Neighborhood Sociodemographics and Change in Built Infrastructure

Systematic Review of Longitudinal Evidence and Methodologies for Research on Neighborhood Characteristics and Brain Health

Objective: Synthesize longitudinal research evaluating neighborhood environments and cognition to identify methodological approaches, findings, and gaps. Methods: Included studies evaluated associations between neighborhood and cognition longitudinally among adults >45 years (or mean age of 65 years) living in developed nations. We extracted data on sample characteristics, exposures, outcomes, methods, overall findings, and assessment of disparities. Results: Forty studies met our inclusion criteria. Most (65%) measured exposure only once and a majority focused on green space and/or blue space (water), neighborhood socioeconomic status, and recreation/physical activity facilities. Similarly, over half studied incident impairment, cognitive function or decline (70%), with one examining MRI (2.5%) or Alzheimer's disease (7.5%). While most studies used repeated measures analysis to evaluate changes in the brain health outcome (51%), many studies did not account for any type of correlation within neighborhoods (35%). Less than half evaluated effect modification by race/ethnicity, socioeconomic status, and/or sex/gender. Evidence was mixed and dependent on exposure or outcome assessed. Conclusion: Although longitudinal research evaluating neighborhood and cognitive decline has expanded, gaps remain in types of exposures, outcomes, analytic approaches, and sample diversity.

Neighborhood-Level Socioeconomic Status and Prescription Fill Patterns Among Patients With Heart Failure

Importance

Medication nonadherence is common among patients with heart failure with reduced ejection fraction (HFrEF) and can lead to increased hospitalization and mortality. Patients living in socioeconomically disadvantaged areas may be at greater risk for medication nonadherence due to barriers such as lower access to transportation or pharmacies.

Objective

To examine the association between neighborhood-level socioeconomic status (nSES) and medication nonadherence among patients with HFrEF and to assess the mediating roles of access to transportation, walkability, and pharmacy density.

Design, Setting, and Participants

This retrospective cohort study was conducted between June 30, 2020, and December 31, 2021, at a large health system based primarily in New York City and surrounding areas. Adult patients with a diagnosis of HF, reduced EF on echocardiogram, and a prescription of at least 1 guideline-directed medical therapy (GDMT) for HFrEF were included.

Exposure

Patient addresses were geocoded, and nSES was calculated using the Agency for Healthcare Research and Quality SES index, which combines census-tract level measures of poverty, rent burden, unemployment, crowding, home value, and education, with higher values indicating higher nSES.

Main Outcomes and Measures

Medication nonadherence was obtained through linkage of health record prescription data with pharmacy fill data and was defined as proportion of days covered (PDC) of less than 80% over 6 months, averaged across GDMT medications.

Results

Among 6247 patients, the mean (SD) age was 73 (14) years, and majority were male (4340 [69.5%]). There were 1011 (16.2%) Black participants, 735 (11.8%) Hispanic/Latinx participants, and 3929 (62.9%) White participants. Patients in lower nSES areas had higher rates of nonadherence, ranging from 51.7% in the lowest quartile (731 of 1086 participants) to 40.0% in the highest quartile (563 of 1086 participants) (P < .001). In adjusted analysis, patients living in the lower 2 nSES quartiles had significantly higher odds of nonadherence when compared with patients living in the highest nSES quartile (quartile 1: odds ratio [OR], 1.57 [95% CI, 1.35-1.83]; quartile 2: OR, 1.35 [95% CI, 1.16-1.56]). No mediation by access to transportation and pharmacy density was found, but a small amount of mediation by neighborhood walkability was observed.

Conclusions and Relevance

In this retrospective cohort study of patients with HFrEF, living in a lower nSES area was associated with higher rates of GDMT nonadherence. These findings highlight the importance of considering neighborhood-level disparities when developing approaches to improve medication adherence.

Neighborhood infrastructure-related risk factors and non-communicable diseases: a systematic meta-review

BACKGROUND

With rapid urbanization, the urban environment, especially the neighborhood environment, has received increasing global attention. However, a comprehensive overview of the association between neighborhood risk factors and human health remains unclear due to the large number of neighborhood risk factor-human health outcome pairs.

METHOD

On the basis of a whole year of panel discussions, we first obtained a list of 5 neighborhood domains, containing 33 uniformly defined neighborhood risk factors. We only focused on neighborhood infrastructure-related risk factors with the potential for spatial interventions through urban design tools. Subsequently, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic meta-review of 17 infrastructure-related risk factors of the 33 neighborhood risk factors (e.g., green and blue spaces, proximity to major roads, and proximity to landfills) was conducted using four databases, Web of Science, PubMed, OVID, and Cochrane Library, from January 2000 to May 2021, and corresponding evidence for non-communicable diseases (NCDs) was synthesized. The review quality was assessed according to the A MeaSurement Tool to Assess Systematic Reviews (AMSTAR) standard.

RESULTS

Thirty-three moderate-and high-quality reviews were included in the analysis. Thirteen major NCD outcomes were found to be associated with neighborhood infrastructure-related risk factors. Green and blue spaces or walkability had protective effects on human health. In contrast, proximity to major roads, industry, and landfills posed serious threats to human health. Inconsistent results were obtained for four neighborhood risk factors: facilities for physical and leisure activities, accessibility to infrastructure providing unhealthy food, proximity to industry, and proximity to major roads.

CONCLUSIONS

This meta-review presents a comprehensive overview of the effects of neighborhood infrastructure-related risk factors on NCDs. Findings on the risk factors with strong evidence can help improve healthy city guidelines and promote urban sustainability. In addition, the unknown or uncertain association between many neighborhood risk factors and certain types of NCDs requires further research.

Equity in temporary street closures: The case of London's Covid-19 'School Streets' schemes

School Streets are a street space reallocation scheme that has proliferated since the beginning of the Covid-19 pandemic in the UK, reducing motor traffic on streets outside many schools. Utilising a minimum-standards approach to equity, this paper examines the distribution of School Streets closures across social and environmental indicators of equity, and spatially across London's administrative geography. Using a multi-level regression analysis, we show that although School Streets have been equally distributed across several socio-demographic indicators, they are less likely to benefit schools in car-dominated areas of poor air quality, and their spatial distribution is highly unequal. This study presents an example of using environmental and spatial variables alongside more typical sociodemographic indicators in measuring the equity of school travel provision. For policymakers, the findings signal the need to implement complementary policies that can benefit schools with worse air quality, and to accelerate School Street implementation in slower districts.

Riding the wave: Predicting the use of the bike-sharing system in Barcelona before and during COVID-19

To simultaneously promote health, economic, and environmental sustainability, a number of cities worldwide have established bike-sharing systems (BSS) that complement the conventional public transport systems. As the rapid spread of COVID-19 becoming a global pandemic disrupted urban mobility due to government-imposed lockdowns and the heightened fear of infection in crowded spaces, populations were increasingly less likely to use public transportation and instead shifted toward alternative transport systems, including BSS. In this study, we use probabilistic machine learning in a quasi-experimental research design to identify how the relevance of a comprehensive set of factors to predict the use of Bicing (the BSS in Barcelona) may have changed as COVID-19 unfolded. We unpack the key factors in predicting the use of Bicing, uncovering evidence of increasing bike-related built infrastructure (e.g., tactical urbanism), trip distance, and the income levels of neighborhoods as the most relevant predictors. Moreover, we find that the relevance of the factors in predicting Bicing usage has generally decreased during the global pandemic, suggesting altered societal behavior. Our study enhances the understanding of BSS and societal behavior, which can have important implications for developing resilient programs for cities to adopt sustainable practices through transport policy, infrastructure planning, and urban development.

Mortality Implications of Increased Active Mobility for a Proposed Regional Transportation Emission Cap-and-Invest Program

The transportation sector is now the primary contributor to greenhouse gas emissions in the USA. The Transportation Climate Initiative (TCI), a partnership of 12 states and the District of Columbia currently under development, would implement a cap-and-invest program to reduce transportation sector emissions across the Northeast and Mid-Atlantic region, including substantial investment in cycling and pedestrian infrastructure. Using outputs from an investment scenario model and the World Health Organization Health Economic Assessment Tool methodology, we estimate the mortality implications of increased active mobility and their monetized value for three different investment allocation scenarios considered by TCI policymakers. We conduct these analyses for all 378 counties in the TCI region. We find that even for the scenario with the smallest investment in active mobility, when it is fully implemented, TCI would result in hundreds of fewer deaths per year across the region, with monetized benefits in the billions of dollars annually. Under all scenarios considered, the monetized benefits from deaths avoided substantially exceed the direct infrastructure costs of investment. We conclude that investing proceeds in active mobility infrastructure is a cost-effective way of reducing mortality, especially in urban areas, providing a strong motivation for investment in modernization of the transportation system and further evidence of the health co-benefits of climate action.

Business Data Categorization and Refinement for Application in Longitudinal Neighborhood Health Research: a Methodology

Retail environments, such as healthcare locations, food stores, and recreation facilities, may be relevant to many health behaviors and outcomes. However, minimal guidance on how to collect, process, aggregate, and link these data results in inconsistent or incomplete measurement that can introduce misclassification bias and limit replication of existing research. We describe the following steps to leverage business data for longitudinal neighborhood health research: re-geolocating establishment addresses, preliminary classification using standard industrial codes, systematic checks to refine classifications, incorporation and integration of complementary data sources, documentation of a flexible hierarchical classification system and variable naming conventions, and linking to neighborhoods and participant residences. We show results of this classification from a dataset of locations (over 77 million establishment locations) across the contiguous U.S. from 1990 to 2014. By incorporating complementary data sources, through manual spot checks in Google StreetView and word and name searches, we enhanced a basic classification using only standard industrial codes. Ultimately, providing these enhanced longitudinal data and supplying detailed methods for researchers to replicate our work promotes consistency, replicability, and new opportunities in neighborhood health research.

National Trends in the Prevalence of Chronic Kidney Disease Among Racial/Ethnic and Socioeconomic Status Groups, 1988-2016

IMPORTANCE

The overall prevalence of chronic kidney disease (CKD) has stabilized in the United States in recent years. However, it is unclear whether all major sociodemographic groups experienced this trend.

OBJECTIVE

To examine trends in CKD prevalence across major sociodemographic groups as defined by race/ethnicity and socioeconomic status.

DESIGN, SETTING, AND PARTICIPANTS

This repeated cross-sectional study used data from the National Health and Nutrition Examination Surveys for 1988 to 1994 and every 2 years from 1999 to 2016 on individuals 20 years or older with information on race/ethnicity, socioeconomic status, and serum creatinine levels. Statistical analysis was conducted from May 1, 2017, to April 6, 2020.

EXPOSURES

Race/ethnicity and socioeconomic status.

MAIN OUTCOMES AND MEASURES

Prevalence of CKD was defined as an estimated glomerular filtration rate of 15 to 59 mL/min/1.73 m2.

RESULTS

A total of 54 554 participants (mean [SE] age, 46.2 [0.2] years; 51.7% female) were examined. The age-, sex- and race/ethnicity-adjusted overall prevalence of stage 3 and 4 CKD increased from 3.9% in 1988-1994 to 5.2% in 2003-2004 (difference, 1.3%; 95% CI, 0.9%-1.7%; P < .001 for change) and remained relatively stable thereafter at 5.1% in 2015-2016 (difference, -0.1%; 95% CI, -0.7% to 0.4%; P = .61 for change). The trend in adjusted CKD prevalence differed significantly by race/ethnicity (P = .009 for interaction). In non-Hispanic white and non-Hispanic black persons, CKD prevalence increased between 1988-1994 and 2003-2004 and remained stable thereafter. Among Mexican American persons, CKD prevalence was lower than in other racial/ethnic groups and remained stable between 1988-1994 and 2003-2004 but nearly doubled (difference, 2.1%; 95% CI, 0.9%-3.3%; P = .001 for change) between 2003-2004 and 2015-2016 to rates similar to those in other racial/ethnic groups. There were higher rates of CKD prevalence among groups with lower educational level and income (eg, 5.8% vs 4.3% and 4.3% vs 3.1% in low vs high education and income, respectively, in 1988-1994), but trends in CKD prevalence mirrored those for the overall population. The higher CKD prevalence among individuals with lower educational level and income remained largely consistent throughout the entire period. Results were similar in most subgroups when including albuminuria to define CKD.

CONCLUSIONS AND RELEVANCE

The prevalence of CKD in the United States has stabilized overall in recent years but has increased among Mexican American persons. More important, gaps in CKD prevalence across racial/ethnic groups and levels of socioeconomic status largely persisted over 28 years. There is a need to identify and address causes of increasing CKD prevalence among Mexican American persons and a need to renew efforts to effectively mitigate persistent disparities in CKD prevalence.

Connecting Air Quality with Emotional Well-Being and Neighborhood Infrastructure in a US City

Cities in the United States have announced initiatives to become more sustainable, healthy, resilient, livable, and environmentally friendly. However, indicators for measuring all outcomes related to these targets and the synergies between them have not been well defined or studied. One such relationship is the linkage between air quality with emotional well-being (EWB) and neighborhood infrastructure. Here, regulatory monitoring, low-cost sensors (LCSs), and air quality modeling were combined to assess exposures to PM2.5 and traffic-related NOx in 6 Minneapolis, MN, neighborhoods of varying infrastructure parameters (median household income, urban vs suburban, and access to light rail). Residents of the study neighborhoods concurrently took real-time EWB assessments using a smart phone application, Daynamica, to gauge happiness, tiredness, stress, sadness, and pain. Both LCS PM2.5 observations and mobile-source-simulated NOx were calibrated using regulatory observations in Minneapolis. No statistically significant (α = 0.05) PM2.5 differences were found between urban poor and urban middle-income neighborhoods, but average mobile-source NOx was statistically significantly (α = 0.05) higher in the 4 urban neighborhoods than in the 2 suburban neighborhoods. Close proximity to light rail had no observable impact on average observed PM2.5 or simulated mobile-source NOx. Home-based exposure assessments found that PM2.5 was negatively correlated with positive emotions such as happiness and to net affect (the sum of positive and negative emotion scores) and positively correlated (ie, a higher PM2.5 concentration led to higher scores) for negative emotions such as tiredness, stress, sadness, and pain. Simulated mobile-source NOx, assessed from both home-based exposures and in situ exposures, had a near-zero relationship with all EWB indicators. This was attributed to low NOx levels throughout the study neighborhoods and at locations were the EWB-assessed activities took place, both owing to low on-road mobile-source NOx impacts. Although none of the air quality and EWB responses were determined to be statistically significant (α = 0.05), due in part to the relatively small sample size, the results are suggestive of linkages between air quality and a variety of EWB outcomes.

Ten-Year Change in Neighborhood Socioeconomic Deprivation and Rates of Total, Cardiovascular Disease, and Cancer Mortality in Older US Adults

Low neighborhood socioeconomic status has been linked to adverse health outcomes. However, it is unclear whether changing the neighborhood may influence health. We examined 10-year change in neighborhood socioeconomic deprivation in relation to mortality rate among 288,555 participants aged 51-70 years who enrolled in the National Institutes of Health-AARP Diet and Health Study in 1995-1996 (baseline) and did not move during the study. Changes in neighborhood socioeconomic deprivation between 1990 and 2000 were measured by US Census data at the census tract level. All-cause, cardiovascular disease, and cancer deaths were ascertained through annual linkage to the Social Security Administration Death Master File between 2000 and 2011. Overall, our results suggested that improvement in neighborhood socioeconomic status was associated with a lower mortality rate, while deterioration was associated with a higher mortality rate. More specially, a 30-percentile-point reduction in neighborhood deprivation among more deprived neighborhoods was associated with 11% and 19% reductions in the total mortality rate among men and women, respectively. On the other hand, a 30-point increase in neighborhood deprivation in less deprived neighborhoods was associated with an 11% increase in the mortality rate among men. Our findings support a longitudinal association between changing neighborhood conditions and mortality.

Physical Activity in Older Mexican Americans Living in Two Cities on the U.S.-Mexico Border

BACKGROUND

There is limited information on physical activity in marginalized older populations like that on the U.S.-Mexico border. This study aims to understand physical activity engagement among older Hispanics residing in two U.S.-Mexico Border counties.

METHODS

The International Physical Activity Questionnaire (IPAQ) was used to measure physical activity in El Paso and Cameron County, Texas. Physical activity levels were reported for vigorous, moderate, and walking met/mins. Adjusted and unadjusted modeling was conducted to determine county differences and sociodemographic covariates.

RESULTS

There were 784 participants and 92.9% were less than 65 years of age. El Paso participants reported a significantly greater natural log met/mins of vigorous (β = 1.34, p = 0.000) and walking (β = 0.331, p = 0.006). Significant sociodemographic covariates in El Paso for vigorous met/mins were gender (females β = -1.20, p = 0.003), having a regular doctor (β = -0.779, p = 0.029), and acculturation (β = 0.513, p = 0.019). Significant associations in Cameron County were having a regular doctor (β = -1.03, p = 0.000) and fair/poor health status (β = -0.475, p = 0.001).

CONCLUSION

Level of physical activity may differ in older Hispanics by urban context on the U.S.-Mexico border. Future physical activity programs to promote physical activity should take context into consideration.

The development of a participatory assessment technique for infrastructure: Neighborhood-level monitoring towards sustainable infrastructure systems

Climate change and increasing natural disasters coupled with years of deferred maintenance have added pressure to infrastructure in urban areas. Thus, monitoring for failure of these systems is crucial to prevent future impacts to life and property. Participatory assessment technique for infrastructure provides a community-based approach to assess the capacity and physical condition of infrastructure. Furthermore, a participatory assessment technique for infrastructure can encourage grassroots activism that engages residents, researchers, and planners in the identification of sustainable development concerns and solutions. As climate change impacts disproportionately affect historically disenfranchised communities, assessment data can further inform planning, aiming to balance the distribution of public resources towards sustainability and justice. This paper explains the development of the participatory assessment technique for infrastructure that can provide empirical data about the condition of infrastructure at the neighborhood-level, using stormwater systems in a vulnerable neighborhood in Houston, Texas as a case study. This paper argues for the opportunity of participatory methods to address needs in infrastructure assessment and describes the ongoing project testing the best use of these methods.

Leveling the Landscape: Landscape Performance as a Green Infrastructure Evaluation Tool for Service-Learning Products

As part of the ongoing recovery from catastrophic flooding associated with Hurricanes Harvey and Florence, communities along the U.S. Atlantic and Gulf Coasts must plan for adaptations that integrate resilience into the redevelopment of community spaces. In designing resilient community spaces, particular consideration must be paid to socially vulnerable communities. Community visioning and neighborhood-scaled design is the first step in the development process. However, it can be a hurdle for communities that lack the capacity to conduct and evaluate such work collaboratively. Service-learning projects implemented through university-community partnerships can help communities increase resilience by developing master plans. The products generated through service-learning projects often conclude at the conceptual level, with no evaluation of the feasibility of their implementation. This study examines the use of landscape performance models in evaluating proposed master plan parameters. It is situated in Manchester, a community in Houston that is physically and socially vulnerable to flooding. Findings demonstrate that landscape performance models can objectively evaluate the costs and performance measures of service-learning products rooted in local conditions and community feedback.

Participatory Action Research: Tools for Disaster Resilience Education

PURPOSE

Participatory action research can improve scientific knowledge and community capacity to address disaster resilience and environmental justice. Evidence from the literature suggests that resident participation enhances assessment of environmental risks, raises awareness, and empowers residents to fight for equitable distribution of hazard and climate risk adaptations. Yet, risk assessment and urban planning processes still frequently operate within expertise-driven groups without significant community engagement. Such fragmentation results in part from a lack of appreciation for community expertise in built environment adaptations and educational tools to support resident involvement in the often technical built environment planning processes.

APPROACH

A participatory research and place-based education project was developed that enhanced co-learning between residents and researchers while collecting and analyzing local data on flood resilience in the built environment. Five research activities constitute the curriculum of resilience education on stormwater infrastructure: 1) establishment of partnership agreement/MOU, 2) participatory GIS to identify flooding issues, 3) water quality testing and health survey, 4) stormwater infrastructure assessment, and 5) urban/landscape design. Partners included high school and college students, residents, and environmental justice organizations.

FINDINGS

Outcomes include a stakeholder approved infrastructure assessment smartphone application, neighborhood maps of drainage issues, a report of water containments, and neighborhood-scaled green infrastructure provisions and growth plans. Findings indicate that participatory research positively contributed to resilience knowledge of participants.

VALUE

This paper outlines an interdisciplinary pedagogical strategy for resilience planning that engages residents to assess and monitor the performance of stormwater infrastructure and create resilience plans. The paper also discusses challenges and opportunities for similar participatory projects.