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Fleming T, Boyd J, Gagnon M, Kerr T, McNeil R. Using drugs alone in single room occupancy housing: Understanding environmental drivers of overdose risk. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104444. [PMID: 38754243 DOI: 10.1016/j.drugpo.2024.104444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/02/2024] [Accepted: 04/23/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Across North America most overdose deaths occur in housing, largely due to individuals using drugs alone. In cities, fatalities are disproportionately concentrated in low-income housing, including single room occupancy (SRO) housing. While research has highlighted how SROs operate as risk environments for various poor outcomes, there has been little attention to specific drug use practices (i.e., using alone) associated with overdose vulnerability in these spaces. This study explores how environmental contexts of SROs shape overdose risks, with specific attention to practices of using drugs alone. METHODS In-depth semi-structured interviews were conducted with 30 people who use drugs (PWUD) living in Vancouver SROs. Interviews covered topics such as social-structural environments of housing, drug use practices, and housing-based harm reduction. Thematic analysis drew on the intersectional risk environment framework. RESULTS Narratives positioned SROs as extensions of public space, with similar expectations of risks and behaviours as in public spaces. For some participants, using alone in their room was characterized as a practice in claiming privacy within the context of a public existence. Participants highlighted how certain features of SRO's social-structural environments were routinely leveraged against them (e.g., security cameras, staff surveillance), suggesting using alone as a tactic to minimize risks of hyper-surveillance and punitive policies. Further, participants discussed using alone as "safer," describing how this practice mitigated place-based risks of social-structural harms (e.g., violence, criminalization) in ways that eclipsed overdose risk. CONCLUSION Using drugs alone may be understood as a spatial negotiation of vulnerability to diverse harms produced by environmental contexts of SROs. Interventions accounting for broader contextual factors (e.g., improvements housing quality/quantity, providing a safer supply of drugs) that render using alone as instrumental to survival, and that reduce the implicit threat of punishment from intensive surveillance and control practices are critical to reduce vulnerability to overdose and other harms.
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Affiliation(s)
- Taylor Fleming
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC V6T 1Z4, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Marilou Gagnon
- School of Nursing, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2, Canada; Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Avenue, Victoria, BC V8N 5M8, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, Yale School of Medicine, 367 Cedar Street, New Haven, CT 10001, USA; Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, New Haven, CT 10001, USA.
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Samarin M, Sharma M. A typology of U.S. metropolises by rent burden and its major drivers. GEOJOURNAL 2023; 88:1-20. [PMID: 37361707 PMCID: PMC10241606 DOI: 10.1007/s10708-023-10898-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/28/2023]
Abstract
Scholarly work on rent burden, a rather scantily discussed topic within the broader realm of declining housing affordability, still lacks a firm theory. This article seeks to address this gap by developing a typology of U.S. metropolises which centers on their rent burden status and serves as an initial step toward theory building. We employ principal component and cluster analyses to identify seven distinct types of metropolises and their potential drivers of rent burden. An examination of these seven types suggests that rent burden has spatial randomness to it, since some metropolises in the seven types do not confine to specific geographies. Metropolises with pronounced specializations in education/medicine, information, and arts, recreation, and entertainment exhibit higher rent burden, whereas older Rust Belt metropolises have lower burden. Interestingly, emerging new-economy metropolises exhibit lower rent burden as well, likely reflecting the benefits of newer housing and a diverse economic base. Finally, rent burden, besides being an outcome of the housing demand/supply mismatch, is also a manifestation of income potentials that are affected in complex ways by local labor markets and regional economic specializations.
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Affiliation(s)
- Mikhail Samarin
- Department of Geography and Sustainability, University of Tennessee, 304 Burchfiel Geography Building, 1000 Phillip Fulmer Way, Knoxville, TN 37996 USA
| | - Madhuri Sharma
- Department of Geography and Sustainability, University of Tennessee, 304 Burchfiel Geography Building, 1000 Phillip Fulmer Way, Knoxville, TN 37996 USA
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Baid D, Yun B, Zang E. Explaining the higher COVID-19 mortality rates among disproportionately Black counties: A decomposition analysis. SSM Popul Health 2023; 22:101360. [PMID: 36785652 PMCID: PMC9908585 DOI: 10.1016/j.ssmph.2023.101360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Background Why is COVID-19 mortality higher in counties with a disproportionately large (>13.4%) share of Black residents (hereafter "Black counties") relative to others ("non-Black counties")? Existing literature points to six categories of determinants: (1) social distancing, (2) COVID-19 testing, (3) socioeconomic characteristics, (4) environmental characteristics, (5) prevalence of (pre-existing) chronic health conditions, and (6) demographic characteristics. The relative importance of these determinants has not yet been thoroughly examined. Methods We built a dataset consisting of 21 sub-indicators across the six categories of determinants for 3108 US counties and their COVID-19 mortality over the period of January 22, 2020-December 31, 2020. Applying the Gelbach's decomposition, we quantified which determinants were most (or least) associated with the COVID-19 mortality disparity between Black and non-Black counties. Results We find that COVID-19 death rates were 26 percent higher in Black counties compared to non-Black counties. This disparity was almost completely explained by the six categories of determinants included in our model. Decomposition analyses indicate that county-level demographic and population health characteristics explained most of this disparity. Among all sub-indicators considered, the greater proportion of females and smaller proportion of rural residents in Black counties were the two largest contributors to the COVID-19 mortality gap between Black and non-Black counties. Proportions of diabetic residents, uninsured residents, and the degree of income inequality also significantly contributed to the gap in COVID-19 mortality. Conclusion The COVID-19 mortality gap between Black and non-Black counties was largely explained by pre-pandemic differences in demographic and population health characteristics. Policies aiming to reduce the prevalence of chronic conditions and uninsured residents in Black counties would have helped narrow the COVID-19 mortality gap between Black and non-Black counties in 2020.
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Affiliation(s)
- Drishti Baid
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA,Corresponding author. Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | - Boseong Yun
- Department of Sociology, Yale University, New Haven, CT, USA
| | - Emma Zang
- Department of Sociology, Yale University, New Haven, CT, USA
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Panczak R, Berlin C, Voorpostel M, Zwahlen M, Egger M. The Swiss neighbourhood index of socioeconomic position: update and re-validation. Swiss Med Wkly 2023; 153:40028. [PMID: 36652707 DOI: 10.57187/smw.2023.40028] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The widely used Swiss neighbourhood index of socioeconomic position (Swiss-SEP 1) was based on data from the 2000 national census on rent, household head education and occupation, and crowding. It may now be out of date. METHODS We created a new index (Swiss-SEP 2) based on the 2012-2015 yearly micro censuses that have replaced the decennial house-to-house census in Switzerland since 2010. We used principal component analysis on neighbourhood-aggregated variables and standardised the index. We also created a hybrid version (Swiss-SEP 3), with updated values for neighbourhoods centred on buildings constructed after the year 2000 and original values for the remaining neighbourhoods. RESULTS A total of 1.54 million neighbourhoods were included. With all three indices, the mean yearly equivalised household income increased from around 52,000 to 90,000 CHF from the lowest to the highest index decile. Analyses of mortality were based on 33.6 million person-years of follow-up. The age- and sex-adjusted hazard ratios of all-cause mortality comparing areas in the lowest Swiss-SEP decile with areas of the highest decile were 1.39 (95% confidence interval [CI] 1.36-1.41), 1.31 (1.29-1.33) and 1.34 (1.32-1.37) using the old, new and hybrid indices, respectively. DISCUSSION The Swiss-SEP indices capture area-based SEP at a high resolution and allow the study of SEP when individual-level SEP data are missing or area-level effects are of interest. The hybrid version (Swiss-SEP 3) maintains high spatial resolution while adding information on new neighbourhoods. The index will continue to be useful for Switzerland's epidemiological and public health research.
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Affiliation(s)
- Radoslaw Panczak
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Claudia Berlin
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Marieke Voorpostel
- Swiss Centre of Expertise in the Social Sciences (FORS), Lausanne, Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Population Health Sciences, Bristol Medical School, University of Bristol, UK.,Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
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Jones A, Squires GD, Nixon C. Ecological Associations Between Inclusionary Zoning Policies and Cardiovascular Disease Risk Prevalence: An Observational Study. Circ Cardiovasc Qual Outcomes 2021; 14:e007807. [PMID: 34493068 DOI: 10.1161/circoutcomes.120.007807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Providing an adequate supply of affordable housing has become an increasingly difficult challenge for US cities. Inclusionary zoning (IZ) policies have become an increasingly popular response. Substantial research has demonstrated the health benefits of stable, affordable housing. There is anecdotal but not systematic evidence that IZ policies may be associated with some health benefits of affordable housing. METHODS We rely on data from the 2017 500 Cities Project, the 2016 to 2017 Lincoln Institute for Land Policy survey, and the 2011 to 2015 American Community Survey. We perform bivariate tests and cluster ordinary least squares regression to examine associations at the municipal level between having inclusionary zoning (IZ) policies, the attributes of those policies, and the prevalence of several cardiovascular outcomes. RESULTS Cardiovascular outcomes and socioeconomic characteristics were uniformly better in cities with IZ policies. IZ policies were associated with lower blood pressure (95% CI, -0.50 to -0.13), cholesterol (CI, -0.89 to -0.31), and blood pressure medication (CI, -0.57 to -0.03) prevalence. Some characteristics of IZ programs such as being mandatory, prioritizing rental development, and allocating a larger share of affordable housing are associated with cardiovascular risk prevalence. CONCLUSIONS Characteristics of IZ programs that ultimately benefit low-income residents are associated with favorable municipal-level cardiovascular health. Further, IZ policies could potentially address complex health challenges among economically vulnerable households.
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Affiliation(s)
- Antwan Jones
- Department of Sociology (A.J., G.D.S.), George Washington University, Washington, DC.,Department of Epidemiology, Milken School of Public Health (A.J.), George Washington University, Washington, DC
| | - Gregory D Squires
- Department of Sociology (A.J., G.D.S.), George Washington University, Washington, DC.,Trachtenberg School of Public Policy & Public Administration (G.D.S., C.N.), George Washington University, Washington, DC
| | - Carolynn Nixon
- Trachtenberg School of Public Policy & Public Administration (G.D.S., C.N.), George Washington University, Washington, DC
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Ng TKS, Matchar DB, Pyrkov TV, Fedichev PO, Chan AWM, Kennedy B. Association between housing type and accelerated biological aging in different sexes: moderating effects of health behaviors. Aging (Albany NY) 2021; 13:20029-20049. [PMID: 34456185 PMCID: PMC8436907 DOI: 10.18632/aging.203447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/10/2021] [Indexed: 11/25/2022]
Abstract
Introduction: Despite associated with multiple geriatric disorders, whether housing type, an indicator of socioeconomic status (SES) and environmental factors, is associated with accelerated biological aging is unknown. Furthermore, although individuals with low-SES have higher body mass index (BMI) and are more likely to smoke, whether BMI and smoking status moderate the association between SES and biological aging is unclear. We examined these questions in urbanized low-SES older community-dwelling adults. Methods: First, we analyzed complete blood count data using the cox proportional hazards model and derived measures for biological age (BA) and biological age acceleration (BAA, the higher the more accelerated aging) (N = 376). Subsequently, BAA was regressed on housing type, controlling for covariates, including four other SES indicators. Interaction terms between housing type and BMI/smoking status were separately added to examine their moderating effects. Total sample and sex-stratified analyses were performed. Results: There were significant differences between men and women in housing type and BAA. Compared to residents in ≥3 room public or private housing, older adults resided in 1–2 room public housing had a higher BAA. Furthermore, BMI attenuated the association between housing type and BAA. In sex-stratified analyses, the main and interaction effects were only significant in women. In men, smoking status instead aggravated the association between housing type and BAA. Conclusion: Controlling for other SES indicators, housing type is an independent socio-environmental determinant of BA and BAA in a low-SES urbanized population. There were also sex differences in the moderating effects of health behaviors on biological aging.
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Affiliation(s)
- Ted Kheng Siang Ng
- Arizona State University, Edson College of Nursing and Health Innovation, Phoenix, AZ 85004, USA.,National Cheng Kung University, Institute of Behavioral Medicine, College of Medicine, Taiwan
| | - David Bruce Matchar
- Duke-National University of Singapore Medical School, Program in Health Services and Systems Research, Singapore.,Duke University School of Medicine, Department of Medicine (General Internal Medicine), Durham, NC 27710, USA
| | | | - Peter O Fedichev
- GERO PTE. LTD., Singapore.,Moscow Institute of Physics and Technology, Dolgoprudny, Moscow Region 141700, Russia
| | - Angelique Wei-Ming Chan
- Duke-National University of Singapore Medical School, Program in Health Services and Systems Research, Singapore.,Duke-National University of Singapore Medical School, Center for Aging, Research and Education, Singapore.,National University of Singapore, Department of Sociology, Faculty of Arts and Social Sciences, Singapore
| | - Brian Kennedy
- National University of Singapore, Center for Healthy Longevity, Healthy Longevity Program and Department of Biochemistry, Yong Loo Lin School of Medicine, Singapore.,Singapore Institute of Clinical Sciences, A*STAR, Singapore
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Russell C, Ali F, Nafeh F, Rehm J, LeBlanc S, Elton-Marshall T. Identifying the impacts of the COVID-19 pandemic on service access for people who use drugs (PWUD): A national qualitative study. J Subst Abuse Treat 2021; 129:108374. [PMID: 34080545 DOI: 10.1016/j.jsat.2021.108374] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Closures and reductions in capacity of select health and social services in response to the COVID-19 pandemic may have placed people who use drugs (PWUD) at a disproportionately increased risk for experiencing harms, and resulted in critical treatment disruptions. We conducted the current national study among a cohort of PWUD to understand how COVID-19 has affected service access, including any significant impacts PWUD may have experienced. Results will contribute to the evidence base for informing future pandemic and public health policy planning for vulnerable populations. METHODS The project involved qualitative telephone-based interviews with 196 adult (aged 18+) PWUD from across Canada. Eligibility criteria included daily or weekly use of psychoactive substance(s), and/or current enrollment in opioid agonist treatment (OAT). Data collection took place between May and July 2020. Data underwent thematic analyses, and common themes informed the results. RESULTS Most participants experienced detrimental service access issues and treatment disruptions during COVID-19, including reduced access to harm reduction services, OAT, withdrawal management and treatment services, medical professionals (e.g., addictions and mental health counseling), shelters/housing, and food banks. Positive impacts included greater access to OAT take-home 'carries' and prescription deliveries. Decreases in service capacity resulted in increased health issues and risky substance use behaviors among PWUD, such as unaccompanied substance use, sharing/re-use of supplies, and overdose events. CONCLUSIONS Reductions in the accessibility of critical services PWUD rely on during COVID-19 has increased existent substance use and health issues among PWUD, while decreasing their ability to mitigate risks related to substance use. Thus, the expansion of the depth and breadth of support options is crucial. Services must remain open and flexible to the unique needs of PWUD during COVID-19, while novel and effective adaptations and interventions should remain available and accessible post-COVID-19.
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Affiliation(s)
- Cayley Russell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.
| | - Farihah Ali
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.
| | - Frishta Nafeh
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Ontario M5T 3M7, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College St., Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Institute of Medical Science (IMS), University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Bol'shaya Pirogovskaya Ulitsa, 19с1, Moscow 119146, Russia.
| | - Sean LeBlanc
- Drug Users Advocacy League, 216 Murray St, Ottawa, Ontario K1N 5S6, Canada; Canadian Association of People who Use Drugs (CAPUD), Canada.
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Ontario M5T 3M7, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College St., Toronto, Ontario M5T 1R8, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., London, Ontario M6A 5C1, Canada; Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, Ontario P7B 5E1, Canada.
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Shi M, Baum A, Pollack CE. Perspectives On Integrating Health Into The Low-Income Housing Tax Credit: A Qualitative Study. Health Aff (Millwood) 2020; 39:622-630. [PMID: 32250674 DOI: 10.1377/hlthaff.2019.00853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
While there is increasing attention to the ways in which safe and affordable housing may promote improved health, less work has focused on the role of the Low-Income Housing Tax Credit (LIHTC) program-the largest source of affordable housing in the United States. Through qualitative interviews, we examined the perspectives of diverse stakeholders in the housing sector on the opportunities and obstacles involved in including health-related criteria in LIHTC funding decisions. Our interviews revealed a growing desire within the housing sector to address health needs but, with the exception of green building criteria, a lack of clear standards on best practices. Stakeholders noted the challenges of effectively partnering with local health institutions, the need to develop sustainable payment mechanisms for health-related services, and the importance of locating developments near health-promoting resources. By describing mechanisms for integrating health services into the affordable housing infrastructure, this study helps lay the groundwork for the development of cross-sector partnerships.
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Affiliation(s)
- Marc Shi
- Marc Shi is a resident in medicine at Albert Einstein College of Medicine, in New York City
| | - Abigail Baum
- Abigail Baum is a graduate student in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Craig E Pollack
- Craig E. Pollack ( cpollac2@jhmi. edu ) is an associate professor in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
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Kolak M, Bhatt J, Park YH, Padrón NA, Molefe A. Quantification of Neighborhood-Level Social Determinants of Health in the Continental United States. JAMA Netw Open 2020; 3:e1919928. [PMID: 31995211 PMCID: PMC6991288 DOI: 10.1001/jamanetworkopen.2019.19928] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
IMPORTANCE An association between social and neighborhood characteristics and health outcomes has been reported but remains poorly understood owing to complex multidimensional factors that vary across geographic space. OBJECTIVES To quantify social determinants of health (SDOH) as multiple dimensions across the continental United States (the 48 contiguous states and the District of Columbia) at a small-area resolution and to examine the association of SDOH with premature mortality within Chicago, Illinois. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, census tracts from the US Census Bureau from 2014 were used to develop multidimensional SDOH indices and a regional typology of the continental United States at a small-area level (n = 71 901 census tracts with approximately 312 million persons) using dimension reduction and clustering machine learning techniques (unsupervised algorithms used to reduce dimensions of multivariate data). The SDOH indices were used to estimate age-adjusted mortality rates in Chicago (n = 789 census tracts with approximately 7.5 million persons) with a spatial regression for the same period, while controlling for violent crime. MAIN OUTCOMES AND MEASURES Fifteen variables, measured as a 5-year mean, were selected to characterize SDOH as small-area variations for demographic characteristics of vulnerable groups, economic status, social and neighborhood characteristics, and housing and transportation availability at the census-tract level. This SDOH data matrix was reduced to 4 indices reflecting advantage, isolation, opportunity, and mixed immigrant cohesion and accessibility, which were then clustered into 7 distinct multidimensional neighborhood typologies. The association between SDOH indices and premature mortality (defined as death before age 75 years) in Chicago was measured by years of potential life lost and aggregated to a 5-year mean. Data analyses were conducted between July 1, 2018, and August 30, 2019. RESULTS Among the 71 901 census tracts examined across the continental United States, a median (interquartile range) of 27.2% (47.1%) of residents had minority status, 12.1% (7.5%) had disabilities, 22.9% (7.6%) were 18 years and younger, and 13.6% (8.1%) were 65 years and older. Among the 789 census tracts examined in Chicago, a median (interquartile range) of 80.4% (56.3%) of residents had minority status, 10.2% (8.2%) had disabilities, 23.2% (10.9%) were 18 years and younger, and 9.5% (7.1%) were 65 years and older. Four SDOH indices accounted for 71% of the variance across all census tracts in the continental United States in 2014. The SDOH neighborhood typology of extreme poverty, which is of greatest concern to health care practitioners and policy advocates, comprised only 9.6% of all census tracts across the continental United States but characterized small areas of known public health crises. An association was observed between all SDOH indices and age-adjusted premature mortality rates in Chicago (R2 = 0.63; P < .001), even after accounting for violent crime and spatial structures. CONCLUSIONS AND RELEVANCE The modeling of SDOH as multivariate indices rather than as a singular deprivation index may better capture the complexity and spatial heterogeneity underlying SDOH. During a time of increased attention to SDOH, this analysis may provide actionable information for key stakeholders with respect to the focus of interventions.
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Affiliation(s)
- Marynia Kolak
- Center for Spatial Data Science, Searle Chemistry Laboratory, University of Chicago, Chicago, Illinois
| | - Jay Bhatt
- Center for Health Innovation, American Hospital Association, Chicago, Illinois
| | - Yoon Hong Park
- Center for Spatial Data Science, Searle Chemistry Laboratory, University of Chicago, Chicago, Illinois
| | - Norma A. Padrón
- Center for Health Innovation, American Hospital Association, Chicago, Illinois
| | - Ayrin Molefe
- Center for Health Innovation, American Hospital Association, Chicago, Illinois
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Rowe CL, Riley ED, Eagen K, Zevin B, Coffin PO. Drug overdose mortality among residents of single room occupancy buildings in San Francisco, California, 2010-2017. Drug Alcohol Depend 2019; 204:107571. [PMID: 31581024 PMCID: PMC11105971 DOI: 10.1016/j.drugalcdep.2019.107571] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 08/14/2019] [Accepted: 08/14/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Single room occupancy (SRO) buildings, also known as residential hotels, are a form of affordable housing common to cities in North America, and residents of these buildings face elevated rates of substance use, physical and mental multimorbidity, and mortality. Identifying distinct populations at greater risk of overdose death is crucial to the planning of interventions aiming to reduce drug-related mortality, yet no studies have assessed the population burden of overdose mortality among SRO residents. The present study quantifies and characterizes drug overdose mortality among residents of SRO buildings in a large U.S. city. METHODS We used mortality records and a database of SRO buildings to calculate rate ratios comparing overdose mortality due to opioids, cocaine, and methamphetamine among SRO residents and non-SRO residents in San Francisco, CA 2010-2017 and assessed bivariate differences in decedent and death location characteristics between SRO resident and other overdose decedents. RESULTS There were 1,551 overdose deaths during the study period, with an overall rate of 21.3 per 100,000 residents (95%CI = 20.2-22.6). The rate among SRO residents (278.7, 95%CI = 252.9-306.5) was 19.3 (95%CI = 17.1-21.7) times that of non-SRO residents (21.3, 95%CI = 20.2-22.6). An additional 79 (5%) deaths among non-residents occurred in SRO buildings, and 86% of SRO resident decedents died at home compared to 64% of non-SRO residents (p < 0.05). CONCLUSIONS Overdose mortality was substantially higher among SRO residents, who were also more likely to die from overdose at home, which highlights the need for resources and targeted interventions directed towards residents of SRO buildings.
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Affiliation(s)
- Christopher L Rowe
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, United States; University of California, Berkeley, 2121 Berkeley Way, 5th Floor, Berkeley, CA, 94702, United States.
| | - Elise D Riley
- University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA, 94143, United States
| | - Kellene Eagen
- San Francisco Department of Public Health, 230 Golden Gate Avenue, San Francisco, CA 94102, United States
| | - Barry Zevin
- San Francisco Department of Public Health, 50 Ivy Street, San Francisco, CA 94102, United States
| | - Phillip O Coffin
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, United States; University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA, 94143, United States
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