Neighborhood Socioeconomic Position Research Articles

Childhood cancer and traffic-related air pollution in Switzerland: A nationwide census-based cohort study.

Motor vehicle exhaust is a major contributor to air pollution, and exposure to benzene or other carcinogenic components may increase cancer risks. We aimed to investigate the association between traffic-related air pollution and risk of childhood cancer in a nationwide cohort study in Switzerland. We identified incident cases from the Swiss Childhood Cancer Registry diagnosed<16years of age between 1990 and 2015 and linked them probabilistically with the census-based Swiss National Cohort study. We developed land use regression models to estimate annual mean ambient levels of nitrogen dioxide (NO2) and benzene outside 1.4 million children's homes. We used risk-set sampling to facilitate the analysis of time-varying exposure and fitted conditional logistic regression models adjusting for neighborhood socio-economic position, level of urbanization, and background ionizing radiation. We included 2,960 cancer cases in the analyses. The adjusted hazard ratios (HR) and 95% confidence intervals for exposure to NO2 per 10μg/m3 were 1.00 (95%-CI 0.88-1.13) for acute lymphoblastic leukemia (ALL) and 1.31 (95%-CI 1.00-1.71) for acute myeloid leukemia (AML). Using exposure lagged by 1 to 5years instead of current exposure attenuated the effect for AML. The adjusted HR for exposure to benzene per 1μg/m3 was 1.03 (95%-CI 0.86-1.23) for ALL and 1.29 (95%-CI 0.86-1.95) for AML. We also observed increased HRs for other diagnostic groups, notably non-Hodgkin lymphoma. Our study adds to the existing evidence that exposure to traffic-related air pollution is associated with an increased risk of childhood leukemia, particularly AML.

Inequities in the incidence and mortality due to COVID-19 in nursing homes in Barcelona by characteristics of the nursing homes.

BackgroundResidents of Nursing Homes (NHs) have suffered greater impacts from the COVID-19 pandemic. However, the rates of COVID-19 in these institutions are heterogeneously distributed. Describing and understanding the structural, functional, and socioeconomic differences between NHs is extremely important to avoid new outbreaks.ObjectivesAnalyze inequalities in the cumulative incidences (CIs) and in the mortality rates (MRs) due to COVID-19 in the NHs of Barcelona based on the characteristics of the NHs.MethodsExploratory ecological study of 232 NHs. The dependent variables were the cumulative incidence and mortality rate due to COVID-19 in NHs between March and June 2020. Structural variables of the NHs were evaluated such as neighborhood socioeconomic position (SEP), isolation and sectorization capacity, occupancy, overcrowding and ownership.ResultsThe cumulative incidence and mortality rate were higher in the low SEP neighborhoods and lower in those of high SEP neighborhoods. Regarding the isolation and sectorization capacity, Type B NHs had a higher risk of becoming infected and dying, while Type C had a lower risk of dying than Type A. Greater overcrowding was associated with greater morbidity and mortality, and higher occupancy was associated with higher incidence. The risk of becoming infected and dying in public NHs was significantly higher than for-profit NH.ConclusionsThe social components together with the functional and infrastructure characteristics of the NHs influence the cumulative incidence and the mortality rate by COVID-19. It is necessary to redefine the care model in the NHs to guarantee the health of the residents.

Cognitive Reserve Mediates the Relation between Neighborhood Socio-Economic Position and Cognitive Decline

Introduction: We investigated the mediating role of leisure activity engagement as marker of cognitive reserve in the relation between neighborhood socio-economic position (SEP) and cognitive decline over 6 years. Methods: The study analyzed longitudinal data from 897 older adults who participated in the two waves (2011 and 2017) of the Vivre-Leben-Vivere (VLV) survey in Switzerland (M = 74.33 years in the first wave). Trail Making Test parts A and B were administered in both waves. Leisure activity engagement was assessed during interviews. Neighborhood SEP was derived from the Swiss Neighborhood Index of Socio-Economic Position (Swiss-SEP), provided by the Swiss National Cohort (SNC). Results: Latent change score modeling revealed that 42.5% of the relationship between higher neighborhood SEP and smaller cognitive decline was mediated via a higher frequency of leisure activities in the first wave. Conclusion: Neighborhood SEP constitutes an important contextual factor potentially influencing the pathways of cognitive reserve accumulation and, therefore, should be taken into account to better understand their effects on cognitive decline in old age.

Placing a housing lens on neighbourhood disadvantage, socioeconomic position and mortality

Placing a housing lens on neighbourhood disadvantage, socioeconomic position and mortality

In Older Adults, Perceived Stress and Self-Efficacy Are Associated with Verbal Fluency, Reasoning, and Prospective Memory (Moderated by Socioeconomic Position).

Despite evidence that stress relates negatively to cognitive functioning in older adults, little is known how appraisal of stress and socioeconomic meso-level factors influence different types of cognitive functions in older adults. Here, we assess the relationship between perceived stress (PSS scale) and a battery of cognitive functions, including prospective memory in 1054 older adults (65+). A moderator analysis assessed whether this relationship varies with neighborhood socioeconomic status using an area-based measure of Socioeconomic Position (SEP). Perceived stress was associated with worse processing speed, verbal fluency, and inductive reasoning. The perceived self-efficacy subscale of the PSS is related to better performance in these measures. Higher self-efficacy was also associated with better prospective memory; this relationship was more pronounced for people with high neighborhood SEP. These findings indicate that not only do perceived stress and perceived self-efficacy relate to cognitive functioning in older age but also that neighborhood SEP is a moderator of this relationship.

Long-term exposure to objective and perceived residential greenness and diabetes mortality: A census-based cohort study

BackgroundResiding close to green spaces might reduce diabetes mellitus (DM) risk; however, evidence for diabetes mortality is limited. Moreover, individual and neighbourhood social factors may determine DM risk. Exposure to green spaces may also depend on socioeconomic position (SEP). This study examined the associations between residential greenness and diabetes-related mortality, and the role of the social environment in these associations. MethodsWe used the 2001 Belgian census linked to mortality register data for the period 2001–2014. We included individuals aged 40–79 years old and residing in the five largest Belgian urban areas at baseline. Exposure to residential greenness was assessed with surrounding greenness using the Normalized Difference Vegetation Index (NDVI) within 500-m of residence (objective indicator), and perceived neighbourhood greenness (subjective indicator). We conducted mixed-effects Cox proportional hazards models to obtain hazard ratios (HR) for diabetes-related mortality per interquartile range (IQR) increments of residential greenness. We assessed effect modification by social factors through stratification. ResultsFrom 2,309,236 individuals included at baseline, 1.2% died from DM during follow-up. Both residential greenness indicators were inversely associated with diabetes-related mortality after adjustment for individual social factors. After controlling for neighbourhood SEP, the beneficial association with surrounding greenness disappeared [HR 1.02 (95%CI:0.99,1.06)], but persisted with perceived neighbourhood greenness [HR 0.93 (95%CI:0.91,0.95)]. After stratification the inverse associations with perceived neighbourhood greenness were strongest for women, the lowest educated, and individuals residing in least deprived neighbourhoods. ConclusionsOur findings suggest that an overall positive perception of neighbourhood green spaces reduces independently the risk of diabetes-related mortality, regardless of the neighbourhood social environment. Nevertheless, neighbourhood SEP may be a strong confounder in the associations between diabetes-related mortality and greenness indicators derived from satellite images. Perception factors not captured by objective measurements of green spaces are potentially relevant in the association with DM, especially among disadvantaged groups.

Neighborhood Deprivation and Incident Alzheimer's Disease: A Regional Cohort Study of Electronic Medical Records

The prevalence of Alzheimer’s disease (AD) is anticipated to increase drastically. Neighborhood socioeconomic position (SEP) has been related to multiple processes of health. Understanding whether SEP is related to AD can inform who is at greatest risk of developing this disease. We analyzed electronic medical records of 394892 patients from the two largest health systems in Northeast Ohio to evaluate the relationship between Ohio Area Deprivation Index quintiles (defined at the census tract level) and hazard for a composite outcome of AD diagnosis or primary AD death. We included residents of Cuyahoga and neighboring counties, and used the first outpatient visit beyond age 60 occurring between 2005 and 2015 as study baseline. Outcome data were censored at the earlier of a) the beginning of any 3-year time period without visits or b) non-AD death. We estimated a Cox proportional hazards regression model, adjusting ADI quintile effects for the interaction between age at baseline, sex and race as well as birth year. We used quadratic terms for continuous predictors. After adjusting for these factors, ADI quintile was significantly related (χ2 = 83.0 on 4 d.f.; p < 0.0001) to the composite time-to-event outcome. Compared to the lowest-deprivation quintile, ADI quintiles 4 (adjusted hazard ratio [95% confidence interval]: 1.18 [1.10, 1.26]) and 5 (1.37 [1.28, 1.47]) had significantly higher hazard for the composite outcome. In conclusion, neighborhood deprivation may be a risk factor for AD independent of demographic factors. Preventive efforts should target individuals living in neighborhoods with high levels of deprivation.

Machine learning approaches to characterize the obesogenic urban exposome

BackgroundCharacteristics of the urban environment may contain upstream drivers of obesity. However, research is lacking that considers the combination of environmental factors simultaneously. ObjectivesWe aimed to explore what environmental factors of the urban exposome are related to body mass index (BMI), and evaluated the consistency of findings across multiple statistical approaches. MethodsA cross-sectional analysis was conducted using baseline data from 14,829 participants of the Occupational and Environmental Health Cohort study. BMI was obtained from self-reported height and weight. Geocoded exposures linked to individual home addresses (using 6-digit postcode) of 86 environmental factors were estimated, including air pollution, traffic noise, green-space, built environmental and neighborhood socio-demographic characteristics. Exposure-obesity associations were identified using the following approaches: sparse group Partial Least Squares, Bayesian Model Averaging, penalized regression using the Minimax Concave Penalty, Generalized Additive Model-based boosting Random Forest, Extreme Gradient Boosting, and Multiple Linear Regression, as the most conventional approach. The models were adjusted for individual socio-demographic variables. Environmental factors were ranked according to variable importance scores attributed by each approach and median ranks were calculated across these scores to identify the most consistent associations. ResultsThe most consistent environmental factors associated with BMI were the average neighborhood value of the homes, oxidative potential of particulate matter air pollution (OP), healthy food outlets in the neighborhood (5 km buffer), low-income neighborhoods, and one-person households in the neighborhood. Higher BMI levels were observed in low-income neighborhoods, with lower average house values, lower share of one-person households and smaller amount of healthy food retailers. Higher BMI levels were observed in low-income neighborhoods, with lower average house values, lower share of one-person households, smaller amounts of healthy food retailers and higher OP levels. Across the approaches, we observed consistent patterns of results based on model’s capacity to incorporate linear or nonlinear associations. DiscussionThe pluralistic analysis on environmental obesogens strengthens the existing evidence on the role of neighborhood socioeconomic position, urbanicity and air pollution.

External background ionizing radiation and childhood cancer: Update of a nationwide cohort analysis

BackgroundExposure to high doses of ionizing radiation is known to cause cancer. Exposure during childhood is associated with a greater excess relative risk for leukemia and tumors of the central nervous system (CNS) than exposure in later life. Cancer risks associated with low-dose exposure (<100 mSv) are uncertain. We previously investigated the association between the incidence of childhood cancer and levels of exposure to external background radiation from terrestrial gamma and cosmic rays in Switzerland using data from a nationwide census-based cohort study. Here, we provide an update of that study using an extended follow-up period and an improved exposure model. MethodsWe included all children 0–15 years of age registered in the Swiss national censuses 1990, 2000, and 2010–2015. We identified incident cancer cases during 1990–2016 using probabilistic record linkage with the Swiss Childhood Cancer Registry. Exposure to terrestrial and cosmic radiation at children's place of residence was estimated using geographic exposure models based on aerial spectrometric gamma-ray measurements. We estimated and included the contribution from 137Cs deposition after the Chernobyl accident. We created a nested case-control sample and fitted conditional logistic regression models adjusting for sex, year of birth, neighborhood socioeconomic position, and modelled outdoor NO2 concentration. We also estimated the population attributable fraction for childhood cancer due to external background radiation. ResultsWe included 3,401,113 children and identified 3,137 incident cases of cancer, including 951 leukemia, 495 lymphoma, and 701 CNS tumor cases. Median follow-up in the cohort was 6.0 years (interquartile range: 4.3–10.1) and median cumulative exposure since birth was 8.2 mSv (range: 0–31.2). Hazard ratios per 1 mSv increase in cumulative dose of external background radiation were 1.04 (95% CI: 1.01–1.06) for all cancers combined, 1.06 (1.01–1.10) for leukemia, 1.03 (0.98–1.08) for lymphoma, and 1.06 (1.01–1.11) for CNS tumors. Adjustment for potential confounders had little effect on the results. Based on these results, the estimated population attributable fraction for leukemia and CNS tumors due to external background radiation was 32% (7–49%) and 34% (5–51%), respectively. ConclusionsOur results suggest that background ionizing radiation contributes to the risk of leukemia and CNS tumors in children.

Individual and neighbourhood socioeconomic measures and the risk of non-central nervous system solid tumours in children: A nationwide register-based case-control study in Denmark

BackgroundThe aetiology for most solid tumours in childhood is largely unknown. The lack of evidence concerns also the relationship between socioeconomic position (SEP) and risk of childhood solid tumours other than in the central nervous system (CNS). We sought to access the association between individual and neighbourhood SEP measures and risk of childhood non-CNS solid tumours in Denmark and to evaluate whether associations varied by measure of SEP, time point of SEP assessment (during pregnancy versus before diagnosis) and tumour type. MethodsWe conducted a nationwide case-control study based on Danish registry data. We identified all children born in 1980–2013 and diagnosed with a non-CNS solid tumour at ages 0–19 years (N = 1961) from the Danish Cancer Registry and sampled four individually matched controls per case using the Population Registry. We fitted conditional logistic regression models to estimate associations with register-based individual-level and neighbourhood-level SEP measures. ResultsWe observed a tendency of increased odd ratios (OR) in association with medium and high maternal income for most tumour types (e.g. OR for the highest income quintile and malignant bone tumours = 2.11; 95 % CI: 1.01, 4.38) and for parental education in association with higher education for some tumour types. For malignant epithelial neoplasms, higher parental education and income level were overall associated with an increased risk, e.g. OR = 1.63 (95 % CI: 1.00, 2.65) for the fourth group of maternal income during pregnancy. We found no risk pattern for neighbourhood SEP. ConclusionThis large register-study with minimal risk of bias found a tendency of slightly to moderately increased risks for most childhood non-CNS solid tumours in association with higher maternal income and parental education. Future research examining the underlying mechanisms of these socioeconomic differences in non-CNS solid tumours as well as other childhood cancer types are warranted.

The ADI-3: a revised neighborhood risk index of the social determinants of health over time and place

Since its development, Singh’s 2003 Area Deprivation Index (ADI) has been routinely used by researchers to measure a global construct of neighborhood socioeconomic deprivation and to investigate how living in neighborhoods of different levels of socioeconomic deprivation affects individuals’ health. We empirically tested the ADI’s dimensionality, using 2013–2017 American Community Survey tract-level estimates (N = 73,056), and the stability of its performance across time and place. Factor analysis findings illuminated three distinct dimensions, the ADI-3, consisting of neighborhood financial strength, economic hardship and inequality, and educational attainment. The prior-assumed unidimensional ADI measure fails standard tests of construct validity. Findings from multigroup structural equation modeling across 2009 and 2017 and between New York and Minnesota suggest that the ADI performs with only partial stability across time and place. In order to most precisely understand the complex role of neighborhood socioeconomic position in health, public health researchers must integrate construct-valid and regionally and temporally relevant measures.

Trends in mortality among Black and White men with prostate cancer in Massachusetts and Pennsylvania: Race and neighborhood socioeconomic position.

Reducing disparities in men with prostate cancer (PCa) that may be caused by racial and socioeconomic differences is a major public health priority. Few reports have studied whether these disparities have changed over time. Men diagnosed with PCa from January 1, 2000 to December 31, 2015 were identified from the Massachusetts and Pennsylvania cancer registries. All-cause mortality and PCa and cardiovascular cause-specific mortality were assessed. To estimate neighborhood socioeconomic position (nSEP), a summary score was generated using census tract-level measures of income, wealth, educational attainment, and racial and income segregation. Participants were grouped by diagnosis year (2000-2003, 2004-2007, 2008-2011, or 2012-2015), and changing trends in the mortality rate ratio by race and nSEP were estimated using covariate-adjusted Cox models with follow-up for up to 10 years, until death, or until censoring on January 1, 2018. There were 193,883 patients with PCa and 43,661 deaths over 1,404,131 person-years of follow-up. The Black-White adjusted hazard ratio (aHR) from 2000 to 2003 through 2012 to 2015 was stable for all-cause mortality (aHR, 1.14 to 0.97; P for heterogeneity = .42), decreased for PCa-specific mortality (aHR, 1.38 to 0.93; P for heterogeneity = .005), and increased for cardiovascular mortality (aHR, 1.09 to 1.28; P for heterogeneity = .034). The aHR comparing those in the lowest versus the highest nSEP quintile increased significantly for all-cause mortality (aHR, 1.54 to 1.79; P for heterogeneity = .008), but not for PCa-specific mortality (aHR, 1.60 to 1.72; P for heterogeneity = .40) or cardiovascular mortality (aHR, 1.72 to 1.89; P for heterogeneity = .085). Although Black-White disparities in prostate mortality declined in Massachusetts and Pennsylvania over the study period, nSEP mortality disparity trends were stagnant or increased, warranting further attention. Few reports have examined whether racial and socioeconomic disparities in prostate cancer mortality have widened or narrowed in recent years. Using data from 2 state registries (Massachusetts and Pennsylvania) with differing intensities of government-mandated health insurance, trends in racial and neighborhood socioeconomic disparities were studied among Black and White men diagnosed from 2000 to 2015. Overall, trends in racial disparities were stagnant for all-cause mortality, shrank for prostate mortality, and widened for cardiovascular mortality. Disparities associated with neighborhood socioeconomic status either were stagnant or widened across all mortality end points. In general, disparities were more pronounced in Pennsylvania than in Massachusetts.

68415 Neural Impact of Neighborhood Disadvantage in Traumatically-Injured Adults: a Multi-Modal Investigation

ABSTRACT IMPACT: Neighborhood disadvantage was significantly associated with brain structure and function in trauma-exposed adults, providing evidence that contextual factors should be assessed in mental health research, particularly in high-risk populations. OBJECTIVES/GOALS: Over 13 percent of Americans live in a socioeconomically disadvantaged neighborhood. Previous work has linked lower individual socioeconomic position to alterations in brain structure and function. However, the neural effects of area-level socioeconomic factors, such as neighborhood disadvantage, are unclear. METHODS/STUDY POPULATION: We recruited two-hundred and fifteen traumatically-injured participants from an Emergency Department in southeastern Wisconsin. An Area Deprivation Index (ADI) score, a national measure of neighborhood socioeconomic disadvantage, was derived from each participant’s home address. Two-weeks post-trauma, participants underwent a battery of self-report measures and functional magnetic resonance imaging (fMRI) scans. Using a multi-modal approach, we investigated the impact of ADI on brain structure as well as neural activation during rest and during an emotional uncertainty task. We sought to disentangle the relationship between neighborhood and individual socioeconomic position and neural activity in the context of trauma. RESULTS/ANTICIPATED RESULTS: We demonstrated that neighborhood disadvantage is associated with decreased volume and alterations of resting state functional connectivity of structures implicated in affect processing, including the hippocampus, amygdala, and ventromedial prefrontal cortex. These results held even after controlling for relevant individual variables, including acute post-traumatic stress symptoms and years of education. Moreover, individuals from disadvantaged neighborhoods exhibited heighted activation of these same structures in response to aversive stimuli. Thus, brain regions critical for recognizing and processing negative stimuli are susceptible to the effects of area-level socioeconomic factors. DISCUSSION/SIGNIFICANCE OF FINDINGS: The results offer additional evidence that neurobiological mechanisms clarify how stress ‘gets under the skin’. Changes to key brain regions may explain why those living in disadvantaged neighborhoods are at a heighted risk of PTSD. Broadly, these findings should inform future policies and community-driven interventions aimed at reducing poverty.

Exploring neighborhood socioeconomic disparity in self-rated health: a multiple mediation analysis

There is still a need for more empirical investigations to better understand the causal pathways by which neighborhood socioeconomic contexts translate into states of health. This study explored the relationship between neighborhood socioeconomic position and health, as well as the role of social cohesion, violence, places to buy healthy food, and sports and leisure spaces in mediating this relationship in a diverse set of neighborhoods in Brazil. We applied a general multiple mediation approach to analyze a cross-sectional survey of 4.046 adults living in 149 neighborhoods in 2008 and 2009. The property value was chosen as an indicator of neighborhood socioeconomic position and self-rated health as the outcome. The four mediators were constructed from the self-perception of the participants. Results: We found that people living in economically advantaged neighborhoods were less likely to report their health as being fair/poor/very poor (OR = 0.71; 95% CI = 0.63, 0.76) than people living in disadvantaged neighborhoods, and this effect was mediated by the perception of violence in the neighborhoods. On average, 8.4% of the neighborhood socioeconomic disparity in self-rated health may be explained by violence. We did not ascertain as mediators social cohesion, places to buy healthy food, and sports and leisure spaces. Violence perception mediates the relationship between neighborhood socioeconomic position and self-rated health. Targeted interventions designed to improve the health status of the population could usefully focus on reducing the level of violence in which people live.

Socioeconomic Position and the Cascade From SARS-CoV-2 Testing to COVID-19 Mortality: Population-Based Analysis of Swiss Surveillance Data

Background: The inverse care law states that disadvantaged populations need more health care than advantaged populations but receive less. Gaps in COVID-19 related health care and infection control are not well understood at present. We examined inequalities in health in the care cascade from testing for SARS-CoV-2 to COVID-19-related hospitalisation, ICU admission and death in Switzerland, a wealthy country strongly affected by the pandemic.Methods: We analysed surveillance data reported to the Federal Office of Public Health from March 1, 2020 to April 16, 2021 and 2018 population data. We geocoded residential addresses of notifications to determine the Swiss neighbourhood index of socioeconomic position (Swiss-SEP). The index describes 1.27 million small neighbourhoods of about 50 households, based on rent per square meter, education and occupation of household heads, and crowding. We used negative binomial regression models to calculate incidence rate ratios (IRR) with 95% credible intervals [CrI] of the association between ten groups of the Swiss-SEP index defined by deciles (1=lowest, 10=highest) and outcomes. Models were adjusted for sex, age, canton and wave of the epidemic (before or after June 8, 2020). We used three different denominators: the general population, the number of tests, and the number of positive tests.Findings: Analyses were based on 4,129,636 tests, 609,782 positive tests, 26,143 hospitalisations, 2,432 ICU admissions, 9,383 deaths, and 8,221,406 residents. Comparing the highest with the lowest Swiss-SEP group, and using the general population as the denominator, more tests were performed among people living in neighbourhoods of highest socioeconomic position (adjusted IRR 1.18; 95%CrI 1.02-1.36). Among tested people, test positivity was lower (adjusted IRR 0.75; 0.69-0.81) in neighbourhoods of highest socioeconomic position. Among people testing positive, the corresponding IRRs for hospitalisation, ICU admission and death were 0.68 (0.62-0.74), 0.54 (0.43-0.70) and 0.86 (0.76-0.99). The associations between neighbourhood socioeconomic position and outcomes were stronger in younger age groups, and there was heterogeneity between areas.Interpretation: The inverse care law and socioeconomic inequalities are evident in Switzerland throughout the care cascade. People living in neighbourhoods of low socioeconomic position were less likely to be tested but more likely to test positive, be hospitalised, or die. It is essential to continue to monitor testing for SARS-CoV-2, access and uptake of COVID-19 vaccination and outcomes of COVID-19. Governments and health care systems should address this pandemic of inequality by taking measures to reduce health inequalities in response to the SARS-CoV-2 pandemic.Funding Information: Federal Office of Public Health, Swiss National Science Foundation (grant 189498), European Union Horizon 2020 (grant 101003688).Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: We conducted this research using surveillance data according to the Swiss law on communicable diseases (EpG, SR 818.101). No ethical approval was required.

Impact of Neighborhood Socioeconomic Status on Cardiovascular Risk Factors in a French Urban Population

Over the past decade, neighborhood deprivation suggested to play a significant role in the repartition of cardiovascular risk factors. We assessed the effect of neighborhood socioeconomic position on the main cardiovascular risk factors in a French urban population with a comprehensive and multidimensional indicator. Between 2010 and 2018, we studied cardiovascular risk factors in 7821 participants residing in Paris west suburb (CARVAR 92 cohort). Three neighborhood clusters of decreasing socioeconomic status were obtained after a hierarchical clustering analysis applied to eighteen measures of socioeconomic status. We used multivariate logistic models to estimate the association between neighborhood clusters and risk factors. Medium and low socioeconomic status were associated with higher risk of diabetes (OR = 1.63; 95%CI 1.23-2.15, OR = 3.28 95%CI 2.49-4.31, respectively) and obesity (OR = 1.42; 95%CI 1.23-1.64, OR = 2.23; 95%CI 1.92-2.58, respectively). High blood pressure and smoking intensity were also significantly associated with the most deprived neighborhoods (OR = 1.42; 95%CI 1.20-1.68, OR = 1.66; 95%CI 1.24-2.22, respectively) ( Fig. 1 ). Higher odds of diabetes and obesity were observed among the subgroup of females, especially in the lowest socioeconomic status neighborhoods (OR 3.85 95%CI 2.47-5.98, OR 2.55 95%CI 2.10-3.09, respectively), compared to those of males (OR = 2.81 95%CI 2.07-3.80, OR = 1.81 95%CI 1.43-2.30) ( Table 1 ). Even in a country owning universal welfare coverage such as France, neighborhoods socioeconomic status is still nowadays strongly associated with an uneven distribution of cardiovascular risk factors. Most affected risks factors are diabetes and obesity. Furthermore, deprivation seems to have a stronger negative effect on women.

Neighborhood Socioeconomic Position and Social Support in a Clinical Population of Older Adults

Models of successful aging underscore the critical role of external social resources in older adults’ health and well-being. Neighborhood socioeconomic position is known to influence health, but little is known about the linkages between neighborhood conditions, social relationships and health among older adults. We identified a cohort of 12,434 adults (aged 65+) who attended a Medicare Annual Wellness Visit from the NEOCARE Learning Health Registry. NEOCARE includes electronic health record (EHR) and neighborhood data from 1999-2017 on over 3 million unique Northeast Ohio individuals. The study population was 60% White, 32% Black or African American, 64% female, and 90% non-Hispanic. Over 60% were ages 65-74, 29% 75-84, and 10% 85 years or older (range from 65 to 101). We used ANOVA and chi square tests to examine variation in social support by quintile of the census tract area deprivation index. Compared to those in less disadvantaged neighborhoods, older adults in more disadvantaged neighborhoods were more likely to report needing help with care needs (Bonferroni-corrected x2=95.21, df=4, n=8,967, p<.001) but were less likely to report having help at home (x2=85.72, 4, n=12,354, p<.001). Similarly, adults in more disadvantaged neighborhoods reported less help available to them compared to those in more advantaged communities (F=39.31, df=4, n=12,099, p<.001). Furthermore, older adults living in more disadvantaged neighborhoods experienced significantly less functional independence (F=3.68, df=4 , n=8,571, p<.01). Our results suggest that the pathway from neighborhood socioeconomic conditions to successful aging includes perceived social needs and social support.

Neighborhood Disadvantage, Cognition, and Health Self-Efficacy of Older Adults in a Clinical Population

The Medicare Annual Wellness Visit (MWV) includes an assessment of health risks for older adults in the United States. Research suggests that neighborhood-level social inequality influences multiple health outcomes. We sought to examine the association between neighborhood socioeconomic position and older adults’ cognition, health management self-efficacy, and other health risks. We identified a cohort of 12,434 adults aged 65 and over from the NEOCARE Learning Health Registry who attended a routine MWV between 2011 and 2019. NEOCARE includes electronic health record and neighborhood data from 1999-2017 on over 3 million unique Northeast Ohio individuals. The study population was 60% White, 32% Black or African American, 64% female, and 90% non-Hispanic. Over 60% were ages 65-74, 29% 75-84, and 10% 85 years or older (range from 65 to 101). We used ANOVA and chi square tests to examine variation in health risks by quintile of census tract area deprivation index. Cognitive functioning differed across quintiles of area deprivation and Bonferroni-corrected tests indicated that adults in the most socioeconomically disadvantaged neighborhoods had lower average cognitive screening scores as compared to older adults in less disadvantaged areas (F=53.50, df=4, n=12,204, p<.001). The proportion of adults feeling efficacious in managing their health differed according to area deprivation, with adults in more disadvantaged neighborhoods having slightly lower self-efficacy, (x2=11.01, df=8, n=11,937, p<.001). Better understanding of the relationship between cognitive functioning and health self-efficacy and neighborhood environment is critical for designing programmatic and policy interventions aimed at supporting proactive aging in older adulthood.

Chronic neighborhood stressors can modify the effect of nitrogen dioxide on term birthweight in New York City

Urban air pollution exposures are associated with decreased newborn birthweight and developmental impairments, potentially with stronger impacts in communities of lower socioeconomic position (SEP). Here, we examined 28 community stressors - which vary with neighborhood SEP - as potential modifiers of the nitrogen dioxide (NO2)-birthweight association in New York City (NYC). We examined birth records data on 245,345 live births from 2007 to 2010 and administrative data on 28 social stressors aggregated to United Hospital Fund (UHF) areas (n = 34), categorized into quartiles. Residence-specific NO2 exposure concentrations, averaged over each pregnancy, were created using NYC Community Air Survey (NYCCAS) and daily EPA regulatory data. We applied linear mixed-effects modeling using UHF as a clustering variable and tested interactions between social factors and NO2. We observed an averaged 12.6-g (SE = 2.72) decrease in newborn birthweight per IQR increase in NO2 (IQR= 6.24 ppb). We also observed significant decrements in birthweight with higher stressor exposures (main effects), including significant decreases across quartiles for assault rates (p=.02 for trend across quartiles), child abuse (p=.02), murder (p=.007), robbery (p=.03), and perceived lack of safety (p=.02). Interaction analyses revealed weaker NO2-birthweight associations in areas with higher community stressors - including higher assault rates (p=.03), murder (p=.03), robbery (p=.04), or perceived lack of safety (p=.02). We found that birthweights in higher-pollution/higher-violence communities were substantially lower, on average, than in lower-pollution/lower-violence communities. These differences were driven, however, by strong direct associations between violence and birthweight; with very high violence exposures, impacts of pollution were dampened. Non-violent social stressors generally did not confer lower birthweights, nor did they substantially alter NO2 effects. Our results suggest complex interactions among stressors and pollutants, including potential saturation effects at the high end of violence exposures. Research in larger datasets and more flexible methods are needed to characterize non-linear interactions.

Transportation noise exposure and cardiovascular mortality: a 15-year analysis in Switzerland

Background: Transportation noise from road, rail and air traffic can be detrimental to health and wellbeing. Previous studies, including our own, have shown death from specific cardiovascular diseases (CVD) to be associated with these exposures. Now, with double the follow-up, integrated address history and transportation noise exposure data for multiple years corresponding to census decades, we conducted an extended analysis of the Swiss National Cohort. Methods: Mean noise exposure in 5-year periods was calculated, and three virtual sub-cohorts were defined (2000-2005, etc.) in addition to the full cohort (2000-2015). Multi-pollutant (Lden_road, Lden_rail, Lden_air), time dependent Cox proportional hazards models were applied to 3.8 mil adults (30-100 years old at 2000; age as timescale) and adjusted for sex, civil status, education, mother tongue, nationality, neighborhood socio-economic position and NO2 exposure. Results: During the 15-year follow-up, there were 249,000 CVD and 30,500 myocardial infarction deaths. In the full cohort, the relative risk for myocardial infarction mortality significantly increased by 4.1% [95% confidence interval: 2.6−5.6], 2.0% [0.9−3.1] and 3.2% [1.5−5.0] per 10 dB road traffic, railway and aircraft noise, respectively. CVD mortality was also significantly associated with road traffic noise (2.7% [2.2−3.2]) and railway noise (1.6% [1.2−2.0]) per 10 dB increase. Relative risks were remarkably consistent with our previous analyses with follow-up until 2008, and rather similar across the three virtual sub-cohorts indicating an absence of time trends for these associations. Conclusions: Cardiovascular effects of transportation noise may be modified by many factors such as building characteristics, window opening habits during the night and other lifestyle factors. For this reason, representative local data can be highly valuable for informing national noise limits aimed at protecting public health.