robust relationships, neuroscientists have attempted to elucidate how socioeconomic-based adversity “gets under the skin.” Historically, this work emphasized individual proxies of socioeconomic position (e.g., income, education), ignoring the effects of broader socioeconomic contexts (e.g., neighborhood socioeconomic disadvantage) which may uniquely contribute to chronic stress. This omission represented a disconnect between neuroscience and other allied fields that have recognized health is undeniably linked to interactions between systems of power and individual characteristics. More recently, neuroscience work has considered how sociopolitical context affects brain structure and function; however, the products of this exciting line of research have lacked critical sociological and historical perspectives. While empirical evidence on this topic is burgeoning, the cultural, ethical, societal, and legal implications of this work have been elusive. Although the mechanisms by which socioeconomic circumstances impact brain structure and function may be similar across people, not everyone is exposed to these factors at similar rates. Individuals from ethnoracially minoritized groups are disproportionally exposed to neighborhood disadvantage. Thus, socioeconomic inequities examined in neuroscience research are undergirding with other forms of oppression, namely structural racism. We utilize a holistic, interdisciplinary approach to interpret findings from neuroscience research and interweave relevant theories from the fields of public health, social sciences, and Black feminist thought. In this perspective piece, we discuss the complex relationship that continues to exist between academic institutions and underserved surrounding communities, acknowledging the areas in which neuroscience research has historically harmed and/or excluded structurally disadvantaged communities. We conclude by envisioning how this work can be used; not just to inform policymakers, but also to engage and partner with communities and shape the future direction of human neuroscience research.

Socioeconomic disparities in distress and coping in gynecologic oncology patients (568)

Socioeconomic disparities in distress and coping in gynecologic oncology patients (568)

Neighborhood Socioeconomic Deprivation in Early Childhood Mediates Racial Disparities in Blood Pressure in a College Student Sample.

The influence of childhood contexts on adult blood pressure is an important yet understudied topic. Using a developmental perspective, this study examines the association between neighborhood socioeconomic disadvantage in early childhood (0-5 yrs), middle childhood (6-12 yrs) and adolescence (13-18 yrs) on subsequent blood pressure in young adulthood. Data were from 263 college students (52% Black; Mage = 19.21 years) and neighborhood socioeconomic disadvantage was measured using a tract-level Area Deprivation Index. Neighborhood disadvantage in early childhood was significantly associated with diastolic blood pressure and explained 22% of the race difference between Black and White adults. The findings are consistent with the notion that early childhood may be a sensitive period for the effects of neighborhood disadvantage on blood pressure.

The role of the built environment in the trajectories of cognitive ability and mental health across early and middle childhood: Results from a street audit tool in a general-population birth cohort

The research exploring the association between the built environment and children's mental health and cognitive abilities has produced mixed results. This may be due to the inconsistency in the approach taken to describe the built environment. This study, using data from the Millennium Cohort Study (MCS), a large general-population birth cohort, considered simultaneously several measures to describe it when the participant child was 3 years old, including neighbourhood disorder (assessed by an MCS interviewer by direct observation of several physical and social aspects of the immediate neighbourhood), area green space, air pollution, urbanicity and neighbourhood socio-economic disadvantage. It then explored its role in the trajectory of mental health (measured with the Strengths and Difficulties Questionnaire-SDQ) and cognitive ability (measured with the British Ability Scales-BAS) across ages 3–11 years in 4454 children of stayer families in England. Using growth curve modelling we found that neighbourhood disorder was associated with emotional symptoms and conduct problems at age 3 and with the trajectory of cognitive ability from ages 3 to 11. These associations were robust to controls for quality of the indoor housing environment and parental mental health and socio-economic status. Neither green space nor air pollution had any effect on our outcomes. Our findings shed light on the importance of specific aspects of the built environment for mental health and cognition during childhood. They also highlight the value of using direct observation of the immediate neighbourhood.