Poorest Census Tracts Research Articles

Predictions of household water affordability under conditions of climate change, demographic growth, and fresh groundwater depletion in a southwest US city indicate increasing burdens on the poor.

Reduced river flows and groundwater depletion as a result of climate change and population growth have increased the effort and difficulty accessing and processing water. In turn, residential water costs from municipal utilities are predicted to rise to unaffordable rates for poor residential water customers. Building on a regional conjunctive use model with future climate scenarios and 50-year future water supply plans, our study communicates the effects of climate change on poor people in El Paso, Texas, as water becomes more difficult and expensive to obtain in future years. Four scenarios for future water supply and future water costs were delineated based on expected impacts of climate change and groundwater depletion. Residential water use was calculated by census tract in El Paso, using basic needs indoor water use and evaporative cooling use as determinants of household water consumption. Based on household size and income data from the US Census, fraction of household income spent on water was determined. Results reveal that in the future, basic water supply will be a significant burden for 40% of all households in El Paso. Impacts are geographically concentrated in poor census tracts. Our study revealed that negative impacts from water resource depletion and increasing populations in El Paso will lead to costly and difficult water for El Paso water users. We provide an example of how to connect future resource scenarios, including those affected by climate change, to challenges of affordability for vulnerable consumers.

An antitrust framework for housing

This article contributes to debates within the financialization literature by examining the rise of monopolies in the US’ rental housing market. Drawing on a dataset of multifamily real estate transactions taken from the poorest census tracts in the US (so-called Opportunity Zones), we develop an antitrust framework and methodology for measuring market structure in housing using the Herfindahl-Hirschman Index. After detailing the geography of these market dynamics, we assess the specific strategies firms use to acquire market power and extract monopoly rents. This analysis reveals three critical aspects of real estate investors’ anticompetitive conduct: integration between housing subsectors, acquisition strategies that rapidly scale up ownership, and corporate forms that promote cooperation. The framework developed in this article and subsequent findings offer three directions policymakers, regulators, and activists can take to reform antitrust law and better ensure affordable housing.

241: Air pollution contributes to to spontaneous, but not medically-indicated, preterm birth risk

Air pollution (PM2.5) exposure has been shown to contribute to the risk of preterm birth (PTB) in some, but not all studies, potentially due to analyzing the heterogeneous outcome of all PTB as opposed to spontaneous (sPTB) or medically-indicated (mPTB). Our objective was to determine if PM2.5 were associated with sPTB and/or mPTB as these outcomes may have different drivers and hence different solutions. We manually reviewed all PTBs from a single center from April 2013 to October 2016 to designate each PTB as sPTB (preterm labor with cervical dilation or preterm premature rupture of membranes) or mPTB (e.g. preeclampsia, fetal growth restriction). We geocoded each woman’s residential address and assigned daily PM2.5 exposures based on a model that generates a 1x1km grid of estimates by integrating ground monitors and NASA satellite data. We calculated trimester averages and then dichotomized at the median. We then used multivariable generalized linear mixed effects models to account for spatial clustering by neighborhood-level demographics to analyze the odds of PTB, sPTB and mPTB (vs. term). Demographics are presented in Table 1. Black women were more likely to have PTB, sPTB and mPTB. Women living in poor census tracts with low levels of education were also more likely to have PTB. While the odds of PTB were higher with higher exposure to PM2.5 (aOR 1.16, 95% CI: 1.02-1.32), the effect was entirely driven by the association among sPTB (aOR 1.39, 95% CI 1.08-1.55) (Table 2). There was no association between PM2.5 exposure and mPTB (aOR 0.97, 95% CI 0.78-1.19). Air pollution was associated with sPTB but not mPTB in this urban single-center study. Careful phenotyping of PTB is critical in environmental studies where effects may be present in sPTB and not mPTB, thereby diluted when combining all PTB. Further efforts to reduce PTB may require identifying women at risk due to environmental exposures and interventions to mitigate them.

ACE, Place, Race, and Poverty: Building Hope for Children

Adverse childhood experiences research has focused attention on the importance of family safety, stability, and nurturing in ensuring healthy development. This safety, stability, and nurturing can be compromised by family poverty, discrimination and marginalization, and geographic location. Drawing upon census data, this report shows that place, race, and poverty are intertwined concepts with particular implications for young children. Examining census tracts according to their levels of poverty shows that the poorest census tracts also: 1) are the “richest” in the proportion of young children, 2) have the least realized social, physical, and educational, as well as economic capital, and 3) are highly racially segregated and separated from many sources of economic opportunity. The implications are that the country's poorest neighborhoods require substantially more supports for young children but currently have many fewer. This includes individual services to young children and their families but also publicly available services and voluntary supports, such as parks, playgrounds, and libraries. These data suggest that improving child health trajectories and reducing health disparities according to race and socioeconomic status therefore will require concerted individual service as well as community-building efforts directed to poor and usually racially segregated neighborhoods and communities.

Economic Disparities and Syphilis Incidence in Massachusetts, 2001-2013.

We used area-level indicators of poverty to describe economic disparities in the incidence rate of infectious syphilis in Massachusetts to (1) determine whether methods developed in earlier AIDS analyses in Massachusetts could be applied to syphilis and (2) characterize syphilis trends during a time of increased rates of syphilis incidence. Using census tract data and population counts from the US Census Bureau and Massachusetts data on syphilis, we analyzed the incidence rate of syphilis infection from 2001 to 2013 by the poverty level of the census tract in which people with syphilis resided, stratified by age, sex, and race/ethnicity. The syphilis incidence rate increased in all census tract groups in Massachusetts from 2001 to 2013, and disparities in incidence rates by area poverty level persisted over time. The overall incidence rate of syphilis increased 6.9-fold from 2001 to 2013 in all census tract poverty-level groupings (from 1.5 to 10.3 per 100 000 population), but the rise in rate was especially high in the poorest census tracts (from 5.6 to 31.0 per 100 000 population) and among men (from 2.2 to 19.4 per 100 000 population). The highest syphilis incidence rate was among non-Hispanic black people. The largest changes in incidence rate occurred after 2010. One region had a disproportionate increase in incidence rates and a disproportionate impact on the statewide trend. Census tract poverty analyses can inform the targeting of interventions that make progress toward reducing disparities in rates of syphilis incidence possible.

MP37-06 DELAYED TREATMENT OF HIGH-RISK PROSTATE CANCER PATIENTS: IMPACT OF SOCIOECONOMIC BARRIERS AND USE OF ADVANCED TECHNOLOGIES

INTRODUCTION AND OBJECTIVES: Though attention has been given to overtreatment of indolent prostate cancer, there has been less focus on potential undertreatment of men with high-risk tumors. To that end, we sought to characterize factors related to delayed or lack of treatment (DT) of high-risk prostate cancer patients, and to assess the impact on case volume and use of advanced technology on this outcome. METHODS: We identified patients with high-risk (i.e., Gleason 8+, PSA>20, cT3) localized (i.e., T1-3Nx-0Mx-0) prostate cancer in the National Cancer Database (2010-2012). Primary outcome was DT (i.e., no treatment within 6 months post-diagnosis). Exposures of interest were facility-level case volume (based on number of positive biopsies), robotic-assisted radical prostatectomy (RARP) volume, and intensitymodulated radiation therapy (IMRT) volume. Multivariable regression models, adjusted for clustering at the facility-level, estimated the association between facility volume factors (arranged in quartiles) and receipt of DT. The model adjusted for patient age, comorbidity, type of cancer center (academic vs comprehensive community vs community), and diagnosis year. Statistical tests were 2-sided and significant if p<0.05. RESULTS: Among 63439 prostate cancer patients with highrisk localized prostate tumors, 3690 (5.8%) received DT. Black patients (9.7% vs 4.9% White, OR 1.67, 95% CI 1.50-1.86), men with Medicaid or no insurance (12.6% vs 5% Private/HMO, OR 1.48, 95% CI 1.251.76), and those in the poorest census tracts (7.7% < $38,000 vs 5.2% $63,000+, OR 1.17, 95%CI: 1.02-1.34) were more likely to receive DT. Patients diagnosed at academic centers were more likely to receive DT (7.7% vs 5.7% community cancer centers, OR 1.48, 95% CI 1.06-2.08). Although facilities with the highest case volume had less delayed treatment (vs. lowest quartile, OR 0.35, 95% CI 0.23-0.52), centers with the highest RARP (OR 3.21, 95% CI 2.21-4.66) and IMRT volume (OR 1.45, 95% CI 1.15-1.83) had more frequent DT of high-risk prostate cancer patients. CONCLUSIONS: Black patients, underinsured men, and patients in the poorest census tracts were more likely to receive delayed treatment of high-risk prostate cancer, which may reflect impaired access to adequate cancer care. The unexpected finding of more delayed treatment at academic and high-volume RARP and IMRT centers may reflect barriers related to treatment capacity.

Racial differences in colorectal cancer survival in the Detroit Metropolitan area

Colorectal carcinoma is the second most common cause of cancer death with African Americans having lower survival compared with White Americans. The purpose of this study was to investigate the effect of demographics, clinical factors, and socioeconomic status (SES) on racial disparities in colorectal cancer survival in the Detroit Metropolitan Area. The study population included 9078 individuals with primary invasive colorectal cancer identified between 1988 and 1992 through the Surveillance, Epidemiology, and End Results (SEER) program. Demographics, clinical information, and survival were obtained through SEER. SES was categorized using occupation, educational level, and poverty status at the census tract level. Kaplan-Meier survival curves and Cox proportional hazards regression were used to compare overall survival by race. African Americans were more likely to be diagnosed with stage IV disease (P < .001), and to reside within poor census tracts (P < .001) compared with White Americans. Unadjusted analysis showed that African Americans had a significantly higher risk of death compared with their White American counterparts (hazards ratio [HR], 1.13; 95% confidence interval [CI], 1.07-1.20). After adjusting for age, marital status, sex, SES group, TNM stage, and treatment, race was no longer significantly associated with overall survival (HR, 1.00; 95% CI, 0.92-1.09). Similar results were seen with colorectal cancer-specific survival. Racial disparities in colorectal cancer survival dissipate after adjusting for other demographic and clinical factors. These results can potentially affect medical guidelines regarding screening and treatment, and possibly influence public health policies that can have a positive impact on equalizing racial differences in access to care.

Disparities in Urban Neighborhood Conditions: Evidence from GIS Measures and Field Observation in New York City

Although many low-income urban areas are highly walkable by conventional measures such as population density or land use mix, chronic diseases related to lack of physical activity are more common among residents of these areas. Disparities in neighborhood conditions may make poor areas less attractive environments for walking, offsetting the advantages of density and land use mix. This study compared poor and nonpoor neighborhoods in New York City, using geographic information systems measures constructed from public data for US census tracts within New York City (N=2,172) as well as field observation of a matched-pair sample of 76 block faces on commercial streets in poor and nonpoor neighborhoods. Poor census tracts had significantly fewer street trees, landmarked buildings, clean streets, and sidewalk cafes, and higher rates of felony complaints, narcotics arrests, and vehicular crashes. The field observation showed similar results. Improving aesthetic and safety conditions in poor neighborhoods may help reduce disparities in physical activity among urban residents.

Inner-City Neighborhoods and Metropolitan Development

This article describes the types of economic isolation that are embedded in various theories of neighborhood poverty. The literature suggests that there are a variety of reasons why inner-city areas are economically isolated. However, inadequate guidance is provided regarding whether poor neighborhoods will benefit from regional prosperity. Census data were examined to determine whether there is an association between changes in metropolitan economic welfare and changes in family income in poor census tracts. No association between the welfare indicators was found, supporting the economic-isolation hypothesis. The analysis of policies designed to strengthen ties between poor neighborhoods and metropolitan areas leads to the suggestion that connections be strengthened by supplementing the creation of economic linkages with broad-based social integration.

Evaluation of an Intervention to Increase Screening Colonoscopy in an Urban Public Hospital Setting

Only 50% of New Yorkers aged 50 and over reported ever being screened for colorectal cancer by any modality according to a recent household survey. The objective of this investigation was to assess the impact of a hospital-based intervention aimed at eliminating health care system barriers to timely colorectal cancer screening at Lincoln Medical Center, a large, urban public hospital in one of the nation's poorest census tracts. We conducted a retrospective analysis of all colonoscopies performed over an 11-month period, during which a multi-pronged intervention to increase the number of screening colonoscopies took place. Two "patient navigators" were hired during the study period to provide continuity for colonoscopy patients. A Direct Endoscopic Referral System (DERS) was also implemented. Enhancements to the gastrointestinal (GI) suite were also made to improve operational efficiency. Immediately following the introduction of the patient navigators, there was a dramatic and sustained decline in the broken appointment rates for both screening and diagnostic colonoscopy (from 67% in May of 2003 to 5% in June of 2003). The likelihood of keeping the appointment for colonoscopy after the patient navigator intervention increased by nearly 3-fold (relative risk = 2.6, 95% CI 2.2-3.0). The rate of screening colonoscopies increased from 56.8 per month to 119 per month. The screening colonoscopy coverage provided by this facility among persons aged 50 and over in surrounding Zip codes increased from 5.2 to 15.6% (RR 3.0, 95% CI 1.9-4.7). Efforts to increase the number of screening colonoscopies were highly successful, due in large part to the influence of patient navigators, a streamlined referral system, and GI suite enhancements. These findings suggest that there are significant health-care system barriers to colonoscopy that, when addressed, could have a significant impact on screening colonoscopy rates in the general population.

Occupational injuries in a poor inner-city population.

This study aims to characterize occupational injuries in a defined poor inner-city population in terms of demographic features, types, and circumstances of injuries, and medical and financial consequences. It is a case series drawn from a larger population-based injury registry in emergency departments that serve 17 poor census tracts in Philadelphia. Of 335 patients from the study area who had been treated at the emergency departments under study for occupational injuries, 107 could be contacted by telephone 2 to 3 years after their injuries. Interviews sought information on the patients, their employment, their injuries, and the consequences. Respondents were almost all African-American, approximately 50% male, and had a median age of 32. Approximately one third were employed in the health care industry, one fourth in the service sector (including conventional service firms, restaurants, and hotels), and the remainder in construction, retail and wholesale trade, education, transportation, and manufacturing. Major causes of injuries included overexertion, contact with sharp objects, and falls. Major types on injuries included sprain/strains and lacerations. Approximately half the respondents had missed more than 3 days of work, with 15% missing more than 1 month. Almost 40% of respondents reported persistent health problems after their injuries. Only about one quarter had received workers' compensation. We conclude that poor and minority workers are at risk of a wide range of occupational injuries, which may result in considerable lost work time and have serious medical and economic consequences. More, attention to the workplace risks of these relatively marginalized workers and more vigorous preventive interventions are needed.

THE INCIDENCE OF ACTIVE TUBERCULOSIS IN A LARGE URBAN AREA

The authors reviewed all cases of active tuberculosis newly reported to a population-based registry between 1970 and 1985 to compare a large urban area with the mostly rural remainder of the province of British Columbia, Canada. Although incidence rates have declined steadily in the rural area, they have not done so in the urban area. Within the urban area, there was a striking relation between tuberculosis incidence and socioeconomic level. Incidence rates in those born in Canada were observed to be higher for men than for women and higher for men who had never married than for those who had ever married, a difference no longer present within census tract groups. The greatest difference in incidence was between unemployed and employed men. Cases in the poorest census tracts more commonly had advanced, infectious pulmonary disease and were more likely to be alcoholics. The incidence of tuberculosis in the poorest census tracts did not decline as rapidly as in other areas. The characteristics of the disease in the poorest urban census tracts suggest the possibility of selective migration of persons at risk for tuberculosis and of continuing transmission of the disease and call for imaginative case-finding and treatment programs to address this problem.