Visual cues of the built environment and perceived stress among a cohort of black breast cancer survivors

Using street view imagery to examine the association between urban neighborhood disorder and the long-term recurrence risk of patients discharged with acute myocardial infarction in central Beijing, China

Background

To examine the association between urban neighborhood disorder and the recurrence risk of patients with acute myocardial infarction (AMI) in central Beijing, China.

Methods

Recurrent AMI was identified by the Beijing Monitoring System for Cardiovascular Diseases through the end of 2019 for patients discharged with AMI between 2007 and 2017. Cox proportional hazards models were performed to estimate associations between neighborhood disorder and AMI recurrence.

Results

Of 66,238 AMI patients, 11,872 had a recurrent event, and 3117 died from AMI during a median followup of 5.92 years. After covariate adjustment, AMI patients living in the high tertile of neighborhood disorder had a higher recurrence risk (hazard ratio [HR] 1.08, 95 % confidence interval [CI], 1.03-1.14) compared with those in the low tertile. A stronger association was noted for fatal recurrent AMI (HR 1.21, 95 % CI 1.10-1.34). The association was mainly observed in females (HR 1.04, 95 % CI: 1.02 to 1.06).

Conclusions

Serious neighborhood disorder may contribute to higher recurrence risk, particularly fatal recurrence, among AMI patients. Policies to eliminate neighborhood disorders may play an important role in the secondary prevention of cardiovascular disease.

Government drivers of breast cancer prevention: A spatiotemporal analysis based on the association between breast cancer and macro factors

Background

Currently, breast cancer (BC) is ranked among the top malignant tumors in the world, and has attracted widespread attention. Compared with the traditional analysis on biological determinants of BC, this study focused on macro factors, including light at night (LAN), PM2.5, per capita consumption expenditure, economic density, population density, and number of medical beds, to provide targets for the government to implement BC interventions.

Methods

A total of 182 prefecture-level cities in China from 2013 to 2016 were selected as the sample of the study. The geographically and temporally weighted regression (GTWR) model was adopted to describe the spatiotemporal correlation between the scale of BC and macro factors.

Results

The results showed that the GTWR model can better reveal the spatiotemporal variation. In the temporal dimension, the fluctuations of the regression coefficients of each variable were significant. In the spatial dimension, the positive impacts of LAN, per capita consumption expenditure, population density and number of medical beds gradually increased from west to east, and the positive coefficient of PM2.5 gradually increased from north to south. The negative impact of economic density gradually increased from west to east.

Conclusion

The fact that the degree of effect of each variable fluctuates over time reminds the government to pay continuous attention to BC prevention. The spatial heterogeneity features also urge the government to focus on different macro indicators in eastern and western China or southern and northern China. In other words, our research helps drive the government to center on key regions and take targeted measures to curb the rapid growth of BC.

Pathways between objective and perceived neighborhood factors among Black breast cancer survivors

BACKGROUND

Mounting evidence supports associations between objective neighborhood disorder, perceived neighborhood disorder, and health, yet alternative explanations involving socioeconomic and neighborhood social cohesion have been understudied. We tested pathways between objective and perceived neighborhood disorder, perceived neighborhood social cohesion, and socioeconomic factors within a longitudinal cohort.

METHODS

Demographic and socioeconomic information before diagnosis was obtained at interviews conducted approximately 10 months post-diagnosis from participants in the Women's Circle of Health Follow-up Study - a cohort of breast cancer survivors self-identifying as African American or Black women (n = 310). Neighborhood perceptions were obtained during follow-up interviews conducted approximately 24 months after diagnosis. Objective neighborhood disorder was from 9 items audited across 23,276 locations using Google Street View and scored to estimate disorder values at each participant's residential address at diagnosis. Census tract socioeconomic and demographic composition covariates were from the 2010 U.S. Census and American Community Survey. Pathways to perceived neighborhood disorder were built using structural equation modelling. Model fit was assessed from the comparative fit index and root mean square error approximation and associations were reported as standardized coefficients and 95% confidence intervals.

RESULTS

Higher perceived neighborhood disorder was associated with higher objective neighborhood disorder (β = 0.20, 95% CI: 0.06, 0.33), lower neighborhood social cohesion, and lower individual-level socioeconomic factors (final model root mean square error approximation 0.043 (90% CI: 0.013, 0.068)). Perceived neighborhood social cohesion was associated with individual-level socioeconomic factors and objective neighborhood disorder (β = - 0.11, 95% CI: - 0.24, 0.02).

CONCLUSION

Objective neighborhood disorder might be related to perceived disorder directly and indirectly through perceptions of neighborhood social cohesion.

Associations between neighborhood disinvestment and breast cancer outcomes within a populous state registry

BACKGROUND

Breast cancer (BrCa) outcomes vary by social environmental factors, but the role of built-environment factors is understudied. The authors investigated associations between environmental physical disorder-indicators of residential disrepair and disinvestment-and BrCa tumor prognostic factors (stage at diagnosis, tumor grade, triple-negative [negative for estrogen receptor, progesterone receptor, and HER2 receptor] BrCa) and survival within a large state cancer registry linkage.

METHODS

Data on sociodemographic, tumor, and vital status were derived from adult women who had invasive BrCa diagnosed from 2008 to 2017 ascertained from the New Jersey State Cancer Registry. Physical disorder was assessed through virtual neighborhood audits of 23,276 locations across New Jersey, and a personalized measure for the residential address of each woman with BrCa was estimated using universal kriging. Continuous covariates were z scored (mean ± standard deviation [SD], 0 ± 1) to reduce collinearity. Logistic regression models of tumor factors and accelerated failure time models of survival time to BrCa-specific death were built to investigate associations with physical disorder adjusted for covariates (with follow-up through 2019).

RESULTS

There were 3637 BrCa-specific deaths among 40,963 women with a median follow-up of 5.3 years. In adjusted models, a 1-SD increase in physical disorder was associated with higher odds of late-stage BrCa (odds ratio, 1.09; 95% confidence interval, 1.02-1.15). Physical disorder was not associated with tumor grade or triple-negative tumors. A 1-SD increase in physical disorder was associated with a 10.5% shorter survival time (95% confidence interval, 6.1%-14.6%) only among women who had early stage BrCa.

CONCLUSIONS

Physical disorder is associated with worse tumor prognostic factors and survival among women who have BrCa diagnosed at an early stage.

Neighborhood Characteristics and Cancer Survivorship: An Overview of the Current Literature on Neighborhood Landscapes and Cancer Care

There is a growing literature on the association between neighborhood contexts and cancer survivorship. To understand the current trends and the gaps in the literature, we aimed to answer the following questions: To what degree, and how, has cancer survivorship research accounted for neighborhood-level effects? What neighborhood metrics have been used to operationalize neighborhood factors? To what degree do the neighborhood level metrics considered in cancer research reflect neighborhood development as identified in the Leadership for Energy and Environmental Design for Neighborhood Development (LEED-ND) guidelines? We first conducted a review guided by PRISMA extension for scoping review of the extant literature on neighborhood effects and cancer survivorship outcomes from January 2000 to January 2021. Second, we categorized the studied neighborhood metrics under six main themes. Third, we assessed the findings based on the LEED-ND guidelines to identify the most relevant neighborhood metrics in association with areas of focus in cancer survivorship care and research. The search results were scoped to 291 relevant peer-reviewed journal articles. Results show that survivorship disparities, primary care, and weight management are the main themes in the literature. Additionally, most articles rely on neighborhood SES as the primary (or only) examined neighborhood level metric. We argue that the expansion of interdisciplinary research to include neighborhood metrics endorsed by current paradigms in salutogenic urban design can enhance the understanding of the role of socioecological context in survivorship care and outcomes.