Neighborhood Socioeconomic Environment Research Articles

Residents’ Satisfaction with Neighbourhood Socio-economic Environment of the Public Sector Employee Housing Schemes in Lagos State, Nigeria

One of the major strategies implemented by both the private and public sectors in the provision of mass housing for their workers in Nigeria is the employee housing scheme. However, not much is known about the occupants’ satisfaction with neighborhood Socio-economic environment of housing provided through this scheme in a large metropolitan area such as Lagos State, where several housing estates have been developed under this scheme. Satisfaction with neighborhood socio-economic environment in nine public-sector employee housing estates in Lagos State, Nigeria was explored. A cross-sectional survey research design involving quantitative research approach was adopted. The survey was carried out between September, 2020 and March, 2021. Using Stratified Sampling, the estates/locations were grouped into Local government areas. Cluster sampling technique was used to select the local governments areas. Also, purposive technique was used to select 688 housing units in the nine purposively selected housing estates. Out of 688 questionnaires administered, about 500 copies of the administered questionnaire were correctly filled and returned by the participants and the information were subjected to descriptive statistics. Statistical package for Social Science(SPSS) was used to analyze the data. The results pointed out that the key respondents were most pleased with the extent of safe keeping of lives and property in the estate, outdoor air quality in the estate, extent of religious activities in the estate and least pleased with extent of collective activities in the estate, extent of noise in the housing estates and price of services and goods within and around the estate. Therefore, to improve neighborhood socio-economic environment satisfaction, residents in public sector employee housing schemes should give priority attention to the key features that ensure residents’ satisfaction in existing and future housing projects.

The association between neighborhood obesogenic factors and prostate cancer risk and mortality: the Southern Community Cohort Study.

Prostate cancer is one of the leading causes of cancer-related mortality among men in the United States. We examined the role of neighborhood obesogenic attributes on prostate cancer risk and mortality in the Southern Community Cohort Study (SCCS). From the total of 34,166 SCCS male participants, 28,356 were included in the analysis. We assessed the relationship between neighborhood obesogenic factors [neighborhood socioeconomic status (nSES) and neighborhood obesogenic environment indices including the restaurant environment index, the retail food environment index, parks, recreational facilities, and businesses] and prostate cancer risk and mortality by controlling for individual-level factors using a multivariable Cox proportional hazards model. We further stratified prostate cancer risk analysis by race and body mass index (BMI). Median follow-up time was 133 months [interquartile range (IQR): 103, 152], and the mean age was 51.62 (SD: ± 8.42) years. There were 1,524 (5.37%) prostate cancer diagnoses and 98 (6.43%) prostate cancer deaths during follow-up. Compared to participants residing in the wealthiest quintile, those residing in the poorest quintile had a higher risk of prostate cancer (aHR = 1.32, 95% CI 1.12-1.57, p = 0.001), particularly among non-obese men with a BMI < 30 (aHR = 1.46, 95% CI 1.07-1.98, p = 0.016). The restaurant environment index was associated with a higher prostate cancer risk in overweight (BMI ≥ 25) White men (aHR = 3.37, 95% CI 1.04-10.94, p = 0.043, quintile 1 vs. None). Obese Black individuals without any neighborhood recreational facilities had a 42% higher risk (aHR = 1.42, 95% CI 1.04-1.94, p = 0.026) compared to those with any access. Compared to residents in the wealthiest quintile and most walkable area, those residing within the poorest quintile (aHR = 3.43, 95% CI 1.54-7.64, p = 0.003) or the least walkable area (aHR = 3.45, 95% CI 1.22-9.78, p = 0.020) had a higher risk of prostate cancer death. Living in a lower-nSES area was associated with a higher prostate cancer risk, particularly among Black men. Restaurant and retail food environment indices were also associated with a higher prostate cancer risk, with stronger associations within overweight White individuals. Finally, residing in a low-SES neighborhood or the least walkable areas were associated with a higher risk of prostate cancer mortality.

Perceived Interpersonal Racism and Incident Stroke Among US Black Women

Black individuals in the US experience stroke and stroke-related mortality at younger ages and more frequently than other racial groups. Studies examining the prospective association of interpersonal racism with stroke are lacking. To examine the association of perceived interpersonal racism with incident stroke among US Black women. The Black Women's Health Study, a prospective cohort study of 59 000 Black women from across the US, assessed the longitudinal association between perceived interpersonal racism and stroke incidence. Stroke-free participants were followed up from 1997 until onset of stroke, death, loss to follow-up, or the end of the study period (December 31, 2019). Cox models were used to estimate hazard ratios (HRs) and 95% CIs, adjusting for major confounders, including education, neighborhood socioeconomic environment, and cardiometabolic factors. Data analysis was performed from March 2021 until December 2022. On a questionnaire completed in 1997, participants reported experiences of racism in everyday life and when dealing with situations that involved employment, housing, and interactions with police. Strokes were identified through self-report on biennial questionnaires, medical records adjudication, and linkage with the National Death Index. In 1997, 48 375 Black women (mean [SD] age, 41 [10] years) provided information on perceived interpersonal racism and were free of cardiovascular disease and cancer. During the 22 years of follow-up, 1664 incident stroke cases were identified; among them, 550 were definite cases confirmed by neurologist review and/or National Death Index linkage. Multivariable HRs for reported experiences of racism in all 3 domains of employment, housing, and interactions with police vs no such experiences were 1.38 (95% CI, 1.14-1.67), a 38% increase, for all incident cases and 1.37 (95% CI, 1.00-1.88) for definite cases. For comparisons of women in the highest quartile of everyday interpersonal racism score vs women in the lowest quartile, multivariable HRs were 1.14 (95% CI, 0.97-1.35) for analyses that included all incident stroke and 1.09 (95% CI, 0.83-1.45) for analyses that included definite cases only. In this study, Black women who reported experiences of interpersonal racism in situations involving employment, housing, and interactions with police appeared to have an increased risk of stroke, even after accounting for demographic and vascular risk factors, suggesting that the high burden of racism experienced by Black US women may contribute to racial disparities in stroke incidence.

Age and sex differences in the association between neighborhood socioeconomic environment and incident diabetes: Results from the diabetes location, environmental attributes and disparities (LEAD) network

ObjectiveWorse neighborhood socioeconomic environment (NSEE) may contribute to an increased risk of type 2 diabetes (T2D). We examined whether the relationship between NSEE and T2D differs by sex and age in three study populations. Research design and methodsWe conducted a harmonized analysis using data from three independent longitudinal study samples in the US: 1) the Veteran Administration Diabetes Risk (VADR) cohort, 2) the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, and 3) a case-control study of Geisinger electronic health records in Pennsylvania. We measured NSEE with a z-score sum of six census tract indicators within strata of community type (higher density urban, lower density urban, suburban/small town, and rural). Community type-stratified models evaluated the likelihood of new diagnoses of T2D in each study sample using restricted cubic splines and quartiles of NSEE. ResultsAcross study samples, worse NSEE was associated with higher risk of T2D. We observed significant effect modification by sex and age, though evidence of effect modification varied by site and community type. Largely, stronger associations between worse NSEE and diabetes risk were found among women relative to men and among those less than age 45 in the VADR cohort. Similar modification by age group results were observed in the Geisinger sample in small town/suburban communities only and similar modification by sex was observed in REGARDS in lower density urban communities. ConclusionsThe impact of NSEE on T2D risk may differ for males and females and by age group within different community types.

Mediation of an association between neighborhood socioeconomic environment and type 2 diabetes through the leisure-time physical activity environment in an analysis of three independent samples

IntroductionInequitable access to leisure-time physical activity (LTPA) resources may explain geographic disparities in type 2 diabetes (T2D). We evaluated whether the neighborhood socioeconomic environment (NSEE) affects T2D through the LTPA...

Anger expression moderates the effects of neighborhood disadvantage on cognitive decline among African‐Americans in the Jackson Heart Study and Atherosclerosis Risk in Communities study

AbstractBackgroundPrevious research has identified neighborhoods and individual psychosocial characteristics such as anger expression as important contributors to cognitive health. However, less is known about whether neighborhood environments interact with individual psychosocial characteristics to confer increased susceptibility to adverse cognitive outcomes such as accelerated cognitive decline. We tested the hypothesis that internalized anger will strengthen the associations between neighborhood disadvantage and faster rates of cognitive decline.MethodAmong 1,314 African Americans dually enrolled in two community‐based cohorts in Jackson, Mississippi—the ARIC and JHS cohort studies—a factor score of global cognitive function was calculated based on ten cognitive tests of working memory, language, and executive function administered repeatedly from 1996 to 2019. Age‐ and sex‐adjusted linear mixed effects models were used to examine whether individual‐level anger expression moderated the associations of four measures of census tract‐level neighborhood socioeconomic and social environment characteristics (the national Area Deprivation Index (ADI), a JHS neighborhood disadvantage score, racial residential segregation, and perceived physical disorder) with individual‐level cognitive decline.ResultOf the four neighborhood characteristics, greater JHS neighborhood disadvantage and racial residential segregation were associated with faster rates of 10‐year cognitive decline. Among those with high inward anger expression (&gt;1 SD above the mean), there was a 33% and 35% faster rate of decline in global cognition associated with higher neighborhood disadvantage (as measured by the JHS score) and segregation, respectively (Table).ConclusionDispositional inward anger expression may increase susceptibility to the detrimental impacts of neighborhood disadvantage on cognitive health.

Neighbourhood socio-economic environment predicts adiposity and obesity risk in children under two.

Neighbourhood socio-economic environment (SEE) is associated with obesity in older children and adults, but little is known about this relationship in younger children. Breastfeeding is an important preventative of adiposity in childhood, but its relationship with neighbourhood SEE is unknown. We assessed differences in adiposity and obesity in children before age two by neighbourhood SEE, controlling for family socio-demographics and breastfeeding duration. Family socio-demographics, child body mass index z scores (BMIz), and breastfeeding duration were collected at periodic study visits from participants in PREVAIL (n= 245), a birth cohort in Cincinnati, OH. Addresses were assigned a Deprivation Index score, a validated measure of SEE, and dichotomized into highest SEE (least deprived quartile of scores) and not highest SEE (remaining quartiles). Longitudinal and Poisson models assessed differences in BMIz by SEE over the second year of life and obesity risk at age two, respectively (highest SEE, reference), while attenuation of obesity risk by breastfeeding duration was tested in mediation models. Residing outside of the highest SEE neighbourhoods was associated with an increased BMIz of 0.04 (95%CI 0.02, 0.06) per month of life and increased obesity risk at age two (aRR: 3.7, 95%CI 1.2, 16.2), controlling for family socio-demographics. Breastfeeding duration attenuated >9% of the obesity risk attributable to SEE (mediated RR: 3.4, 95%CI 1.1, 14.8). In the PREVAIL Cohort, residing outside of the highest SEE neighbourhoods predicted a significant increase in BMIz and obesity risk in children before age two, a relationship that was partially mediated by breastfeeding duration. Breastfeeding support may play an important role in reducing obesity rates in children in lower SEE neighbourhoods.

Relations of the neighbourhood socio-economic and physical environment with 3-year changes in health-related quality of life among community-dwelling older adults in Belgium

Current evidence on the relations between neighbourhood environments and older adults' health-related quality of life (HRQoL) relies mainly on cross-sectional studies. This longitudinal study aimed to examine the relations of neighbourhood socio-economic status (SES) and objective and perceived physical environmental factors with 3-year changes in physical and mental HRQoL. Baseline and three-year follow-up data were collected in 503 Belgian older adults. Generalized linear mixed models were applied. Participants living in low compared to high SES neighbourhoods experienced stronger decreases in physical and mental HRQoL. Shorter objective distances to the nearest private recreational facility and park and better perceived aesthetics were associated with weaker decreases in physical HRQoL. Independent of time, higher perceived safety from crime was related to better physical and mental HRQoL. Unexpectedly, higher levels of perceived access to recreational facilities, land use mix diversity, connectivity and traffic safety were associated with stronger decreases in HRQoL. To prevent decreases in HRQoL, policies should prioritize older adults living in low SES neighbourhoods and provide aesthetically pleasing and safe neighbourhoods with nearby parks and private recreational facilities. Future research is needed to clarify the observed unanticipated effects and mediating pathways in the relations between neighbourhood environments and HRQoL.

1204-P: Evaluation of Mediation via the Physical Activity Environment of Neighborhood, Socioeconomic Environment, and Type 2 Diabetes Associations

Inequitable access to neighborhood leisure-time physical activity (LTPA) resources may explain geographic disparities in type 2 diabetes (T2D) . We evaluated the LTPA environment as a potential mediating pathway through which the neighborhood socioeconomic environment (NSEE) affects T2D. We used harmonized measures and analytic approaches in three independent study samples in the Diabetes Location, Environmental Attributes, and Disparities Network: the national Veterans Administration Diabetes Risk (VADR) cohort, comprising electronic health records (EHR) of 4.1 million T2D-free veterans; Reasons for Geographic and Racial Differences in Stroke (REGARDS) , a national prospective cohort (n=11,2T2D-free) ; and a case-control study in the Geisinger EHR in Pennsylvania (15,888 T2D cases) . We measured NSEE with an index of census tract-level Census metrics (higher indicates disadvantage) . The LTPA environment was evaluated by PA facility density within street network buffers and population-weighted distance to parks. In models stratified by levels of community urbanicity, we estimated natural direct effects and indirect effects for each mediator. PA facility density mediated NSEE-T2D effects, but the magnitude and direction of the indirect effects differed by urbanicity and study sample. In rural communities, we found positive indirect effects via PA facility density (incidence rate difference [95% confidence interval] of NSEE quartile 4 vs. 1: 0.0[0.0038, 0.0099] in VADR; 1.53 [0.25, 3.05] in REGARDS) , representing a proportion mediated of 3% (VADR) and 51% (REGARDS) . We found small indirect effects for all other community types in VADR but none in the Geisinger sample. Distance to parks mediated NSEE-T2D effects only in VADR rural communities. Results suggest regional or population-specific differences in how and whether the LTPA environment mediates NSEE-T2D relations, which could support local T2D prevention efforts. Disclosure K.A. Moon: None. C.M. Nordberg: None. A. Zhu: Research Support; Amgen Inc. J. Uddin: None. P.M. Lopez: None. S.L. Orstad: None. M.D. Schwartz: None. V. Ryan: None. B.S. Schwartz: None. A.P. Carson: Research Support; Amgen Inc. D. Long: Research Support; Amgen Inc. J.R. Brown: None. G.S. Lovasi: None. S. Adhikari: Research Support; Johnson &amp; Johnson. R. Kanchi: None. S. Avramovic: None. K.R. Siegel: None. M.N. Poulsen: None. Funding Centers for Disease Control (U01DP006293, Drexel University; U01DP006296, Geisinger-Johns Hopkins University; U01DP006299, New York University School of Medicine; U01DP006302, University of Alabama at Birmingham) .

Abstract P202: Optimism Moderates The Effects Of Neighborhood Disadvantage On Incident Heart Failure Among African-Americans In The Jackson Heart Study (JHS) And Atherosclerosis Risk In Communities (ARIC) Study

Background: African-Americans experience a disproportionate burden of heart failure. Although previous research has identified neighborhoods as an important contributor to these disparities, less is understood about how psychosocial resilience factors, such as optimism, may provide protection from the effects of neighborhood disadvantage on heart failure risk. We tested the hypothesis that higher levels of optimism will attenuate the associations between greater neighborhood disadvantage and higher incidence of heart failure. Methods: Among 1,448 African-Americans dually enrolled in two community-based cohorts in Jackson, Mississippi—JHS and the ARIC study—who were free of heart failure as of January 1, 2000, 459 failure events classified by reviewer panel accrued through December 31, 2019. Multi-level age- and sex-adjusted Cox regression models with interaction terms were used to examine whether individual-level optimism moderated the associations of four measures of census tract-level neighborhood socioeconomic and social environment characteristics (the national Area Deprivation Index (ADI), a JHS neighborhood disadvantage score, racial residential segregation, and perceived physical disorder) on individual-level incident hospitalized heart failure. Results: Optimism moderated the associations of some neighborhood disadvantage measures (ADI and JHS neighborhood disadvantage score) on hospitalized heart failure risk (Table). Compared to participants reporting the lowest level of optimism, those in the highest tertile had 12%, 6%, 16%, and 9% lower rates of heart failure associated with increasing neighborhood disadvantage, respectively for each exposure. Interaction estimates for racial residential segregation and perceived physical disorder did not reach statistical significance. Conclusions: Optimism may provide resilience to the detrimental effects of neighborhood disadvantage on risk for heart failure.

Neighborhood Socioeconomic Environment and Risk of Type 2 Diabetes: Associations and Mediation Through Food Environment Pathways in Three Independent Study Samples.

OBJECTIVEWe examined whether relative availability of fast-food restaurants and supermarkets mediates the association between worse neighborhood socioeconomic conditions and risk of developing type 2 diabetes (T2D).RESEARCH DESIGN AND METHODSAs part of the Diabetes Location, Environmental Attributes, and Disparities Network, three academic institutions used harmonized environmental data sources and analytic methods in three distinct study samples: 1) the Veterans Administration Diabetes Risk (VADR) cohort, a national administrative cohort of 4.1 million diabetes-free veterans developed using electronic health records (EHRs); 2) Reasons for Geographic and Racial Differences in Stroke (REGARDS), a longitudinal, epidemiologic cohort with Stroke Belt region oversampling (N = 11,208); and 3) Geisinger/Johns Hopkins University (G/JHU), an EHR-based, nested case-control study of 15,888 patients with new-onset T2D and of matched control participants in Pennsylvania. A census tract–level measure of neighborhood socioeconomic environment (NSEE) was developed as a community type-specific z-score sum. Baseline food-environment mediators included percentages of 1) fast-food restaurants and 2) food retail establishments that are supermarkets. Natural direct and indirect mediating effects were modeled; results were stratified across four community types: higher-density urban, lower-density urban, suburban/small town, and rural.RESULTSAcross studies, worse NSEE was associated with higher T2D risk. In VADR, relative availability of fast-food restaurants and supermarkets was positively and negatively associated with T2D, respectively, whereas associations in REGARDS and G/JHU geographies were mixed. Mediation results suggested that little to none of the NSEE–diabetes associations were mediated through food-environment pathways.CONCLUSIONSWorse neighborhood socioeconomic conditions were associated with higher T2D risk, yet associations are likely not mediated through food-environment pathways.

Sex Differences in Factors Contributing to the Racial Disparity in Diabetes Risk

Diabetes incidence differs by race in the U.S., with a persistent reported Black-White disparity. However, the factors that contribute to this excess risk in middle-aged and older adults are unclear. This prospective cohort study included 7,171 Black and White adults aged ≥45 years without diabetes at baseline (2003‒2007) who completed a follow-up examination (2013‒2016). Modified Poisson regression was used to obtain sex-stratified RRs for diabetes. Mediation analyses using a change in β coefficient assessed individual and neighborhood factors that contribute to the racial disparity in diabetes incidence. Statistical analyses were conducted in 2018-2019. The cumulative incidence of diabetes was higher for Black men (16.2%) and women (17.7%) than for White men (11.0%) and women (8.1%). Adjusting for age and prediabetes, diabetes risk was higher for Black women than for White women (RR=1.75, 95% CI=1.47, 2.07) and for Black men than for White men (RR=1.33, 95% CI=1.09, 1.64). The individual factors that attenuated the racial disparity the most were Southern dietary pattern (change in β=42.8%) and neighborhood socioeconomic environment (change in β=26.3%) among men and BMI (change in β=34.4%) and waist circumference (change in β=32.4%) among women. When including all factors collectively, the racial disparity in diabetes incidence was similar for men (RR=1.38, 95% CI=1.04, 1.83) and was attenuated for women (RR=1.41, 95% CI=1.11, 1.81). The racial disparity in diabetes incidence remained after accounting for individual and neighborhood factors. Further investigation of additional factors underlying this racial disparity is needed to inform multilevel strategies for diabetes prevention.

Association of maternal exposure to ambient PM2.5with birthweight and effect modification by maternal socioeconomic factors

Background: Few prior studies of prenatal air pollutant exposures on birth outcomes have examined effect modification by socioeconomic factors or infant sex, nor examined critical exposure windows smaller than trimesters. We investigated associations of prenatal concentrations of fine particulate matter (PM2.5) with birthweight and small for gestational age (SGA).Methods: The analytic population (n=1,879) comprised of term (≥37 weeks) births in two pregnancy cohorts in the ECHO-PATHWAYS consortium (CANDLE and TIDES). PM2.5 exposure was estimated using a fine-scale spatiotemporal model and averaged over windows that may be critical to prenatal growth and development (0-2, 10-12 weeks of gestation, and last month of pregnancy as well as each trimester. SGA was calculated as &lt;10th percentile based on U.S. referent percentiles. We fit adjusted linear and modified Poisson regression models to estimate linear associations with birthweight and relative risk (RR) of SGA, respectively, per 2-µg/m3 PM2.5. Interactions by maternal education, household income, neighborhood socioeconomic environment, and infant sex were explored.Results: Overall, 2.5% of births were low birthweight (&lt;2,500g) and 10.3% were SGA. Mean PM2.5 pregnancy exposure was 9.8 µg/m3 (interquartile range = 2.2). Birthweight was inversely associated with PM2.5 during 0-2 weeks (β: -25.0g; 95%CI: -46.3,-3.8), month before delivery (β: -35.5g; 95%CI: -62.1,-8.9), and in trimester 1, 2, and 3 (βs: -43.3g, -70.2g, -51.3g; 95%CIs: -85.0,-1.7; -111.4,-29.0; -90.7,-11.9; respectively), but not 10-12 weeks (β: -9.7g; 95%CI: -34.3,14.8). For SGA, we only observed associations with 0-2 weeks (RR: 1.2; 95%CI: 1.0,1.4). There was suggestive evidence associations with SGA is modified by household income, with stronger associations in lower incomes. No modification by other socioeconomic factors or sex were observed.Conclusions: Findings indicate that prenatal PM2.5 exposure, particularly during early and late pregnancy, is associated with fetal growth. There is suggestive evidence that the association is stronger with lower household incomes.

The Diabetes Location, Environmental Attributes, and Disparities Network: Protocol for Nested Case Control and Cohort Studies, Rationale, and Baseline Characteristics.

BackgroundDiabetes prevalence and incidence vary by neighborhood socioeconomic environment (NSEE) and geographic region in the United States. Identifying modifiable community factors driving type 2 diabetes disparities is essential to inform policy interventions that reduce the risk of type 2 diabetes.ObjectiveThis paper aims to describe the Diabetes Location, Environmental Attributes, and Disparities (LEAD) Network, a group funded by the Centers for Disease Control and Prevention to apply harmonized epidemiologic approaches across unique and geographically expansive data to identify community factors that contribute to type 2 diabetes risk.MethodsThe Diabetes LEAD Network is a collaboration of 3 study sites and a data coordinating center (Drexel University). The Geisinger and Johns Hopkins University study population includes 578,485 individuals receiving primary care at Geisinger, a health system serving a population representative of 37 counties in Pennsylvania. The New York University School of Medicine study population is a baseline cohort of 6,082,146 veterans who do not have diabetes and are receiving primary care through Veterans Affairs from every US county. The University of Alabama at Birmingham study population includes 11,199 participants who did not have diabetes at baseline from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a cohort study with oversampling of participants from the Stroke Belt region.ResultsThe Network has established a shared set of aims: evaluate mediation of the association of the NSEE with type 2 diabetes onset, evaluate effect modification of the association of NSEE with type 2 diabetes onset, assess the differential item functioning of community measures by geographic region and community type, and evaluate the impact of the spatial scale used to measure community factors. The Network has developed standardized approaches for measurement.ConclusionsThe Network will provide insight into the community factors driving geographical disparities in type 2 diabetes risk and disseminate findings to stakeholders, providing guidance on policies to ameliorate geographic disparities in type 2 diabetes in the United States.International Registered Report Identifier (IRRID)DERR1-10.2196/21377

Abstract C063: Impact of neighborhood socioeconomic status on breast cancer subtypes among Black women

Abstract Background: Compared to White women, African American/Black women are more likely to develop triple-negative breast cancer (TNBC), an aggressive breast cancer subtype. While many studies have examined individual-level socioeconomic status (SES) as a major social determinant of more aggressive breast tumor phenotypes, the impact of neighborhood-level SES (nSES) on breast cancer is not well understood, particularly among Blacks. Objective: To evaluate the impact of nSES on breast cancer subtypes among Black women with breast cancer. Methods: We evaluated the association of interest among 1,220 Black women with invasive breast cancer from 2006 to 2018 enrolled from 10 counties of New Jersey in the Women’s Circle of Health Study (WCHS). Residential address at diagnosis was geocoded to the census tract-level. Neighborhood SES was measured using the NCI’s census tract-level SES index, a time-dependent score constructed by a factor analysis of seven variables measuring different aspects of census tract SES (education index, percent unemployed, percent working class, median household income, percent below 150% of poverty line, median house value, and median rent). In a case-only analysis, we used multilevel multinomial logistic regressions to estimate nSES in relation to breast cancer subtype (TNBC, HER2-enriched, Luminal B vs. Luminal A). Models were adjusted for individual-level SES variables, body mass index and reproductive factors, and census tract-level percentage of Black residents. We tested whether the associations were modified by percentage of Black residents and participant’s education. Results: Higher nSES was found to predict a lower risk of TNBC. Compared to tertile 1 (lowest nSES score), the odds ratio (OR) was 0.91 (95% CI: 0.65, 1.29) for tertile 2 and 0.52 (95% CI: 0.34, 0.79) for tertile 3 (highest nSES score; p-trend: 0.001). Higher nSES was borderline significantly associated with a lower risk of Luminal B (OR: 0.61 comparing highest vs. lowest nSES tertile; 95% CI: 0.36, 1.03; p-trend: 0.055). The inverse association between nSES and TNBC was observed only among Black women living in census tracts with lower proportion of Black residents (p-for-interaction=0.08). Compared to the lowest nSES tertile, OR was 0.38 (95% CI: 0.21, 0.68) for the highest tertile (p-trend: &amp;lt;0.001). There was a suggestion that the inverse relationship of nSES with TNBC was also more pronounced among women who had relatively lower levels of education. Conclusion: Neighborhood socioeconomic environment may influence the development of TNBC among Black women, which might be buffered by some contextual factors in areas with more Black residents. Further investigation to elucidate these factors is needed. Citation Format: Bo Qin, Adana A.M. Llanos, Riddhi Babel, Jesse J. Plascak, Karen Pawlish, Christine B. Ambrosone, Kitaw Demissie, Chi-Chen Hong, Elisa V. Bandera. Impact of neighborhood socioeconomic status on breast cancer subtypes among Black women [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C063.

Race, Neighborhood Socioeconomic Status, and Gut Microbiome

Abstract Gut microbiome plays an increasingly recognized important role in human health. This study aims to evaluate the association among race, neighborhood disadvantage index (NDI), and gut microbiome in patients undergoing screening colonoscopy. Methods: The study includes 689 patients aged 50–80 years undergoing screening colonoscopy at University Hospitals Cleveland Medical Center. Each patient donated a stool sample 1–4 weeks prior to their colonoscopy examination. 16S ribosomal RNA genes in stools were sequenced and classified into 236 Operational Taxonomic Units (OTUs) to species level. Neighborhood Disadvantage Index (NDI) was derived from 17 variables reflecting neighborhood contextual environment. We first examined the association of race with microbiota, and race with NDI. We then examined further the association between NDI and each microbiota by linear mixed effect model to account for the correlation within census tract, with adjustment of age, sex, BMI, smoking, and sequencing batch. The significance of associations between microbiota and NDI are evaluated by likelihood ratio tests. Q-value was estimated for False Discovery Rate (FDR)-based multiple testing correction. For the microbiota associated with NDI with Q-value ⇐ 0.05, we additionally adjusted for genetic ancestry in the model in a subset of 222 patients who have available genome-wide ancestry informative SNP genotype data. Results: Of all the 172 microbiota that have minimum relative abundances &amp;gt;0.005, 13 microbiota were significantly associated with race. We speculate that such association with race could be at least partially driven by neighborhood socioeconomic environment, i.e., racialized neighborhood environment - given the high correlation of race and NDI (corr = 0.60, P = 3.38E-56). Multivariate-adjusted regression models showed that 5 microbiota were positively associated with NDI (Q-value &amp;lt; 0.05). Subset analysis of 222 patients with further controlling for genetic ethnicity shows that two microbiotas remain significantly associated with NDI. Conclusions: Residential neighborhood disadvantage was found to impact gut microbiota. Further studies to validate our findings and to delineate the functionality of these NDI-associated microbiota are warranted.

The Association Between Neighborhood Socioeconomic Deprivation, Cardiorespiratory Fitness, and Physical Activity in US Youth

Growing evidence suggests that the broader neighborhood socioeconomic environment is independently associated with cardiometabolic health. However, few studies have examined this relationship among younger populations. The purpose of the study was to (1)investigate the association between neighborhood socioeconomic deprivation (SED) and cardiorespiratory fitness and (2)determine the extent to which physical activity mediates this relationship. Data from 312 youth (aged 12-15y) were obtained from the 2012 National Health and Nutrition Examination Survey National Youth Fitness Survey. Cardiorespiratory fitness was measured using a standard submaximal treadmill test, and maximal oxygen consumption was estimated. Physical activity was self-reported time spent in moderate to vigorous activity. Neighborhood SED was measured by a composite index score at the census tract of residence. Logistic regression analyses examined relationships between neighborhood SED, physical activity, and cardiorespiratory fitness, adjusting for individual-level characteristics and the complex sampling design. Neighborhood SED was not significantly associated with cardiorespiratory fitness or physical activity among youth in the study sample. While not significant, cardiorespiratory fitness levels were observed to decrease as neighborhood SED increased. Future research is needed to better understand this relationship and to identify underlying mechanisms beyond fitness or physical activity that may drive the relationship between neighborhood SED and health.

Neighborhood Deprivation Predicts Heart Failure Risk in a Low-Income Population of Blacks and Whites in the Southeastern United States.

Recent data suggest that neighborhood socioeconomic environment predicts heart failure (HF) hospital readmissions. We investigated whether neighborhood deprivation predicts risk of incident HF beyond individual socioeconomic status in a low-income population. Participants were 27 078 whites and blacks recruited during 2002 to 2009 in the SCCS (Southern Community Cohort Study), who had no history of HF and were using Centers for Medicare or Medicaid Services. Incident HF diagnoses through December 31, 2010, were ascertained using International Classification of Diseases, Ninth Revision, codes 428.x via linkage with Centers for Medicare or Medicaid Services research files. Participant residential information was geocoded and census tract determined by a spatial join to the US Census Bureau TIGER/Line Shapefiles. The neighborhood deprivation index was constructed using principal components analysis based on census tract-level socioeconomic variables. Cox models with Huber-White cluster sandwich estimator of variance were used to investigate the association between neighborhood deprivation index and HF risk. The study sample was predominantly middle aged (mean, 55.5 years), black (69%), female (63%), low income (70% earned <$15 000/y), and >50% of participants lived in the most deprived neighborhoods (third neighborhood deprivation index tertile). Over median follow-up of 5.2 years, 4300 participants were diagnosed with HF. After adjustment for demographic, lifestyle, and clinical factors, a 1 interquartile increase in neighborhood deprivation index was associated with a 12% increase in risk of HF (hazard ratio, 1.12; 95% confidence interval, 1.07-1.18), and 4.8% of the variance in HF risk (intraclass correlation coefficient, 4.8; 95% confidence interval, 3.6-6.4) was explained by neighborhood deprivation. In this low-income population, scant neighborhood resources compound the risk of HF above and beyond individual socioeconomic status and traditional cardiovascular risk factors. Improvements in community resources may be a significant axis for curbing the burden of HF.

Associations Between Neighborhood Environment, Health Behaviors, and Mortality.

Considering the joint association of neighborhood socioeconomic environment and individual-level health behaviors with health outcomes may help officials design effective disease prevention strategies. This study evaluates the joint influences of neighborhood socioeconomic environment and individual health behaviors on mortality in a cohort primarily comprising people with low individual-level SES. The prospective Southern Community Cohort Study includes 77,896 white and African American participants recruited in the years 2002-2009; 55% of participants had a household income <$15,000 at baseline interview. Mortality from cancer (n=2,471), cardiovascular diseases (n=3,005), and all-causes (n=10,099) was identified from the National Death Index through December 31, 2013 (median follow-up, 8 years). Data were analyzed in 2016 and 2017. Associations were assessed between mortality, a neighborhood deprivation index composed of 11 census tract-level variables, five health behaviors, and a composite healthy lifestyle score. Living in a neighborhood with the greatest socioeconomic disadvantage was associated with higher all-cause mortality in both men (hazard ratio=1.41, 95% CI=1.27, 1.57) and women (hazard ratio=1.77, 95% CI=1.57, 2.00). Associations were attenuated after adjustment for individual-level SES and major risk factors (hazard ratio for men=1.09, 95% CI=0.98, 1.22, and hazard ratio for women=1.26, 95% CI=1.12, 1.42). The dose-response association between neighborhood disadvantage and mortality was less apparent among smokers. Nevertheless, individuals who lived in disadvantaged neighborhoods and had the unhealthiest lifestyle scores experienced the highest mortality. Disadvantaged neighborhood socioeconomic environments are associated with increased mortality in a cohort of individuals of low SES. Positive individual-level health behaviors may help negate the adverse effect of disadvantage on mortality.

Decomposition Analysis of Black-White Disparities in Birth Outcomes: The Relative Contribution of Air Pollution and Social Factors in California.

Background:Racial/ethnic disparities in preterm birth (PTB) are well documented in the epidemiological literature, but little is known about the relative contribution of different social and environmental determinants of such disparities in birth outcome. Furthermore, increased focus has recently turned toward modifiable aspects of the environment, including physical characteristics, such as neighborhood air pollution, to reduce disparities in birth outcomes.Objectives:To apply decomposition methods to understand disparities in preterm birth (PTB) prevalence between births of non-Hispanic black individuals and births of non-Hispanic white individuals in California, according to individual demographics, neighborhood socioeconomic environment, and neighborhood air pollution.Methods:We used all live singleton births in California spanning 2005 to 2010 and estimated PTBs and other adverse birth outcomes for infants borne by non-Hispanic black mothers and white mothers. To compare individual-level, neighborhood-level, and air pollution [Particulate Matter, 2.5 micrometers or less () and nitrogen dioxide ()] predictors, we conducted a nonlinear extension of the Blinder–Oaxaca method to decompose racial/ethnic disparities in PTB.Results:The predicted differences in probability of PTB between black and white infants was 0.056 (95% CI: 0.054, 0.058). All included predictors explained 37.8% of the black–white disparity. Overall, individual (17.5% for PTB) and neighborhood-level variables (16.1% for PTB) explained a greater proportion of the black–white difference in birth outcomes than air pollution (5.7% for PTB).Conclusions:Our results suggest that, although the role of individual and neighborhood factors remains prevailing in explaining black–white differences in birth outcomes, the individual contribution of is comparable in magnitude to any single individual- or neighborhood-level factor. https://doi.org/10.1289/EHP490