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Shakoor A, van Maarschalkerwaart WA, Schaap J, de Boer RA, van Mieghem NM, Boersma EH, van Heerebeek L, Brugts JJ, van der Boon RMA. Socio-economic inequalities and heart failure morbidity and mortality: A systematic review and data synthesis. ESC Heart Fail 2024. [PMID: 39318286 DOI: 10.1002/ehf2.14986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 09/26/2024] Open
Abstract
Socio-economic status (SES) has been associated with incident and prevalent heart failure (HF), as well as its morbidity and mortality. However, the precise nature of the relationship between SES and HF remains unclear due to inconsistent data. This study aims to provide a comprehensive assessment and data synthesis of the relationship between SES and HF morbidity and mortality. We performed a systematic search and data synthesis using six databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. The included studies comprised observational studies that reported on HF incidence and prevalence, HF hospitalizations, worsening HF (WHF) and all-cause mortality, as well as treatment options (medical, device and advanced HF therapies). SES was measured on both individual and area levels, encompassing single (e.g., income, education, employment, social risk score, living conditions and housing characteristics) and composite indicators. Among the 4124 studies screened, 79 were included, with an additional 5 identified through cross-referencing. In the majority of studies, a low SES was associated with an increased HF incidence (72%) and prevalence (75%). For mortality, we demonstrated that low SES was associated with increased mortality in 45% of the studies, with 18% of the studies showing mixed results (depending on the indicator, gender or follow-up) and 38% showing non-significant results. Similar patterns were observed for the association between SES, WHF, medical therapy prescriptions and the utilization of devices and advanced HF therapies. There was no clear pattern in the used SES indicators and HF outcomes. This systematic review, using contemporary data, shows that while socio-economic disparity may influence HF incidence, management and subsequent adverse events, these associations are not uniformly predictive. Our review highlights that the impact of SES varies depending on the specific indicators used, reflecting the complexity of its influence on health disparities. Assessment and recognition of SES as an important risk factor can assist clinicians in early detection and customizing HF treatment, while also aiding policymakers in optimizing resource allocation.
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Affiliation(s)
- Abdul Shakoor
- Department of Cardiology, Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Willemijn A van Maarschalkerwaart
- Department of Cardiology, Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
- Department of Cardiology, OLVG, Amsterdam, The Netherlands
| | - Jeroen Schaap
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
- Dutch Network for Cardiovascular Research (WCN), Utrecht, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Nicolas M van Mieghem
- Department of Cardiology, Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Eric H Boersma
- Department of Cardiology, Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | | | - Jasper J Brugts
- Department of Cardiology, Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Robert M A van der Boon
- Department of Cardiology, Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
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Hawkins NM, Peterson S, Salimian S, Demers C, Keshavjee K, Virani SA, Mancini GJ, Wong ST. Epidemiology and treatment of heart failure with chronic obstructive pulmonary disease in Canadian primary care. ESC Heart Fail 2023; 10:3612-3621. [PMID: 37786365 PMCID: PMC10682874 DOI: 10.1002/ehf2.14497] [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: 06/25/2023] [Accepted: 07/24/2023] [Indexed: 10/04/2023] Open
Abstract
AIMS Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are largely managed in primary care, but their intersection in terms of disease burden, healthcare utilization, and treatment is ill-defined. METHODS AND RESULTS We examined a retrospective cohort including all patients with HF or COPD in the Canadian Primary Care Sentinel Surveillance Network from 2010 to 2018. The population size in 2018 with HF, COPD, and HF with COPD was 15 778, 27 927, and 4768 patients, respectively. While disease incidence declined, age-sex-standardized prevalence per 100 population increased for HF alone from 2.33 to 3.63, COPD alone from 3.44 to 5.96, and COPD with HF from 12.70 to 15.67. Annual visit rates were high and stable around 8 for COPD alone but declined significantly over time for HF alone (9.3-8.1, P = 0.04) or for patients with both conditions (14.3-11.9, P = 0.006). For HF alone, cardiovascular visits were common (29.4%), while respiratory visits were infrequent (3.5%), with the majority of visits being non-cardiorespiratory. For COPD alone, respiratory and cardiovascular visits were common (16.4% and 11.3%) and the majority were again non-cardiorespiratory. For concurrent disease, 39.0% of visits were cardiorespiratory. The commonest non-cardiorespiratory visit reasons were non-specific symptoms or signs, endocrine, musculoskeletal, and mental health. In patients with HF with and without COPD, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor use was similar, while mineralocorticoid receptor antagonist use was marginally higher with concurrent COPD. Beta-blocker use was initially lower with concurrent COPD compared with HF alone (69.3% vs. 74.0%), but this progressively declined by 2018 (74.5% vs. 73.5%). CONCLUSIONS The prevalence of HF and COPD continues to rise. Although patients with either or both conditions are high utilizers of primary care, the majority of visits relate to non-cardiorespiratory comorbidities. Medical therapy for HF was similar and the initially lower beta-blocker utilization disappeared over time.
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Affiliation(s)
- Nathaniel M. Hawkins
- Division of Cardiology, Centre for Cardiovascular InnovationUniversity of British ColumbiaVancouverCanada
- Centre for Health Services and Policy ResearchUniversity of British ColumbiaVancouverCanada
| | - Sandra Peterson
- Centre for Health Services and Policy ResearchUniversity of British ColumbiaVancouverCanada
| | - Samaneh Salimian
- Division of Cardiology, Centre for Cardiovascular InnovationUniversity of British ColumbiaVancouverCanada
| | | | - Karim Keshavjee
- Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
| | - Sean A. Virani
- Division of Cardiology, Centre for Cardiovascular InnovationUniversity of British ColumbiaVancouverCanada
| | - G.B. John Mancini
- Division of Cardiology, Centre for Cardiovascular InnovationUniversity of British ColumbiaVancouverCanada
| | - Sabrina T. Wong
- Centre for Health Services and Policy ResearchUniversity of British ColumbiaVancouverCanada
- Division of Intramural ResearchNational Institute of Nursing Research, National Institutes of HealthBethesdaMDUSA
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Quashie NT, García C, Meltzer G, Andrade FCD, Matos-Moreno A. Neighborhood socioeconomic position, living arrangements, and cardiometabolic disease among older Puerto Ricans: An examination using PREHCO 2002-2007. PLoS One 2023; 18:e0289170. [PMID: 37527246 PMCID: PMC10393176 DOI: 10.1371/journal.pone.0289170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023] Open
Abstract
Cardiometabolic diseases are among the leading causes of mortality worldwide and are increasingly prevalent in rapidly aging populations. Neighborhood socioeconomic position (SEP) and living arrangements are increasingly recognized as important determinants of cardiometabolic health but have not been examined within Puerto Rico. This study examined the association between neighborhood SEP, living arrangements, and incidence of cardiometabolic conditions among island-dwelling older Puerto Ricans, using longitudinal data from the Puerto Rican Elderly Health Conditions Project (Waves I 2002/03 and II 2006/07) linked with 2000 Census data for neighborhood-level conditions. Our sample consists of non-institutionalized adults aged 60 and older who remained in the same residence over both waves of data collection (N = 2,769). We used multilevel multinomial logistic regression models to examine the relationship between neighborhood SEP and the prevalence and incidence of cardiometabolic disease. Findings show that residence in a socioeconomically advantaged neighborhood was positively associated with reporting having one cardiometabolic condition at baseline, but not associated with the incidence of cardiometabolic conditions at follow-up. Living without a partner was negatively associated with reporting having cardiometabolic conditions compared to living with a partner. Similar results were found for the incidence of cardiometabolic conditions. Living arrangements significantly modified the relationship between neighborhood SEP and cardiometabolic conditions. Compared to living with a partner, living alone in a socioeconomically advantaged neighborhood was associated with a reduced risk of reporting having one condition. Living with children in a socioeconomically advantaged neighborhood was associated with a reduced risk of developing one cardiometabolic condition than living with a partner. Living arrangements are more salient to cardiometabolic health than neighborhood SEP. Social programs and services focused on household composition and familial support are needed to identify older Puerto Ricans potentially at risk of underdiagnosed chronic conditions, especially as ongoing economic, demographic, environmental, and healthcare crises potentially exacerbate social inequalities.
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Affiliation(s)
- Nekehia T Quashie
- Department of Health Studies, University of Rhode Island, Kingston, RI, United States of America
| | - Catherine García
- Department of Human Development and Family Science, Aging Studies Institute, Center for Aging and Policy Studies, Lerner Center for Public Health Promotion and Population Health, Syracuse University, Syracuse, NY, United States of America
| | - Gabriella Meltzer
- Departments of Epidemiology and Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, United States of America
| | - Flavia C D Andrade
- School of Social Work, University of Illinois, Urbana-Champaign, Urbana, IL, United States of America
| | - Amílcar Matos-Moreno
- Population Research Institute, The Pennsylvania State University, State College, PA, United States of America
- Clinical Psychology Department, Carlos Albizu University, San Juan, Puerto Rico
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Yu G, Tang EYH, Fu Y. Health Disparities and Comparison of Psychiatric Medication Use before and after the COVID-19 Pandemic Lockdown among General Practitioner Practices in the North East of England. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6034. [PMID: 37297638 PMCID: PMC10252938 DOI: 10.3390/ijerph20116034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/27/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Psychiatric medications play a vital role in the management of mental health disorders. However, the COVID-19 pandemic and subsequent lockdown limited access to primary care services, leading to an increase in remote assessment and treatment options to maintain social distancing. This study aimed to investigate the impact of the COVID-19 pandemic lockdown on the use of psychiatric medication in primary care settings. METHODS We conducted a retrospective claims-based analysis of anonymized monthly aggregate practice-level data on anxiolytics and hypnotics use from 322 general practitioner (GP) practices in the North East of England, where health disparities are known to be higher. Participants were all residents who took anxiolytics and hypnotics from primary care facilities for two financial years, from 2019/20 to 2020/21. The primary outcome was the volume of Anxiolytics and Hypnotics used as the standardized, average daily quantities (ADQs) per 1000 patients. Based on the OpenPrescribing database, a random-effect model was applied to quantify the change in the level and trend of anxiolytics and hypnotics use after the UK national lockdown in March 2020. Practice characteristics extracted from the Fingertips data were assessed for their association with a reduction in medication use following the lockdown. RESULTS This study in the North East of England found that GP practices in higher health disparate regions had a lower workload than those in less health disparate areas, potentially due to disparities in healthcare utilization and socioeconomic status. Patients in the region reported higher levels of satisfaction with healthcare services compared to the England average, but there were differences between patients living in higher versus less health disparate areas. The study highlights the need for targeted interventions to address health disparities, particularly in higher health disparate areas. The study also found that psychiatric medication use was significantly more common in residents living in higher health disparate areas. Daily anxiolytics and hypnotics use decreased by 14 items per 1000 patients between the financial years 2019/20 and 2020/21. A further nine items per 1000 decreased for higher health disparate areas during the UK national lockdown. CONCLUSIONS People during the COVID-19 lockdown were associated with an increased risk of unmet psychiatric medication demand, especially for higher health disparate areas that had low-socioeconomic status.
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Affiliation(s)
- Ge Yu
- NIHR Applied Research Collaboration North East and North Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust, The Clocktower Building, St Nicholas Hospital, Gosforth, Cumbria, Newcastle upon Tyne NE3 3XT, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
| | - Eugene Y. H. Tang
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
| | - Yu Fu
- Primary Care & Mental Health, University of Liverpool, Liverpool L69 3GL, UK
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Kaim A, Saban M. Dynamic Trends in Sociodemographic Disparities and COVID-19 Morbidity and Mortality—A Nationwide Study during Two Years of a Pandemic. Healthcare (Basel) 2023; 11:healthcare11070933. [PMID: 37046860 PMCID: PMC10094509 DOI: 10.3390/healthcare11070933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
Social epidemiological research has documented that health outcomes, such as the risk of becoming diseased or dying, are closely tied to socioeconomic status. The aim of the current study was to investigate the impact of socioeconomic status on morbidity, hospitalization, and mortality outcomes throughout five waves of the pandemic amongst the Israeli population. A retrospective archive study was conducted in Israel from March 2020 to February 2022 in which data were obtained from the Israeli Ministry of Health’s (MOH) open COVID-19 database. Our findings, though requiring careful and cautious interpretation, indicate that the socioeconomic gradient patterns established in previous COVID-19 literature are not applicable to Israel throughout the five waves of the pandemic. The conclusions of this study indicate a much more dynamic and complex picture, where there is no single group that dominates the realm of improved outcomes or bears the burden of disease with respect to morbidity, hospitalization, and mortality. We show that health trends cannot necessarily be generalized to all countries and are very much dynamic and contingent on the socio-geographical context and must be thoroughly examined throughout distinct communities with consideration of the specific characteristics of the disease. Furthermore, the implications of this study include the importance of identifying the dynamic interplay and interactions of sociodemographic characteristics and health behavior in order to enhance efforts toward achieving improved health outcomes by policymakers and researchers.
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Enogela EM, Buchanan T, Carter CS, Elk R, Gazaway SB, Goodin BR, Jackson EA, Jones R, Kennedy RE, Perez-Costas E, Zubkoff L, Zumbro EL, Markland AD, Buford TW. Preserving independence among under-resourced older adults in the Southeastern United States: existing barriers and potential strategies for research. Int J Equity Health 2022; 21:119. [PMID: 36030252 PMCID: PMC9419141 DOI: 10.1186/s12939-022-01721-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
Disability prevention and preservation of independence is crucial for successful aging of older adults. To date, relatively little is known regarding disparities in independent aging in a disadvantaged older adult population despite widely recognized health disparities reported in other populations and disciplines. In the U.S., the Southeastern region also known as “the Deep South”, is an economically and culturally unique region ravaged by pervasive health disparities – thus it is critical to evaluate barriers to independent aging in this region along with strategies to overcome these barriers. The objective of this narrative review is to highlight unique barriers to independent aging in the Deep South and to acknowledge gaps and potential strategies and opportunities to fill these gaps. We have synthesized findings of literature retrieved from searches of computerized databases and authoritative texts. Ultimately, this review aims to facilitate discussion and future research that will help to address the unique challenges to the preservation of independence among older adults in the Deep South region.
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Affiliation(s)
- Ene M Enogela
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Taylor Buchanan
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Christy S Carter
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Ronit Elk
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Shena B Gazaway
- Department of Family, Community, and Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth A Jackson
- Department of Medicine - Division of Cardiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Raymond Jones
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Richard E Kennedy
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Emma Perez-Costas
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Lisa Zubkoff
- Department of Medicine - Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, AL, USA
| | - Emily L Zumbro
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Alayne D Markland
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA.,Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, AL, USA
| | - Thomas W Buford
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA. .,Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, AL, USA.
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Liang LJ, Casillas A, Longstreth WT, PhanVo L, Vassar SD, Brown AF. Fishing for health: Neighborhood variation in fish intake, fish quality and association with stroke risk among older adults in the Cardiovascular Health Study. Nutr Metab Cardiovasc Dis 2022; 32:1410-1417. [PMID: 35346546 PMCID: PMC9472873 DOI: 10.1016/j.numecd.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS Fish consumption has been associated with better health outcomes. Dietary patterns may vary substantially by neighborhood of residence. However, it is unclear if the benefits of a healthy diet are equivalent in different communities. This study examines associations of fish consumption with stroke incidence and stroke risk factors, and whether these differ by neighborhood socioeconomic status (NSES). METHODS AND RESULTS We studied 4007 participants in the Cardiovascular Health Study who were 65 years or older and recruited between 1989 and 1990 from 4 US communities. Outcomes included fish consumption type (bakes/broiled vs. fried) and frequency, stroke incidence, and stroke risk factors. Multilevel regressions models were used to estimate fish consumption associations with clinical outcomes. Lower NSES was associated with higher consumption of fried fish (aOR = 1.47, 95% CI: 1.10-1.98) and lower consumption of non-fried fish (0.64, 0.47-0.86). Frequent fried fish (11.9 vs. 9.2 person-years for at least once weekly vs. less than once a month, respectively) and less frequent non-fried fish (17.7 vs. 9.6 person-years for less than once a month vs. at least once weekly, respectively) were independently associated with an increased risk of stroke (p-values < 0.05). However, among those with similar levels of healthy fish consumption, residents with low NSES had less benefit on stroke risk reduction, compared with high NSES. CONCLUSION Fish consumption type and frequency both impact stroke risk. Benefits of healthy fish consumption differ by neighborhood socioeconomic status.
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Affiliation(s)
- Li-Jung Liang
- Division of General Internal Medicine and Health Services Research, University of California, 1100 Glendon Avenue, Suite 850, Los Angeles, CA 90024, USA.
| | - Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, University of California, 1100 Glendon Avenue, Suite 850, Los Angeles, CA 90024, USA
| | - W T Longstreth
- Departments of Neurology and Epidemiology, University of Washington, 908 Jefferson St, Seattle, WA 98104, USA
| | - Lynn PhanVo
- Division of General Internal Medicine and Health Services Research, University of California, 1100 Glendon Avenue, Suite 850, Los Angeles, CA 90024, USA
| | - Stefanie D Vassar
- Division of General Internal Medicine and Health Services Research, University of California, 1100 Glendon Avenue, Suite 850, Los Angeles, CA 90024, USA
| | - Arleen F Brown
- Division of General Internal Medicine and Health Services Research, University of California, 1100 Glendon Avenue, Suite 850, Los Angeles, CA 90024, USA
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Santos CJ, Paciência I, Ribeiro AI. Neighbourhood Socioeconomic Processes and Dynamics and Healthy Ageing: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116745. [PMID: 35682327 PMCID: PMC9180257 DOI: 10.3390/ijerph19116745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 02/05/2023]
Abstract
Elderly citizens are concentrated in urban areas and are particularly affected by the immediate residential environment. Cities are unequal and segregated places, where there is an intensification of urban change processes such as gentrification and displacement. We aimed to understand how neighbourhood socioeconomic processes and dynamics influence older people’s health. Three bibliographic databases—PubMed, Web of Science, and Scopus—were used to identify evidence of the influence of neighbourhood socioeconomic deprivation, socio-spatial segregation, urban renewal, and gentrification on healthy ageing. We followed the method of Arksey and O’Malley, Levac and colleagues, the Joanna Briggs Institute, and the PRISMA-ScR. The included studies (n = 122) were published between 2001 and 2021. Most evaluated neighbourhood deprivation (n = 114), followed by gentrification (n = 5), segregation (n = 2), and urban renewal (n = 1). Overall, older people living in deprived neighbourhoods had worse healthy ageing outcomes than their counterparts living in more advantaged neighbourhoods. Older adults pointed out more negative comments than positive ones for gentrification and urban renewal. As to segregation, the direction of the association was not entirely clear. In conclusion, the literature has not extensively analysed the effects of segregation, gentrification, and urban renewal on healthy ageing, and more quantitative and longitudinal studies should be conducted to draw better inferences.
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Affiliation(s)
- Cláudia Jardim Santos
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal;
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
- Correspondence: ; Tel.: +351-222-061-820
| | - Inês Paciência
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, P.O. Box 5000, 90570 Oulu, Finland;
- Biocenter Oulu, University of Oulu, P.O. Box 5000, 90570 Oulu, Finland
| | - Ana Isabel Ribeiro
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal;
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
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Lawrence KG, Werder EJ, Sandler DP. Association of neighborhood deprivation with pulmonary function measures among participants in the Gulf Long-Term Follow-up Study. ENVIRONMENTAL RESEARCH 2021; 202:111704. [PMID: 34280418 PMCID: PMC8578346 DOI: 10.1016/j.envres.2021.111704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Individual-level socioeconomic status (SES) has been shown to be an important determinant of lung function. Neighborhood level SES factors may increase psychological and physiologic stress and may also reflect other exposures that can adversely affect lung function, but few studies have considered neighborhood factors. OBJECTIVE Our aim was to assess the association between neighborhood-level SES and lung function. METHODS We cross-sectionally analyzed 6168 spirometry test results from participants in the Gulf long-term Follow-up Study, a large cohort of adults enrolled following the largest maritime oil spill in US history. Outcomes of interest included the forced expiratory volume in 1 s (FEV1; mL), the forced vital capacity (FVC; mL), and the FEV1/FVC ratio (%). Neighborhood deprivation was measured by linking participant home addresses to an existing Area Deprivation Index (ADI) and categorized into quartiles. Individual-level SES measures were collected at enrollment using a structured questionnaire and included income, educational attainment, and financial strain. We used multilevel regression to estimate associations between ADI quartiles and each lung function measure. RESULTS Greater neighborhood deprivation was associated with lower FEV1: βQ2vsQ1: -30 mL (95% CI: -97, 36), βQ3vsQ1: -70 mL (95% CI: -135, -4) and βQ4vsQ1: -104 mL (95% CI: -171, -36). FVC showed similar patterns of associations with neighborhood deprivation. No associations with the FEV1/FVC ratio were observed. CONCLUSION Neighborhood deprivation, a measure incorporating economic and other stressors, was associated with lower FEV1 and FVC, with magnitudes of associations reaching clinically meaningful levels. The impact of this neighborhood SES measure persisted even after adjustment for individual-level SES factors.
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Affiliation(s)
- Kaitlyn G Lawrence
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA
| | - Emily J Werder
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA.
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Boccio CM. Exploring Potential Protective Factors for the Relationship between Low Self-Control in Adolescence and Negative Health Outcomes in Adulthood. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2021; 65:1559-1585. [PMID: 32501167 DOI: 10.1177/0306624x20931441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Previous research links low levels of self-control with criminal involvement and negative life outcomes. A similar line of inquiry has begun to explore whether low levels of self-control are also associated with developing health problems in adulthood. This paper extends this research by examining associations between adolescent levels of self-control and four different categories of health outcomes in adulthood. In addition, this study examines whether associations between adolescent levels of low self-control and health outcomes in adulthood are moderated by environmental protective factors. The results reveal that low levels of self-control in adolescence are consistently associated with reporting more health problems. In addition, some evidence emerged in support of the role of environmental protective factors in buffering the risk of developing health problems conferred by low levels of self-control in adolescence.
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Dasgupta D, Chaudhry B, Greeves K, Long J, Duarte M, Chawla N. A Tablet-based App for Successful Aging in Community-Dwelling Older Adults with Low Socioeconomic Status: A Feasibility Study (Preprint). JMIR Aging 2020. [DOI: 10.2196/26686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Identifying and assessing the impact of key neighborhood-level determinants on geographic variation in stroke: a machine learning and multilevel modeling approach. BMC Public Health 2020; 20:1666. [PMID: 33160324 PMCID: PMC7648288 DOI: 10.1186/s12889-020-09766-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/26/2020] [Indexed: 12/31/2022] Open
Abstract
Background Stroke is a chronic cardiovascular disease that puts major stresses on U.S. health and economy. The prevalence of stroke exhibits a strong geographical pattern at the state-level, where a cluster of southern states with a substantially higher prevalence of stroke has been called the stroke belt of the nation. Despite this recognition, the extent to which key neighborhood characteristics affect stroke prevalence remains to be further clarified. Methods We generated a new neighborhood health data set at the census tract level on nearly 27,000 tracts by pooling information from multiple data sources including the CDC’s 500 Cities Project 2017 data release. We employed a two-stage modeling approach to understand how key neighborhood-level risk factors affect the neighborhood-level stroke prevalence in each state of the US. The first stage used a state-of-the-art Bayesian machine learning algorithm to identify key neighborhood-level determinants. The second stage applied a Bayesian multilevel modeling approach to describe how these key determinants explain the variability in stroke prevalence in each state. Results Neighborhoods with a larger proportion of older adults and non-Hispanic blacks were associated with neighborhoods with a higher prevalence of stroke. Higher median household income was linked to lower stroke prevalence. Ozone was found to be positively associated with stroke prevalence in 10 states, while negatively associated with stroke in five states. There was substantial variation in both the direction and magnitude of the associations between these four key factors with stroke prevalence across the states. Conclusions When used in a principled variable selection framework, high-performance machine learning can identify key factors of neighborhood-level prevalence of stroke from wide-ranging information in a data-driven way. The Bayesian multilevel modeling approach provides a detailed view of the impact of key factors across the states. The identified major factors and their effect mechanisms can potentially aid policy makers in developing area-based stroke prevention strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09766-3.
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Hamad R, Öztürk B, Foverskov E, Pedersen L, Sørensen HT, Bøtker HE, White JS. Association of Neighborhood Disadvantage With Cardiovascular Risk Factors and Events Among Refugees in Denmark. JAMA Netw Open 2020; 3:e2014196. [PMID: 32821923 PMCID: PMC7442927 DOI: 10.1001/jamanetworkopen.2020.14196] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
IMPORTANCE Refugees are among the most disadvantaged individuals in society, and they often have elevated risks of cardiovascular risk factors and events. Evidence is limited regarding factors that may worsen cardiovascular health among this vulnerable group. OBJECTIVE To test the hypothesis that refugee placement in socioeconomically disadvantaged neighborhoods is associated with increased cardiovascular risk. DESIGN, SETTING, AND PARTICIPANTS The study population of this quasi-experimental, registry-based cohort study included 49 305 adults 18 years and older who came to Denmark as refugees from other countries during the years of Denmark's refugee dispersal policy from 1986 to 1998. Refugees were dispersed to neighborhoods with varying degrees of socioeconomic disadvantage in an arbitrary manner conditional on observed characteristics. The association of neighborhood disadvantage on arrival with several cardiovascular outcomes in subsequent decades was evaluated using regression models that adjusted for individual, family, and municipal characteristics. Health outcomes were abstracted from the inpatient register, outpatient specialty clinic register, and prescription drug register through 2016. Data analysis was conducted from May 2018 to July 2019. EXPOSURES A composite index of neighborhood disadvantage was constructed using 8 neighborhood-level socioeconomic characteristics derived from Danish population register data. MAIN OUTCOMES AND MEASURES Primary study outcomes included hypertension, hyperlipidemia, type 2 diabetes, myocardial infarction, and stroke. Before data analysis commenced, it was hypothesized that higher levels of neighborhood disadvantage were associated with an increased risk of cardiovascular risk factors and events. RESULTS A total of 49 305 participants were included (median [interquartile range] age, 30.5 [24.9-39.8] years; 43.3% women). Participant region of origin included 6318 from Africa (12.8%), 7253 from Asia (14.7%), 3446 from Eastern Europe (7.0%), 5416 from Iraq (11.0%), 6206 from Iran (12.6%), 5558 from Palestine (via Lebanon, Israel, Occupied Palestinian Territories; 11.3%), and 15 108 from Yugoslavia (30.6%). Adjusted models revealed an association between placement in disadvantaged neighborhoods and increased risk of hypertension (0.71 [95% CI, 0.30-1.13] percentage points per unit of disadvantage index; P < .01), hyperlipidemia (0.44 [95% CI, 0.06-0.83] percentage points; P = .01), diabetes (0.45 [95% CI, 0.09-0.81] percentage points; P = .01), and myocardial infarction (0.14 [95% CI, 0.03-0.25] percentage points; P = .01). No association was found for stroke. Individuals who arrived in Denmark before age 35 years had an increased risk of hyperlipidemia (1.16 [95% CI, 0.41-1.92] percentage points; P < .01), and there were no differences by sex. CONCLUSIONS AND RELEVANCE In this quasi-experimental cohort study, neighborhood disadvantage was associated with increased cardiovascular risk in a relatively young population of refugees. Neighborhood characteristics may be an important consideration when refugees are placed by resettlement agencies and host countries. Future work should examine additional health outcomes as well as potential mediating pathways to target future interventions (eg, neighborhood ease of walking, employment opportunities).
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Affiliation(s)
- Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, University of California School of Medicine, San Francisco
- Department of Family & Community Medicine, University of California School of Medicine, San Francisco
| | - Buket Öztürk
- Department of Clinical Epidemiology, Aarhus University, Denmark
| | - Else Foverskov
- Philip R. Lee Institute for Health Policy Studies, University of California School of Medicine, San Francisco
- Department of Clinical Epidemiology, Aarhus University, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University, Denmark
| | - Henrik T. Sørensen
- Department of Clinical Epidemiology, Aarhus University, Denmark
- Center for Population Health Science, Stanford University, Stanford, California
| | - Hans E. Bøtker
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - Justin S. White
- Philip R. Lee Institute for Health Policy Studies, University of California School of Medicine, San Francisco
- Department of Epidemiology & Biostatistics, University of California School of Medicine, San Francisco
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Ramphal B, DeSerisy M, Pagliaccio D, Raffanello E, Rauh V, Tau G, Posner J, Marsh R, Margolis AE. Associations between Amygdala-Prefrontal Functional Connectivity and Age Depend on Neighborhood Socioeconomic Status. Cereb Cortex Commun 2020; 1:tgaa033. [PMID: 32984815 PMCID: PMC7503474 DOI: 10.1093/texcom/tgaa033] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 12/15/2022] Open
Abstract
Although severe early life stress has been shown to accelerate the development of frontolimbic resting-state functional connectivity (RSFC), less is known about the effects of socioeconomic disadvantage, a prolonged and multifaceted stressor. In a cross-sectional study of 127 participants aged 5–25, we examined whether lower neighborhood socioeconomic status (SES; measured by Area Deprivation Index and neighborhood poverty and educational attainment) was associated with prematurely reduced amygdala-ventromedial prefrontal cortex (vmPFC) RSFC. We further tested whether neighborhood SES was more predictive than household SES and whether SES effects on connectivity were associated with anxiety symptoms. We found reduced basolateral amygdala-vmPFC RSFC at earlier ages in participants from more disadvantaged neighborhoods; this effect was unique to neighborhood SES and absent for household SES. Furthermore, this reduced connectivity in more disadvantaged youth and increased connectivity in more advantaged youth were associated with less anxiety; children who deviated from the connectivity pattern associated with their neighborhood SES had more anxiety. These results demonstrate that neighborhood socioeconomic disadvantage is associated with accelerated maturation of amygdala-vmPFC RSFC and suggest that the pathophysiology of pediatric anxiety depends on a child’s neighborhood socioeconomic characteristics. Our findings also underscore the importance of examining SES effects in studies of brain development.
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Affiliation(s)
- Bruce Ramphal
- New York State Psychiatric Institute and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Mariah DeSerisy
- Department of Psychology, Fordham University, Bronx, NY 10458, USA
| | - David Pagliaccio
- New York State Psychiatric Institute and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Elizabeth Raffanello
- New York State Psychiatric Institute and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Virginia Rauh
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Gregory Tau
- New York State Psychiatric Institute and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Jonathan Posner
- New York State Psychiatric Institute and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Rachel Marsh
- New York State Psychiatric Institute and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Amy E Margolis
- New York State Psychiatric Institute and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
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McMaughan DJ, Oloruntoba O, Smith ML. Socioeconomic Status and Access to Healthcare: Interrelated Drivers for Healthy Aging. Front Public Health 2020; 8:231. [PMID: 32626678 PMCID: PMC7314918 DOI: 10.3389/fpubh.2020.00231] [Citation(s) in RCA: 246] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 05/15/2020] [Indexed: 01/30/2023] Open
Abstract
The rapid growth of the global aging population has raised attention to the health and healthcare needs of older adults. The purpose of this mini-review is to: (1) elucidate the complex factors affecting the relationship between chronological age, socio-economic status (SES), access to care, and healthy aging using a SES-focused framework; (2) present examples of interventions from across the globe; and (3) offer recommendations for research-guided action to remediate the trend of older age being associated with lower SES, lack of access to care, and poorer health outcomes. Evidence supports a relationship between SES and healthcare access as well as healthcare access and health outcomes for older adults. Because financial resources are proportional to health status, efforts are needed to support older adults and the burdened healthcare system with financial resources. This can be most effective with grassroots approaches and interventions to improve SES among older adults and through data-driven policy and systems change.
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Affiliation(s)
- Darcy Jones McMaughan
- Department of Health Education and Promotion, School of Community Health Sciences, Counseling, and Counseling Psychology, Oklahoma State University, Stillwater, OK, United States
- Center for Population Health and Aging, Texas A&M University, College Station, TX, United States
| | - Oluyomi Oloruntoba
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, United States
| | - Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M University, College Station, TX, United States
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, United States
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16
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Feng C, Forthman KL, Kuplicki R, Yeh HW, Stewart JL, Paulus MP. Neighborhood affluence is not associated with positive and negative valence processing in adults with mood and anxiety disorders: A Bayesian inference approach. Neuroimage Clin 2019; 22:101738. [PMID: 30870735 PMCID: PMC6416773 DOI: 10.1016/j.nicl.2019.101738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/09/2019] [Accepted: 02/27/2019] [Indexed: 10/27/2022]
Abstract
Survey-based studies show that neighborhood disadvantage is associated with community reported mental health problems. However, fewer studies have examined whether neighborhood characteristics have measurable impact on mental health status of individuals in general and whether neighborhood characteristics impact positive/negative valence processing at both behavioral and brain levels. This study addressed these questions by investigating effects of census-based neighborhood affluence on self-reported symptoms, brain functions, and structures associated with positive/negative valence processing in a sample of individuals with mood and anxiety disorders (n = 262). Employing a Bayesian inference approach, our investigation demonstrates that neighborhood affluence fails to be associated with positive/negative valence processing measured across multiple modalities, with the only effects of neighborhood affluence identified in trait anxiety scores. These findings highlight that while community-based relationships between neighborhood characteristics and mental health problems are strong, it is much less clear that these characteristics have a measurable impact on the individual.
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Affiliation(s)
- Chunliang Feng
- Laureate Institute for Brain Research, Tulsa, OK, United States of America
| | - Katherine L Forthman
- Laureate Institute for Brain Research, Tulsa, OK, United States of America; University of Tulsa, Tulsa, OK, United States of America
| | - Rayus Kuplicki
- Laureate Institute for Brain Research, Tulsa, OK, United States of America
| | - Hung-Wen Yeh
- Laureate Institute for Brain Research, Tulsa, OK, United States of America
| | - Jennifer L Stewart
- Laureate Institute for Brain Research, Tulsa, OK, United States of America
| | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, OK, United States of America.
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Huang Y, Meyer P, Jin L. Neighborhood socioeconomic characteristics, healthcare spatial access, and emergency department visits for ambulatory care sensitive conditions for elderly. Prev Med Rep 2018; 12:101-105. [PMID: 30233997 PMCID: PMC6138954 DOI: 10.1016/j.pmedr.2018.08.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 07/01/2018] [Accepted: 08/26/2018] [Indexed: 11/22/2022] Open
Abstract
The objective of this study is to explore relationships among neighborhood socioeconomic characteristics (for example, income and ethnicity), spatial access to health care, and emergency department (ED) visits for ambulatory care sensitive conditions (ACSC) for adults aged 65 years and over. ED visit data were from 15 counties in the Texas Coastal Bend from September 1, 2009 and August 1, 2012. ED visits for ACSC that were common for elderly were estimated based on Agency for Healthcare Research and Quality's (AHRQ's) ACSC and Prevention Quality Indicators. The U.S. Census American Community Service (ACS) data provided neighborhood socioeconomic characteristics. Spatial access to general practices and to hospitals, respectively at the zip code level were estimated using the enhanced two-step floating catchment area method. Using multivariable regression models, we estimated associations of elderly ACSC ED visits with neighborhood socioeconomic characteristics and spatial accessibility of healthcare. We found higher rates of elderly ACSC ED visits are significantly associated with higher rates of elderly Hispanic and poverty at the zip code level. Spatial access to general practices and hospitals play inverse roles in the rate of elderly ACSC ED visits. Poorer access to general practices but easier access to hospitals contributes to the higher elderly ACSC ED rate at the zip code level. Neighborhood socioeconomic characteristics and spatial access to healthcare affect the rate of elderly ACSC ED visits. Research informing policy action is needed to decrease racial/ethnic and economic disadvantage and increase equitable spatial access to primary care for the elderly.
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Affiliation(s)
- Yuxia Huang
- Department of Computing Sciences, Texas A&M University – Corpus Christi, Corpus Christi, TX 78412, USA
| | - Pamela Meyer
- Department of Psychology and Sociology, Texas A&M University – Corpus Christi, Corpus Christi, TX 78412, USA
| | - Lei Jin
- Department of Mathematics and Statistics, Texas A&M University – Corpus Christi, Corpus Christi, TX 78412, USA
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18
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Relationships between the neighborhood environment and depression in older adults: a systematic review and meta-analysis. Int Psychogeriatr 2018; 30:1153-1176. [PMID: 29223174 DOI: 10.1017/s104161021700271x] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
UNLABELLED ABSTRACTBackground:While depression is a growing public health issue, the percentage of individuals with depression receiving treatment is low. Physical and social attributes of the neighborhood may influence the level of depressive symptoms and the prevalence of depression in older adults. METHODS This review systematically examined the literature on neighborhood environmental correlates of depression in older adults. Findings were analyzed according to three depression outcomes: depressive symptoms, possible depression, and clinical depression. Based on their description in the article, environmental variables were assigned to one of 25 categories. The strength of evidence was statistically quantified using a meta-analytical approach with articles weighted for sample size and study quality. Findings were summarized by the number of positive, negative, and statistically non-significant associations by each combination of environmental attribute - depression outcome and by combining all depression outcomes. RESULTS Seventy-three articles met the selection criteria. For all depression outcomes combined, 12 of the 25 environmental attribute categories were considered to be sufficiently studied. Three of these, neighborhood socio-economic status, collective efficacy, and personal/crime-related safety were negatively associated with all depression outcomes combined. Moderating effects on associations were sparsely investigated, with 52 articles not examining any. Attributes of the physical neighborhood environment have been understudied. CONCLUSION This review provides support for the potential influence of some neighborhood attributes on population levels of depression. However, further research is needed to adequately examine physical attributes associated with depression and moderators of both social and physical neighborhood environment attribute - depression outcome associations.
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19
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McDoom MM, Palta P, Vart P, Juraschek SP, Kucharska-Newton A, Roux AVD, Coresh J. Late life socioeconomic status and hypertension in an aging cohort: the Atherosclerosis Risk in Communities Study. J Hypertens 2018; 36:1382-1390. [PMID: 29621068 PMCID: PMC6453664 DOI: 10.1097/hjh.0000000000001696] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To investigate the association between individual and area-level socioeconomic status and hypertension risk among individuals later in life. METHODS We used Cox proportional hazards models to examine the association of socioeconomic status with incident hypertension using race-specific neighborhood socioeconomic status, median household income, and education among 3372 participants (mean age, 61 years) from the Atherosclerosis Risk in Communities Study at Visit 4 (1996-1998). Incident hypertension was defined as self-reported diagnosis or reported use of antihypertensive medications. RESULTS Over a median follow-up time of 9.4 years, there were 1874 new cases of hypertension (62.1 per 1000 person-years). Overall, being in high as compared with low socioeconomic status categories was associated with a lower risk of developing hypertension in late life, with hazard ratios (95% confidence intervals) of 0.87 (0.77-0.98) for high neighborhood socioeconomic status tertile, 0.79 (0.69-0.90) for high individual income, and 0.75 (0.63-0.89) for college education after adjustment for traditional risk factors. These findings were consistent and robust whenever accounting for competing risks of all-cause mortality. No significant interactions by race and age (dichotomized at age 65) were observed. CONCLUSION Among participants free of hypertension in midlife, high neighborhood and individual socioeconomic status are associated with a decreased risk of incident hypertension. Our findings support population-level interventions, such as blood pressure screening at senior centers and faith-based organizations, that are tailored to shift the distribution of blood pressure and reduce hypertension health inequalities among older adults.
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Affiliation(s)
- M. Maya McDoom
- Johns Hopkins University Bloomberg School of Public Health
and Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore,
Maryland
| | - Priya Palta
- University of North Carolina at Chapel Hill Gillings School
of Global Public Health, Chapel Hill, North Carolina
| | - Priya Vart
- Johns Hopkins University Bloomberg School of Public Health
and Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore,
Maryland
| | | | - Anna Kucharska-Newton
- University of North Carolina at Chapel Hill Gillings School
of Global Public Health, Chapel Hill, North Carolina
| | - Ana V. Diez Roux
- Drexel University Dornsife School of Public Health,
Philadelphia, Pennsylvania, USA
| | - Josef Coresh
- Johns Hopkins University Bloomberg School of Public Health
and Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore,
Maryland
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20
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Zhang CJP, Barnett A, Sit CHP, Lai PC, Johnston JM, Lee RSY, Cerin E. Cross-sectional associations of objectively assessed neighbourhood attributes with depressive symptoms in older adults of an ultra-dense urban environment: the Hong Kong ALECS study. BMJ Open 2018; 8:e020480. [PMID: 29581207 PMCID: PMC5875633 DOI: 10.1136/bmjopen-2017-020480] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES This study aimed to examine the associations between objectively assessed neighbourhood environmental attributes and depressive symptoms in Hong Kong Chinese older adults and the moderating effects of neighbourhood environmental attributes on the associations between living arrangements and depressive symptoms. DESIGN Cross-sectional observational study. SETTING Hong Kong. PARTICIPANTS 909 Hong Kong Chinese community dwellers aged 65+ years residing in preselected areas stratified by walkability and socioeconomic status. EXPOSURE AND OUTCOME MEASURES Attributes of participants' neighbourhood environment were objectively assessed using geographic information systems and environmental audits. Depressive symptoms were measured using the Geriatric Depression Scale. RESULTS Overall, pedestrian infrastructure (OR=1.025; P=0.008), connectivity (OR=1.039; P=0.002) and prevalence of public transport stops (OR=1.056; P=0.012) were positively associated with the odds of reporting depressive symptoms. Older adults living alone were at higher risk of reporting any depressive symptoms than those living with others (OR=1.497; P=0.039). This association was moderated by neighbourhood crowdedness, perceptible pollution, access to destinations and presence of people. Residing in neighbourhoods with lower levels of these attributes was associated with increased deleterious effects of living alone. Living in neighbourhoods with lower public transport density also increased the deleterious effects of living alone on the number of depressive symptoms. Those living alone and residing in neighbourhoods with higher levels of connectivity tended to report more depressive symptoms than their counterparts. CONCLUSIONS The level of access to destinations and social networks across Hong Kong may be sufficiently high to reduce the risk of depressive symptoms in older adults. Yet, exposure to extreme levels of public transport density and associated traffic volumes may increase the risk of depressive symptoms. The provision of good access to a variety of destinations, public transport and public open spaces for socialising in the neighbourhood may help reduce the risk of depressive symptoms in older adults who live alone.
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Affiliation(s)
- Casper J P Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Anthony Barnett
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Cindy H P Sit
- Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Poh-chin Lai
- Department of Geography, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
| | - Janice M Johnston
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Ruby S Y Lee
- Elderly Health Service, Department of Health, The Government of Hong Kong Special Administration Region, Hong Kong, China
| | - Ester Cerin
- School of Public Health, The University of Hong Kong, Hong Kong, China
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
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Schultz ASH, Dahl L, McGibbon E, Brownlie RJ, Cook C, Elbarouni B, Katz A, Nguyen T, Sawatzky JA, Sinclaire M, Throndson K, Fransoo R. Index coronary angiography use in Manitoba, Canada: a population-level descriptive analysis of First Nations and non-First Nations recipients. BMJ Open 2018; 8:e020856. [PMID: 29581209 PMCID: PMC5875607 DOI: 10.1136/bmjopen-2017-020856] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To investigate recipient characteristics and rates of index angiography among First Nations (FN) and non-FN populations in Manitoba, Canada. SETTING Population-based, secondary analysis of provincial administrative health data. PARTICIPANTS All adults 18 years or older who received an index angiogram between 2000/2001 and 2008/2009. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Descriptive statistics for age, sex, income quintile by rural and urban residency and Charlson Comorbidity Index for FN and non-FN recipients. (2) Annual index angiogram rates for FN and non-FN populations and among those rates of 'urgent' angiograms based on acute myocardial infarction (AMI)-related hospitalisations during the previous 7 days. (3) Proportions of people who did not receive an angiogram in the 20 years preceding an ischaemic heart disease (IHD) diagnosis or a cardiovascular death; stratified by age (<65 or ≥65 years old). RESULTS FN recipients were younger (56.3vs63.8 years; p<0.0001) and had higher Charlson Comorbidity scores (1.32vs0.78; p<0.001). During all years examined, index angiography rates were lower among FN people (2.67vs3.33 per 1000 population per year; p<0.001) with no notable temporal trends. Among the index angiogram recipients, a higher proportion was associated with an AMI-related hospitalisation in the FN group (28.8%vs25.0%; p<0.01) and in both groups rates significantly increased over time. FN people who died from cardiovascular disease or were older (65+years old) diagnosed with IHD were more likely to have received an angiogram in the preceding 20-30 years (17.8%vs12.5%; p<0.01 and 50.9%vs49.5%; p<0.03, respectively). FN people diagnosed with IHD who were under the age of 65 were less likely to have received an angiogram (47.8%vs53.1%; p<0.01) CONCLUSIONS: Index angiogram use differences are suggested between FN and non-FN populations, which may contribute to reported IHD disparities. Investigating factors driving these rates will determine any association between ethnicity and angiography services.
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Affiliation(s)
- Annette S H Schultz
- College of Nursing, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lindsey Dahl
- College of Nursing, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth McGibbon
- Rankin School of Nursing Faculty of Health Sciences, St Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - R Jarvis Brownlie
- Department of History, Faculty of Arts, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Catherine Cook
- Indigenous Health, Rady Faculty of Health Sciences (RFHS), First Nations, Métis and Inuit Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Basem Elbarouni
- Max Rady College of Medicine, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alan Katz
- College of Medicine, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Thang Nguyen
- Max Rady College of Medicine, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jo Ann Sawatzky
- College of Nursing, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Moneca Sinclaire
- College of Nursing, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Karen Throndson
- Clinical Nurse Specialist Cardiac Sciences Program, St Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Randy Fransoo
- Manitoba Centre for Health Policy, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
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Cooley ME, Thompson HM, Murray H. Health Outcomes of Medically and Economically Vulnerable Adults: A Comparison of Former Foster Youth and Nonfoster Youth. FAMILY & COMMUNITY HEALTH 2018; 41:159-167. [PMID: 29781917 DOI: 10.1097/fch.0000000000000190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Medically and economically vulnerable adults experience various challenges that can impact their health. Within this vulnerable population, there may be individuals who are even more vulnerable, those who have a history of involvement with the foster care system. The purpose of this study was to evaluate the difference of reported health-related problems between adults with previous foster care experience and other vulnerable adults. Physical, mental, and relational health was evaluated in this study. Practice and policy implications for mental health and medical professionals are discussed.
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23
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Gan DRY. Neighborhood effects for aging in place: a transdisciplinary framework toward health-promoting settings. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/08882746.2017.1393283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Daniel Rong Yao Gan
- Centre for Ageing Research in the Environment, National University of Singapore, Singapore
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Besser LM, McDonald NC, Song Y, Kukull WA, Rodriguez DA. Neighborhood Environment and Cognition in Older Adults: A Systematic Review. Am J Prev Med 2017; 53:241-251. [PMID: 28455123 PMCID: PMC5522645 DOI: 10.1016/j.amepre.2017.02.013] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 01/10/2017] [Accepted: 02/16/2017] [Indexed: 01/14/2023]
Abstract
CONTEXT Some evidence suggests that treating vascular risk factors and performing mentally stimulating activities may delay cognitive impairment onset in older adults. Exposure to a complex neighborhood environment may be one mechanism to help delay cognitive decline. EVIDENCE ACQUISITION PubMed, Web of Science, and ProQuest Dissertation and Theses Global database were systematically reviewed, identifying 25 studies published from February 1, 1989 to March 5, 2016 (data synthesized, May 3, 2015 to October 7, 2016). The review was restricted to quantitative studies focused on: (1) neighborhood social and built environment and cognition; and (2) community-dwelling adults aged ≥45 years. EVIDENCE SYNTHESIS The majority of studies were cross-sectional, U.S.-based, and found at least one significant association. The diversity of measures and neighborhood definitions limited the synthesis of findings in many instances. Evidence was moderately strong for an association between neighborhood SES and cognition, and modest for associations between neighborhood demographics, design, and destination accessibility and cognition. Most studies examining effect modification found significant associations, with some evidence for effect modification of the neighborhood SES-cognition association by individual-level SES. No studies had low risk of bias and many tested multiple associations that increased the chance of a statistically significant finding. Considering the studies to date, the evidence for an association between neighborhood characteristics and cognition is modest. CONCLUSIONS Future studies should include longitudinal measures of neighborhood characteristics and cognition; examine potential effect modifiers, such as sex and disability; and study mediators that may help elucidate the biological mechanisms linking neighborhood environment and cognition.
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Affiliation(s)
- Lilah M Besser
- Department of City and Regional Planning, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, National Alzheimer's Coordinating Center, University of Washington, Seattle, Washington.
| | - Noreen C McDonald
- Department of City and Regional Planning, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yan Song
- Department of City and Regional Planning, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Walter A Kukull
- Department of Epidemiology, National Alzheimer's Coordinating Center, University of Washington, Seattle, Washington
| | - Daniel A Rodriguez
- Department of City and Regional Planning, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of City and Regional Planning, University of California, Berkeley, Berkeley, California
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Majeed T, Forder PM, Mishra G, Kendig H, Byles JE. Exploring Workforce Participation Patterns and Chronic Diseases Among Middle-Aged Australian Men and Women Over the Life Course. J Aging Health 2017; 29:343-361. [PMID: 26957550 DOI: 10.1177/0898264316635586] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study identified associations between chronic diseases (diabetes, asthma, depression, and arthritis) and workforce participation patterns with a gendered perspective. METHOD We used data from 1,261 middle-aged participants of the Australian Life Histories and Health (LHH) Survey, aged 60 to 64 years in 2011. Latent class analysis identified dominant workforce patterns and associations between chronic diseases and these patterns were explored by multinomial regression models. RESULTS Diabetes, asthma, depression, and arthritis were less prevalent in men and women in class "mostly full-time work," compared with other workforce patterns. The odds of "mostly full-time work" were lower for men reporting depression or arthritis, whereas among women, depression was associated with "increasing part-time work" after adjusting early and adult life factors. DISCUSSION The results strengthen the importance of gender focused policies aimed to promote and preserve health of young and middle-aged workers, and creating supportive environment for those with chronic health issues over the life course.
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Affiliation(s)
| | | | - Gita Mishra
- 2 The University of Queensland, Brisbane, Australia
| | - Hal Kendig
- 3 Australian National University, Canberra, Australia
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Osypuk TL, Ehntholt A, Moon JR, Gilsanz P, Glymour MM. Neighborhood Differences in Post-Stroke Mortality. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.002547. [PMID: 28228449 DOI: 10.1161/circoutcomes.116.002547] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 12/22/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Post-stroke mortality is higher among residents of disadvantaged neighborhoods, but it is not known whether neighborhood inequalities are specific to stroke survival or similar to mortality patterns in the general population. We hypothesized that neighborhood disadvantage would predict higher poststroke mortality, and neighborhood effects would be relatively larger for stroke patients than for individuals with no history of stroke. METHODS AND RESULTS Health and Retirement Study participants aged ≥50 years without stroke at baseline (n=15 560) were followed ≤12 years for incident stroke (1715 events over 159 286 person-years) and mortality (5325 deaths). Baseline neighborhood characteristics included objective measures based on census tracts (family income, poverty, deprivation, residential stability, and percent white, black, or foreign-born) and self-reported neighborhood social ties. Using Cox proportional hazard models, we compared neighborhood mortality effects for people with versus people without a history of stroke. Most neighborhood variables predicted mortality for both stroke patients and the general population in demographic-adjusted models. Neighborhood percent white predicted lower mortality for stroke survivors (hazard ratio, 0.75 for neighborhoods in highest 25th percentile versus below, 95% confidence interval, 0.62-0.91) more strongly than for stroke-free adults (hazard ratio, 0.92; 95% confidence interval, 0.83-1.02; P=0.04 for stroke-by-neighborhood interaction). No other neighborhood characteristic had different effects for people with versus without stroke. Neighborhood-mortality associations emerged within 3 months after stroke, when associations were often stronger than among stroke-free individuals. CONCLUSIONS Neighborhood characteristics predict mortality, but most effects are similar for individuals without stroke. Eliminating disparities in stroke survival may require addressing pathways that are not specific to traditional poststroke care.
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Affiliation(s)
- Theresa L Osypuk
- From the Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis (T.L.O.); Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA (A.E., P.G., M.M.G.); SBH Health System, Bronx Partners for Healthy Communities, NY (J.R.M.); and Department of Epidemiology & Biostatistics, University of California, San Francisco (P.G., M.M.G.).
| | - Amy Ehntholt
- From the Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis (T.L.O.); Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA (A.E., P.G., M.M.G.); SBH Health System, Bronx Partners for Healthy Communities, NY (J.R.M.); and Department of Epidemiology & Biostatistics, University of California, San Francisco (P.G., M.M.G.)
| | - J Robin Moon
- From the Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis (T.L.O.); Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA (A.E., P.G., M.M.G.); SBH Health System, Bronx Partners for Healthy Communities, NY (J.R.M.); and Department of Epidemiology & Biostatistics, University of California, San Francisco (P.G., M.M.G.)
| | - Paola Gilsanz
- From the Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis (T.L.O.); Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA (A.E., P.G., M.M.G.); SBH Health System, Bronx Partners for Healthy Communities, NY (J.R.M.); and Department of Epidemiology & Biostatistics, University of California, San Francisco (P.G., M.M.G.)
| | - M Maria Glymour
- From the Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis (T.L.O.); Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA (A.E., P.G., M.M.G.); SBH Health System, Bronx Partners for Healthy Communities, NY (J.R.M.); and Department of Epidemiology & Biostatistics, University of California, San Francisco (P.G., M.M.G.)
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27
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Wagner KJP, Boing AF, Subramanian SV, Höfelmann DA, D'Orsi E. Effects of neighborhood socioeconomic status on blood pressure in older adults. Rev Saude Publica 2016; 50:78. [PMID: 28099662 PMCID: PMC5152802 DOI: 10.1590/s1518-8787.2016050006595] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/25/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To test if the neighborhood socioeconomic status is associated with systolic blood pressure and hypertension in older adults. METHODS A cross-sectional population-based study with a sample of 1,705 older adults from Florianópolis, SC, Southern Brazil. The contextual variable used was the average years of schooling of the head of the household in census tracts. Participants were considered hypertensive when the systolic blood pressure was ≥ 140 mmHg, diastolic ≥ 90 mmHg, or both. Additionally, the use of antihypertensive medication was also considered. Data were analyzed by using multilevel models of logistic and linear regression. RESULTS The average age of the sample was 70.7 years and the average of systolic and diastolic blood pressure was 133.5 mmHg (SD = 20.5 mmHg) and 81.9 mmHg (SD = 12.5 mmHg), respectively. The systolic blood pressure was 4.46 mmHg (95%CI 1.00-7.92) higher and the chance of hypertension was 1.80 (95%CI 1.26-2.57) among those who lived in census tracts with lower level of schooling. When the use of antihypertensive medication was combined with blood pressure levels, none association was found between the outcome and the level of schooling of the census tract. CONCLUSIONS Analytical models more robust (such as multilevel analysis) in Brazil are still little used, with a small number of articles published. Neighborhood socioeconomic status is associated with systolic blood pressure and the chance of hypertension, regardless of individual characteristics.
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Affiliation(s)
| | - Antonio Fernando Boing
- Programa de Pós-Graduação em Saúde Pública. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil.,Department of Society, Human Development and Health. Harvard School of Public Health. Massachusetts, United States
| | - S V Subramanian
- Department of Society, Human Development and Health. Harvard School of Public Health. Massachusetts, United States
| | | | - Eleonora D'Orsi
- Programa de Pós-Graduação em Saúde Pública. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
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Hirsch JA, Green GF, Peterson M, Rodriguez DA, Gordon-Larsen P. Neighborhood Sociodemographics and Change in Built Infrastructure. JOURNAL OF URBANISM 2016; 10:181-197. [PMID: 28316645 PMCID: PMC5353850 DOI: 10.1080/17549175.2016.1212914] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
While increasing evidence suggests an association between physical infrastructure in neighbourhoods and health outcomes, relatively little research examines how neighbourhoods change physically over time and how these physical improvements are spatially distributed across populations. This paper describes the change over 25 years (1985-2010) in bicycle lanes, off-road trails, bus transit service, and parks, and spatial clusters of changes in these domains relative to neighbourhood sociodemographics in four U.S. cities that are diverse in terms of geography, size and population. Across all four cities, we identified increases in bicycle lanes, off-road trails, and bus transit service, with spatial clustering in these changes that related to neighbourhood sociodemographics. Overall, we found evidence of positive changes in physical infrastructure commonly identified as supportive of physical activity. However, the patterning of infrastructure change by sociodemographic change encourages attention to the equity in infrastructure improvements across neighbourhoods.
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Affiliation(s)
- Jana A. Hirsch
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Geoffrey F. Green
- City and Regional Planning, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marc Peterson
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel A. Rodriguez
- City and Regional Planning, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Institute for the Environment, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Penny Gordon-Larsen
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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29
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Rosso AL, Flatt JD, Carlson MC, Lovasi GS, Rosano C, Brown AF, Matthews KA, Gianaros PJ. Neighborhood Socioeconomic Status and Cognitive Function in Late Life. Am J Epidemiol 2016; 183:1088-97. [PMID: 27257114 DOI: 10.1093/aje/kwv337] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 12/02/2015] [Indexed: 11/12/2022] Open
Abstract
Neighborhood socioeconomic status (NSES) is associated with cognitive function, independently of individual demographic, health, and socioeconomic characteristics. However, research has been largely cross-sectional, and mechanisms of the association are unknown. In 1992-1993, Cardiovascular Health Study participants (n = 3,595; mean age = 74.8 years; 15.7% black) underwent cognitive testing and magnetic resonance imaging of white matter hyperintensities (WMH), and their addresses were geocoded. NSES was calculated using 1990 US Census data (block groups; 6 measures of wealth, education, and occupation). The Modified Mini-Mental State Examination (3MS) was used to assess general cognition, and the Digit Symbol Substitution Test (DSST) was used to assess speed of processing annually for 6 years. Associations of race-specific NSES tertiles with 3MS, DSST, and WMH were estimated using linear mixed-effects models accounting for geographic clustering, stratified by race, and adjusted for demographic, health, and individual socioeconomic status (education, income, lifetime occupational status) variables. In fully adjusted models, higher NSES was associated with higher 3MS scores in blacks (mean difference between highest and lowest NSES = 2.4 points; P = 0.004) and whites (mean difference = 0.7 points; P = 0.02) at baseline but not with changes in 3MS over time. NSES was marginally associated with DSST and was not associated with WMH. Adjustment for WMH did not attenuate NSES-3MS associations. Associations of NSES with cognition in late adulthood differ by race, are not explained by WMH, and are evident only at baseline.
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Physical activity in older age: perspectives for healthy ageing and frailty. Biogerontology 2016; 17:567-80. [PMID: 26936444 PMCID: PMC4889622 DOI: 10.1007/s10522-016-9641-0] [Citation(s) in RCA: 635] [Impact Index Per Article: 79.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 02/19/2016] [Indexed: 12/24/2022]
Abstract
Regular physical activity helps to improve physical and mental functions as well as reverse some effects of chronic disease to keep older people mobile and independent. Despite the highly publicised benefits of physical activity, the overwhelming majority of older people in the United Kingdom do not meet the minimum physical activity levels needed to maintain health. The sedentary lifestyles that predominate in older age results in premature onset of ill health, disease and frailty. Local authorities have a responsibility to promote physical activity amongst older people, but knowing how to stimulate regular activity at the population-level is challenging. The physiological rationale for physical activity, risks of adverse events, societal and psychological factors are discussed with a view to inform public health initiatives for the relatively healthy older person as well as those with physical frailty. The evidence shows that regular physical activity is safe for healthy and for frail older people and the risks of developing major cardiovascular and metabolic diseases, obesity, falls, cognitive impairments, osteoporosis and muscular weakness are decreased by regularly completing activities ranging from low intensity walking through to more vigorous sports and resistance exercises. Yet, participation in physical activities remains low amongst older adults, particularly those living in less affluent areas. Older people may be encouraged to increase their activities if influenced by clinicians, family or friends, keeping costs low and enjoyment high, facilitating group-based activities and raising self-efficacy for exercise.
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31
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Eibich P, Krekel C, Demuth I, Wagner GG. Associations between Neighborhood Characteristics, Well-Being and Health Vary over the Life Course. Gerontology 2016; 62:362-70. [DOI: 10.1159/000438700] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 07/14/2015] [Indexed: 11/19/2022] Open
Abstract
Background: Neighborhood characteristics are important determinants of individual health and well-being. For example, characteristics such as noise and pollution affect health directly, while other characteristics affect health and well-being by either providing resources (e.g. social capital in the neighborhood), which individuals can use to cope with health problems, or limiting the use thereof (e.g. crime). This also suggests that there might be age differentials in the impact of these characteristics, since individuals at different stages of life might need different resources. However, there is a lack of empirical evidence on age differentials in associations between well-being, health, and neighborhood characteristics. Objective: This paper studies associations between a wide range of neighborhood characteristics with the health and well-being of residents of the greater Berlin area. In particular, we focus on differences in the effects between younger (aged 20-35) and older (aged 60+) residents. Methods: We used data from the Berlin Aging Study II (312 younger and 993 older residents of the Berlin metropolitan area in Germany). We used survey data on health and well-being, combined these with subjective perceptions of the neighborhood, and geo-referenced indicators on the neighborhood, e.g. amenities (public transport, physicians, and hospitals). Results: The results show that access to public transportation is associated with better outcomes on all measures of health and well-being, and social support is associated with higher life satisfaction and better mental health. There are considerable differences between both age groups: while the associations between access to public transport and health and well-being are similar for both age groups, neighborhood social capital shows stronger associations for older residents. However, the difference is not always statistically significant. Conclusion: Having access to services is associated with better health and well-being regardless of age. Local policy makers should focus on lowering barriers to mobility in order to improve the health and well-being of the population. Since the social capital of a neighborhood is associated with better health and well-being among older residents, investments that increase social capital (e.g. community centers) might be warranted in neighborhoods with higher shares of older residents.
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Examining childhood obesity and the environment of a segregated, lower-income US suburb. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE 2015. [DOI: 10.1108/ijhrh-09-2014-0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The contribution of the built environment within communities plays a significant role in the higher rates of childhood obesity, particularly among black and Hispanic youth. The purpose of this paper is to investigate neighborhood assets and barriers to nutrition and physical activity in an underserved, majority-minority suburban community in New York State, USA using Photovoice, a community-based participatory research method.
Design/methodology/approach
– Nine local youth took photographs to visually identify the community’s environmental assets and barriers. Through an extensive review and selection of photos and group discussion themes were identified. Final results of the Photovoice project were presented to local policy makers and community members for action.
Findings
– Participants provided complex and insightful perspectives of health inequalities in the suburbs, including limited access to fresh, healthy food, and safe spaces for physical activity. They also understood that improving nutrition and physical activity practices required policy changes and civic engagement.
Research limitations/implications
– This study represented one suburban area of New York, and is not meant to be representative of all suburban areas. However, the findings of environmental barriers to childhood obesity are similar to those found in urban areas, suggesting similarities in low-income communities of color.
Social implications
– This study suggests that Photovoice is an effective way of collaborating between various community stakeholders (particularly youth) in an underserved suburb that can result in community changes.
Originality/value
– Besides achieving all three Photovoice goals – recording and reflection, dialogue, and reaching policymakers – the Photovoice project identified a long-standing environmental hazard as a result of the partnerships established between the youth, academic institution, community-based organizations, and residents. This study also identified factors in the built environment that contribute to health disparities in a racially segregated suburban community.
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Choi NG, Kim J, DiNitto DM, Marti CN. Perceived Social Cohesion, Frequency of Going Out, and Depressive Symptoms in Older Adults: Examination of Longitudinal Relationships. Gerontol Geriatr Med 2015; 1:2333721415615478. [PMID: 28138478 PMCID: PMC5119803 DOI: 10.1177/2333721415615478] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 10/02/2015] [Indexed: 11/16/2022] Open
Abstract
Objective: To examine both cross-sectional and longitudinal relationships between older adults’ perceptions of social cohesion in their community and depressive symptoms and the potential mediating effect of the frequency of going outside one’s home/building. Method: Using two waves (T1 and T2) of the National Health and Aging Trend Study (n = 5,326), gender-stratified structural equation models were estimated to determine direct and indirect effects of perceived social cohesion on depressive symptoms. Results: At T1, both perceived cohesion and frequency of going out were directly associated with depressive symptoms; however, perceived cohesion predicted frequency of going out only for women. At T2, only frequency of going out was directly associated with depressive symptoms, although perceived cohesion predicted frequency of going out for both genders. T1 perceived cohesion did not predict T2 depressive symptoms. T1 depressive symptoms were the strongest predictor of T2 depressive symptoms. Conclusion: The findings underscore the importance of enhancing the social environment in promoting mental health in late life through active aging.
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O'Donnell A, de Vries McClintock HF, Wiebe DJ, Bogner HR. Neighborhood Social Environment and Patterns of Depressive Symptoms Among Patients with Type 2 Diabetes Mellitus. Community Ment Health J 2015; 51:978-86. [PMID: 25761720 PMCID: PMC4567942 DOI: 10.1007/s10597-015-9855-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
Abstract
This study sought to examine whether neighborhood social environment was related to patterns of depressive symptoms among primary care patients with type 2 diabetes mellitus (DM). Neighborhood social environment was assessed in 179 patients with type 2 DM. Individual patient residential data at baseline was geo-coded at the tract level and was merged with measures of neighborhood social environment. Depressive symptoms at baseline and at 12-week follow up were assessed using the nine-item Patient Health Questionnaire (PHQ-9). Patients in neighborhoods with high social affluence, high residential stability, and high neighborhood advantage were much less likely to have a persistent pattern of depressive symptoms compared to a pattern of few or no depressive symptoms (adjusted odds ratio (OR) = 0.06, 95 % confidence interval (CI) [0.01, 0.36]). Detrimental neighborhood influences may amplify risk for persistent depressive symptoms.
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Affiliation(s)
- Alison O'Donnell
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Heather F de Vries McClintock
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, The University of Pennsylvania, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA
| | - Douglas J Wiebe
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, The University of Pennsylvania, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA
| | - Hillary R Bogner
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA. .,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, The University of Pennsylvania, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA.
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35
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Emerging psychopathology moderates upward social mobility: The intergenerational (dis)continuity of socioeconomic status. Dev Psychopathol 2015; 27:1217-36. [DOI: 10.1017/s0954579415000784] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractSocioeconomic status (SES) is relatively stable across generations, but social policies may create opportunities for upward social mobility among disadvantaged populations during periods of economic growth. With respect to expanded educational opportunities that occurred in Québec (Canada) during the 1960s, we hypothesized that children's social and academic competence would promote upward mobility, whereas aggression and social withdrawal would have the opposite effect. Out of 4,109 children attending low-SES schools in 1976–1978, a representative subsample of 503 participants were followed until midadulthood. Path analyses revealed that parents’ SES predicted offspring's SES through associations with offspring's likeability, academic competence, and educational attainment. Interaction effects revealed individual risk factors that moderated children's ability to take advantage of intrafamilial or extrafamilial opportunities that could enhance their educational attainment. Highly aggressive participants and those presenting low academic achievement were unable to gain advantage from having highly educated parents. They reached lower educational attainment than their less aggressive or higher achieving peers who came from a similarly advantaged family background. Growing up with parents occupying low-prestige jobs put withdrawn boys and outgoing girls at risk for low educational attainment. In conclusion, social policies can raise SES across generations, with great benefits for the most disadvantaged segments of the population. However, children presenting with emerging psychopathology or academic weaknesses do not benefit from these policies as much as others, and should receive additional, targeted services.
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36
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Kim K, Lee M. Depressive Symptoms of Older Adults Living Alone: The Role of Community Characteristics. Int J Aging Hum Dev 2015. [PMID: 26195500 DOI: 10.1177/0091415015590315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although some evidence suggests that community characteristics may play an important role in the development of depressive symptoms among older adults, current literature has not attended to the role of community characteristics in depression in South Korea. This study begins to address this gap in the literature by examining the relationship of community characteristics and depressive symptoms, controlling for individual characteristics. Using a cross-sectional design and probability sampling, we surveyed 949 older adults living alone in 70 communities in the Busan metropolitan area in South Korea in 2012. A multilevel logistic regression analysis was conducted to test the hypothesis that community characteristics are predictive of depressive symptoms. We find that both the proportion of older adults and the number of senior citizen facilities in a community are associated with depressive symptoms, whereas community poverty is not related to depressive symptoms. Men with lower income, with lower levels of functional abilities, and without stronger family and friend social networks have a higher risk of depressive symptoms. Implications for research, practice, and policy are discussed.
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Affiliation(s)
- Kyeongmo Kim
- School of Social Work, University of Maryland, Baltimore, MD, USA
| | - Minhong Lee
- Department of Social Welfare, Dong-Eui University, Busan, South Korea
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37
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Egan M, Kubina LA, Dubouloz CJ, Kessler D, Kristjansson E, Sawada M. Very low neighbourhood income limits participation post stroke: preliminary evidence from a cohort study. BMC Public Health 2015; 15:528. [PMID: 26040279 PMCID: PMC4453923 DOI: 10.1186/s12889-015-1872-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 04/28/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Neighbourhood income level is associated with the incidence of stroke and stroke-related mortality. It has also been linked to receipt of appropriate services, post discharge motor recovery and functional status following a stroke. We examined the impact of neighbourhood income on participation among community-dwelling stroke survivors during the two years following the stroke. METHODS Secondary analysis of data from a prospective cohort study. Participants were 67 individuals who were treated in acute care or rehabilitation following a first ever stroke, and were discharged to the community with FIM™ scores of at least 3 for comprehension, memory and problem solving. On this functional independence measure, these scores indicate that assistance is needed with related tasks up to 50 % of the time. Participation at 6, 9, 12, 18 and 24-months post stroke was measured using the Reintegration to Normal Living Index (RNLI). Income was measured by median neighbourhood annual family income according to postal code. The impact of very low neighbourhood income (median family income $20,000 Cdn or less) on participation at each follow-up period was determined controlling for potential confounders. RESULTS Six (9.0 %) of the participants lived in very low-income neighbourhoods. These participants had average RNLI scores approximately 25 % lower at each follow-up period. While there was a trend for increasing participation with time among those in higher income neighbourhoods, this was not seen among very low-income neighbourhood participants. Very low me neighbourhood income had an independent effect on participation after controlling for discharge FIM™, 2-min walk test, gender, self-rated health, age, and emotional well-being at all follow-up periods. CONCLUSIONS Our results indicate that very low neighbourhood income is linked with decreased participation during the first two years following stroke. Our findings indicate the need for further investigation of this relationship, and the importance of close follow-up of stroke survivors living in very low-income contexts.
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Affiliation(s)
- Mary Egan
- School of Rehabilitation Sciences University of Ottawa, 451 Smyth Road, K1H 8M5, Ottawa, ON, Canada.
- Bruyere Research Institute, 43 Bruyere St, K1N 5C8, Ottawa, ON, Canada.
| | - Lucy-Ann Kubina
- School of Rehabilitation Sciences University of Ottawa, 451 Smyth Road, K1H 8M5, Ottawa, ON, Canada.
| | - Claire-Jehanne Dubouloz
- School of Rehabilitation Sciences University of Ottawa, 451 Smyth Road, K1H 8M5, Ottawa, ON, Canada.
| | - Dorothy Kessler
- School of Rehabilitation Sciences University of Ottawa, 451 Smyth Road, K1H 8M5, Ottawa, ON, Canada.
- Bruyere Research Institute, 43 Bruyere St, K1N 5C8, Ottawa, ON, Canada.
| | - Elizabeth Kristjansson
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, K1N 6N5, Ottawa, ON, Canada.
| | - Michael Sawada
- Department of Geography, University of Ottawa, 60 Université, K1N 6N5, Ottawa, ON, Canada.
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Abstract
RÉSUMÉCette étude a examiné les facteurs qui influent l'adhésion dans un programme de de tai-chi à 16 semaines parmi les adultes multi-ethniques d'âge moyen et plus âgés qui vivent dans un environnement faible socio-économique à Toronto. L'analyse a été basée sur des données recueillies auprès de trois cohortes du programme de tai-chi qui ont eu lieu à partir d'août 2009 à mars 2012. La variable principale de résultat, l'adhésion, a été mesurée par le nombre total de sessions suivies par chacun des participants. L'échantillon total était de 210 participants, avec un âge moyen de 68,1 ± 8,6. Basé sur le modèle de régression, l'adhésion a été associée de façon significative à l'âge plus avancé, au stress plus perçu, à l'enseignement supérieur, et aux scores mentales et physiques plus élevés de composants sur le Questionnaire Abrégée 36. Inversement, une faible observance était significativement associée à une activité physique hebdomadaire de base plus élevée. Nos résultats suggèrent que nous devrions cibler les personnes les moins instruites, à la santé mentale et physique médiocre, pour optimiser l'adhésion aux futurs programmes de tai-chi communautaires.
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Chen PC, Tsai CY, Woung LC, Lee YC. Socioeconomic disparities in preventable hospitalization among adults with diabetes in Taiwan: a multilevel modelling approach. Int J Equity Health 2015; 14:31. [PMID: 25889800 PMCID: PMC4377057 DOI: 10.1186/s12939-015-0160-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 03/05/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Literature shows socioeconomic disparities are related to various aspects of diabetes care. However, few studies have explored the relationship between socioeconomics and healthcare outcomes, particularly with regard to preventable hospitalization. This cohort study employed hierarchical modelling to evaluate the role of socioeconomics at both the individual and regional levels in order to examine disparities associated with the preventable hospitalization of diabetes patients in Taiwan. METHODS This study employed the Longitudinal Health Insurance Database 2010, which provided a representative cohort comprising one million people enrolled in Taiwan's National Health Insurance in 2010. All diabetes patients aged 18 and older who received regular care in 2010 were included in this study. The outcome examined in this study was diabetes-related preventable hospitalization during the period of 2010 to 2011. Socioeconomic status at the individual level was measured according to income and at the regional level according to level of urbanization and the proportion of residents who had completed college education. Control variables included age, gender, comorbidities, time of diabetes diagnosis, participated in the pay-for-performance program status, and the characteristics of regular sources of care, including the level of the facility (i.e., medical centre, regional hospital, local hospital, outpatient clinic) and ownership. Statistical analysis was performed using generalized linear mixed models. RESULTS A total of 57,791 patients from 25 regions diagnosed with type-2 diabetes mellitus were identified in the National Health Insurance claim data for the year 2010. 1040 of these patients (1.8%) had at least one diabetes-related preventable hospitalization event during the period of 2010-2011. After controlling for the characteristics of patients and health care providers, our results show that dependents and patients in low and middle income brackets (OR = 2.48, 2.44, and 2.08 respectively) as well as those living in regions with a low, median, or high education bracket (OR = 1.32, 1.38, and 1.46 respectively) face a higher probability of preventable hospitalization. CONCLUSIONS Our results demonstrate that the socioeconomic effects of higher education at the regional level as well as income at the individual level are important factors which affect disparities in diabetes-related preventable hospitalization.
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Affiliation(s)
- Pei-Ching Chen
- Institute of Health and Welfare Policy, National Yang-Ming University, No.155, Sec. 2, Linong St, Beitou Dist, Taipei City, 112, Taiwan. .,Department of Education and Research, Taipei City Hospital, No.145, Zhengzhou Rd, Datong Dist, Taipei City, 103, Taiwan.
| | - Ching-Yao Tsai
- Department of Ophthalmology, Zhongxing Branch, Taipei City Hospital, No.145, Zhengzhou Rd, Datong Dist, Taipei City, 103, Taiwan. .,Institute of Public Health, National Yang-Ming University, No.155, Sec. 2, Linong St, Beitou Dist, Taipei City, 112, Taiwan.
| | - Lin-Chung Woung
- Department of Ophthalmology, Zhongxing Branch, Taipei City Hospital, No.145, Zhengzhou Rd, Datong Dist, Taipei City, 103, Taiwan. .,Institute of Hospital and Health Care Administration, National Yang-Ming University, No.155, Sec. 2, Linong St, Beitou Dist, Taipei City, 112, Taiwan.
| | - Yue-Chune Lee
- Institute of Health and Welfare Policy, National Yang-Ming University, No.155, Sec. 2, Linong St, Beitou Dist, Taipei City, 112, Taiwan.
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Fernández-Niño JA, Manrique-Espinoza BS, Bojorquez-Chapela I, Salinas-Rodríguez A. Income inequality, socioeconomic deprivation and depressive symptoms among older adults in Mexico. PLoS One 2014; 9:e108127. [PMID: 25250620 PMCID: PMC4176015 DOI: 10.1371/journal.pone.0108127] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 08/23/2014] [Indexed: 12/04/2022] Open
Abstract
Objective Depression is the second most common mental disorder in older adults (OA) worldwide. The ways in which depression is influenced by the social determinants of health – specifically, by socioeconomic deprivation, income inequality and social capital - have been analyzed with only partially conclusive results thus far. The objective of our study was to estimate the association of income inequality and socioeconomic deprivation at the locality, municipal and state levels with the prevalence of depressive symptoms among OA in Mexico. Methods Cross-sectional study based on a nationally representative sample of 8,874 OA aged 60 and over. We applied the brief seven-item version of the Center for Epidemiologic Studies Depression Scale (CES-D) to determine the presence of depressive symptoms. Additionally, to select the principal context variables, we used the Deprivation Index of the National Population Council of Mexico at the locality, municipal and state levels, and the Gini Index at the municipal and state levels. Finally, we estimated the association of income inequality and socioeconomic deprivation with the presence of depressive symptoms using a multilevel logistic regression model. Results Socioeconomic deprivation at the locality (OR = 1.28; p<0.10) and municipal levels (OR = 1.16; p<0.01) correlated significantly with the presence of depressive symptoms, while income inequality did not. Conclusions The results of our study confirm that the social determinants of health are relevant to the mental health of OA. Further research is required, however, to identify which are the specific socioeconomic deprivation components at the locality and municipal levels that correlate with depression in this population group.
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Affiliation(s)
| | | | - Ietza Bojorquez-Chapela
- Department of Population Studies, El Colegio de la Frontera Norte, Tijuana, Baja California, Mexico
| | - Aarón Salinas-Rodríguez
- Center for Evaluation Research and Surveys, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Bikdeli B, Wayda B, Bao H, Ross JS, Xu X, Chaudhry SI, Spertus JA, Bernheim SM, Lindenauer PK, Krumholz HM. Place of residence and outcomes of patients with heart failure: analysis from the telemonitoring to improve heart failure outcomes trial. Circ Cardiovasc Qual Outcomes 2014; 7:749-56. [PMID: 25074375 DOI: 10.1161/circoutcomes.113.000911] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Recent studies show an association between neighborhood-level measures of socioeconomic status (SES) and outcomes for patients with heart failure. We do not know whether neighborhood SES has a primary effect or is a marker for individual SES. METHODS AND RESULTS We used the data from participants of the Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) trial, recruited from 33 US internal medicine and cardiology practices and examined the association between neighborhood SES and outcomes of patients with heart failure. We used census tracts as proxies for neighborhoods and constructed summary SES scores that included information about wealth and income, education, and occupation. The primary end points were readmission and all-cause mortality at 6 months. We conducted patient interviews and medical chart reviews to obtain demographic information, clinical factors, therapies, and individual SES. We included 1557 patients: 524, 516, and 517 from low, medium, and high SES neighborhoods, respectively (mean age, 61.1±15.2 years; 42.2% women).Overall, 745 patients (47.8%) had ≥1 readmission and 179 patients (11.5%) died. When compared with patients in high SES neighborhoods, those living in low-SES neighborhoods were more likely to be readmitted (odds ratio, 1.35; 95% confidence interval, 1.01-1.82), but the mortality rates were not significantly different (odds ratio, 0.78; 95% confidence interval, 0.50-1.18). The results were consistent after multivariable adjustments for individual demographics, clinical factors, and individual SES. CONCLUSIONS Among patients with heart failure, neighborhood SES was significantly associated with 6-month all-cause readmission even after adjusting for other patient-level factors, including individual SES. Greater number of events and longer follow-up is required to ascertain the potential effect of neighborhood SES on mortality. CLINICAL TRIAL REGISTRATION URL http://clinicaltrials.gov/. Unique identifier: NCT00303212.
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Affiliation(s)
- Behnood Bikdeli
- From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (B.B., B.W., H.B., J.S.R., X.X., S.I.C., S.M.B., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (B.B., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (J.S.R., S.I.C., S.M.B.), Department of Obstetrics, Gynecology, and Reproductive Sciences (X.X.), Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.); Department of Medicine, Center for Quality of Care Research, Baystate Medical Center, Springfield, MA (P.K.L.); Tufts University School of Medicine, Boston, MA (P.K.L.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K., J.S.R.)
| | - Brian Wayda
- From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (B.B., B.W., H.B., J.S.R., X.X., S.I.C., S.M.B., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (B.B., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (J.S.R., S.I.C., S.M.B.), Department of Obstetrics, Gynecology, and Reproductive Sciences (X.X.), Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.); Department of Medicine, Center for Quality of Care Research, Baystate Medical Center, Springfield, MA (P.K.L.); Tufts University School of Medicine, Boston, MA (P.K.L.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K., J.S.R.)
| | - Haikun Bao
- From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (B.B., B.W., H.B., J.S.R., X.X., S.I.C., S.M.B., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (B.B., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (J.S.R., S.I.C., S.M.B.), Department of Obstetrics, Gynecology, and Reproductive Sciences (X.X.), Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.); Department of Medicine, Center for Quality of Care Research, Baystate Medical Center, Springfield, MA (P.K.L.); Tufts University School of Medicine, Boston, MA (P.K.L.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K., J.S.R.)
| | - Joseph S Ross
- From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (B.B., B.W., H.B., J.S.R., X.X., S.I.C., S.M.B., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (B.B., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (J.S.R., S.I.C., S.M.B.), Department of Obstetrics, Gynecology, and Reproductive Sciences (X.X.), Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.); Department of Medicine, Center for Quality of Care Research, Baystate Medical Center, Springfield, MA (P.K.L.); Tufts University School of Medicine, Boston, MA (P.K.L.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K., J.S.R.)
| | - Xiao Xu
- From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (B.B., B.W., H.B., J.S.R., X.X., S.I.C., S.M.B., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (B.B., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (J.S.R., S.I.C., S.M.B.), Department of Obstetrics, Gynecology, and Reproductive Sciences (X.X.), Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.); Department of Medicine, Center for Quality of Care Research, Baystate Medical Center, Springfield, MA (P.K.L.); Tufts University School of Medicine, Boston, MA (P.K.L.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K., J.S.R.)
| | - Sarwat I Chaudhry
- From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (B.B., B.W., H.B., J.S.R., X.X., S.I.C., S.M.B., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (B.B., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (J.S.R., S.I.C., S.M.B.), Department of Obstetrics, Gynecology, and Reproductive Sciences (X.X.), Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.); Department of Medicine, Center for Quality of Care Research, Baystate Medical Center, Springfield, MA (P.K.L.); Tufts University School of Medicine, Boston, MA (P.K.L.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K., J.S.R.)
| | - John A Spertus
- From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (B.B., B.W., H.B., J.S.R., X.X., S.I.C., S.M.B., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (B.B., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (J.S.R., S.I.C., S.M.B.), Department of Obstetrics, Gynecology, and Reproductive Sciences (X.X.), Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.); Department of Medicine, Center for Quality of Care Research, Baystate Medical Center, Springfield, MA (P.K.L.); Tufts University School of Medicine, Boston, MA (P.K.L.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K., J.S.R.)
| | - Susannah M Bernheim
- From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (B.B., B.W., H.B., J.S.R., X.X., S.I.C., S.M.B., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (B.B., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (J.S.R., S.I.C., S.M.B.), Department of Obstetrics, Gynecology, and Reproductive Sciences (X.X.), Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.); Department of Medicine, Center for Quality of Care Research, Baystate Medical Center, Springfield, MA (P.K.L.); Tufts University School of Medicine, Boston, MA (P.K.L.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K., J.S.R.)
| | - Peter K Lindenauer
- From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (B.B., B.W., H.B., J.S.R., X.X., S.I.C., S.M.B., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (B.B., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (J.S.R., S.I.C., S.M.B.), Department of Obstetrics, Gynecology, and Reproductive Sciences (X.X.), Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.); Department of Medicine, Center for Quality of Care Research, Baystate Medical Center, Springfield, MA (P.K.L.); Tufts University School of Medicine, Boston, MA (P.K.L.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K., J.S.R.)
| | - Harlan M Krumholz
- From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (B.B., B.W., H.B., J.S.R., X.X., S.I.C., S.M.B., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (B.B., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (J.S.R., S.I.C., S.M.B.), Department of Obstetrics, Gynecology, and Reproductive Sciences (X.X.), Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.); Department of Medicine, Center for Quality of Care Research, Baystate Medical Center, Springfield, MA (P.K.L.); Tufts University School of Medicine, Boston, MA (P.K.L.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K., J.S.R.).
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Meyer OL, Castro-Schilo L, Aguilar-Gaxiola S. Determinants of mental health and self-rated health: a model of socioeconomic status, neighborhood safety, and physical activity. Am J Public Health 2014; 104:1734-41. [PMID: 25033151 DOI: 10.2105/ajph.2014.302003] [Citation(s) in RCA: 177] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated the underlying mechanisms of the influence of socioeconomic status (SES) on mental health and self-rated health (SRH), and evaluated how these relationships might vary by race/ethnicity, age, and gender. METHODS We analyzed data of 44 921 adults who responded to the 2009 California Health Interview Survey. We used a path analysis to test effects of SES, neighborhood safety, and physical activity on mental health and SRH. RESULTS Low SES was associated with greater neighborhood safety concerns, which were negatively associated with physical activity, which was then negatively related to mental health and SRH. This model was similar across different racial/ethnic and gender groups, but mean levels in the constructs differed across groups. CONCLUSIONS SES plays an important role in SRH and mental health, and this effect is further nuanced by race/ethnicity and gender. Identifying the psychological (neighborhood safety) and behavioral (physical activity) factors that influence mental health and SRH is critical for tailoring interventions and designing programs that can improve overall health.
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Affiliation(s)
- Oanh L Meyer
- At the time of writing, Oanh L. Meyer was with the Center for Reducing Health Disparities, University of California, Davis and the Department of Psychiatry, University of California, San Francisco. Laura Castro-Schilo was with the Department of Psychology, University of North Carolina, Chapel Hill. Sergio Aguilar-Gaxiola was with the Center for Reducing Health Disparities and the Department of Internal Medicine, University of California, Davis
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Chen SH, Cheng HY, Chuang YH, Shao JH. Nutritional status and its health-related factors among older adults in rural and urban areas. J Adv Nurs 2014; 71:42-53. [PMID: 24894954 DOI: 10.1111/jan.12462] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2014] [Indexed: 11/29/2022]
Abstract
AIM To compare health-related characteristics, nutrition-related factors and nutritional status of older adults living in rural and urban counties of Taiwan. BACKGROUND The older adult population of Taiwan is increasing. Furthermore, older people living in rural areas have shorter life expectancy and more chronic diseases than their urban counterparts. However, little is known about the health-related characteristics, nutrition-related factors and nutritional status of older adults living in rural and urban areas of Taiwan, limiting nurses' ability to identify and care for older adults at risk of poor nutritional health. DESIGN Cross-sectional, comparative. METHODS Older adults were randomly selected from names of residents of an adjacent rural and urban area of northern Taiwan and having completing the 2009 health evaluation. From March-July 2010, older adult participants (N = 366) provided data on demographic and health-related information, nutritional self-efficacy, health locus of control and nutritional status. Data were analysed by descriptive statistics and compared using chi-square and t-test. RESULTS Older rural participants had significantly lower educational level, less adequate income, higher medication use, lower scores on self-rated health status and researcher-rated health status and lower self-rated healthy eating status than their urban counterparts. Moreover, rural participants had significantly lower nutritional self-efficacy, higher chance health locus of control and poorer nutritional status than their urban counterparts. CONCLUSIONS Our results suggest that nurses should assess older adults living in rural areas for nutritional health and nutrition knowledge. Based on this assessment, nurses should develop easy, practical and accessible nutritional programmes for this population.
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Affiliation(s)
- Su-Hui Chen
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
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Kim ES, Park N, Peterson C. Perceived neighborhood social cohesion and stroke. Soc Sci Med 2013; 97:49-55. [PMID: 24161088 DOI: 10.1016/j.socscimed.2013.08.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 07/07/2013] [Accepted: 08/05/2013] [Indexed: 01/10/2023]
Abstract
Research in the last three decades has shown that negative neighborhood factors such as neighborhood violence, noise, traffic, litter, low neighborhood socioeconomic status, and poor air quality increase the risk of poor health. Fewer studies have examined the potential protective effect that neighborhood factors can have on health, particularly stroke. We examined whether higher perceived neighborhood social cohesion was associated with lower stroke incidence after adjusting for traditional risk and psychological factors that have been linked with stroke risk. Prospective data from the Health and Retirement Study--a nationally representative panel study of American adults over the age of 50--were used. Analyses were conducted on a subset of 6740 adults who were stroke-free at baseline. Analyses adjusted for chronic illnesses and relevant sociodemographic, behavioral, and psychosocial factors. Over a four-year follow-up, higher perceived neighborhood social cohesion was associated with a lower risk of stroke. Each standard deviation increase in perceived neighborhood social cohesion was associated with a multivariate-adjusted odds ratio (O.R.) of 0.85 for stroke incidence (95% CI, 0.75-0.97, p < 0.05). The effect of perceived neighborhood social cohesion remained significant after adjusting for a comprehensive set of risk factors. Therefore, perceived neighborhood social cohesion plays an important role in protecting against stroke.
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Affiliation(s)
- Eric S Kim
- Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI 48109-1043, USA.
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Hawkins K, Musich S, Bottone FG, Ozminkowski RJ, Cheng Y, Rush S, Carcione J, Migliori RJ, Yeh CS. The Impact of Pain on Physical and Mental Quality of Life in Adults 65 and Older. J Gerontol Nurs 2013; 39:32-44. [DOI: 10.3928/00989134-20130402-02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 09/19/2012] [Indexed: 11/20/2022]
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Michimi A, Ellis-Griffith G, Nagy C, Peterson T. Coronary heart disease prevalence and occupational structure in U.S. metropolitan areas: A multilevel analysis. Health Place 2013; 21:192-204. [DOI: 10.1016/j.healthplace.2013.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 01/29/2013] [Accepted: 02/04/2013] [Indexed: 11/25/2022]
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Hämel K, Ewers M, Schaeffer D. Versorgungsgestaltung angesichts regionaler Unterschiede. Z Gerontol Geriatr 2013; 46:323-8. [DOI: 10.1007/s00391-012-0465-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sathyanarayanan S, Brooks AJ, Hagen SE, Edington DW. Multilevel analysis of the physical health perception of employees: community and individual factors. Am J Health Promot 2012; 26:e126-36. [PMID: 22548431 DOI: 10.4278/ajhp.110316-qual-120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate whether the communities where employees reside are associated with employee perception of overall physical health after adjusting for individual factors. DESIGN Retrospective cross-sectional. SETTING Active employees from a large manufacturing company representing 157 zip code tabulation areas (ZCTAs) in Michigan. PARTICIPANTS 22,012 active employees who completed at least one voluntary health risk appraisal (HRA) during 1999-2001. METHOD Community deprivation and racial segregation at the ZCTA level were obtained using indices created from 2000 U.S. Census data. Demographics and HRA-related data (health-related behaviors, medical history, and quality of life indicators) at the individual level were used as independent variables. A two-level logistic regression model (employees nested in ZCTA) was used to model the probability of better self-rated health perception (SRH) (better health: 89.1% versus poor health: 10.9%). RESULTS Relative to those living in highly deprived communities, employees residing in less-deprived communities showed 2.06 (95% confidence interval [CI], 1.57-2.72) and those living in moderately deprived communities showed 1.83 (95% CI, 1.42-2.35) increased odds of better SRH. After adjusting for individual-level variables, employees living in less-deprived communities had increased odds (1.31 [95% CI, 1.07-1.60]) and those living in moderately deprived communities had increased odds (1.33 [95% CI, 1.11-1.59]) of better SRH compared with individuals from highly deprived communities. The association of racial segregation with employees' SRH was mediated after adjusting for other variables. Individual-level variables showed significant statistical associations with SRH. CONCLUSION Communities do have a modest association with SRH of the employees living there. After adjusting for individual-level and demographic variables, employees living in less/moderately deprived communities are more likely to perceive better physical health relative to those who live in highly deprived communities.
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Luong MLN, Cleveland RJ, Nyrop KA, Callahan LF. Social determinants and osteoarthritis outcomes. AGING HEALTH 2012; 8:413-437. [PMID: 23243459 PMCID: PMC3519433 DOI: 10.2217/ahe.12.43] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Osteoarthritis (OA) is one of the most frequently occurring musculoskeletal diseases, posing a significant public health problem due to its impact on pain and disability. Traditional risk factors fail to account for all of the risk observed for OA outcomes. In recent years, our view of disease causation has broadened to include health risks that are created by an individual's socioeconomic circumstances. Early research into social determinants has focused on social position and explored factors related to the individual such as education, income and occupation. Results from these investigations suggest that low education attainment and nonprofessional occupation are associated with poorer arthritis outcomes. More recently, research has expanded to examine how one's neighborhood socioeconomic environment may be relevant to OA outcomes. This narrative review proposes a framework to help guide our understanding of how social context may interact with pathophysiological processes and individual-level variables to influence health outcomes in those living with OA.
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Affiliation(s)
- My-Linh N Luong
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Building, Chapel Hill, NC 27599, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Rebecca J Cleveland
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Building, Chapel Hill, NC 27599, USA
| | - Kirsten A Nyrop
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Building, Chapel Hill, NC 27599, USA
| | - Leigh F Callahan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Building, Chapel Hill, NC 27599, USA
- Departments of Medicine & Social Medicine, University of North Carolina at Chapel Hill, 333 South Columbia St, MacNider Hall, Chapel Hill, NC 27599, USA
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Abstract
BACKGROUND There is growing evidence that neighborhood environments are related to depressive mood in the general population. Older adults may be even more vulnerable to neighborhood factors than other adults. The aim of this paper is to review empirical findings on the relationships between neighborhood characteristics and depressive mood among older adults. METHODS A search of the literature was undertaken in PsycINFO and MEDLINE. RESULTS Nineteen studies were identified. Study designs were most often cross-sectional, included large sample sizes, and controlled for major individual characteristics. Mediational effects were not investigated. Statistical analysis strategies often included multilevel models. Spatial delimitations of neighborhood of residence were usually based on administrative and statistical spatial boundaries. Six neighborhood characteristics were assessed most often: neighborhood socioeconomic disadvantage, neighborhood poverty, affluence, racial/ethnic composition, residential stability, and elderly concentration. Selected neighborhood characteristics were associated with depressive mood after adjusting for individual variables. These associations were generally theoretically meaningful. CONCLUSIONS Neighborhood variables seem to make a unique and significant contribution to the understanding of depressive mood among older adults. However, few studies investigated these associations and replication of results is needed. Several substantive neighborhood variables have been ignored or neglected in the literature. The implications of neighborhood effects for knowledge advancement and public health interventions remain unclear. Recommendations for future research are discussed.
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