Neighbourhood environments and the risk of hospital admission for cardiometabolic and mental health comorbidities in multiple sclerosis: A population cohort analysis using linked administrative data

Gendering Neighbourhood Marginalization Metrics in Mental Health Services Research: A Cross-Sectional Exploration of a Rural and Small Urban Population

Background: Little is known about the extent to which socioenvironmental characteristics may influence mental health outcomes in smaller population centres or differently among women and men. This study used a gender-based analysis approach to explore individual- and neighbourhood-level sex differences in mental health service use in a context of uniquely smaller urban and rural settlements. Methods: This cross-sectional analysis leveraged multiple person-based administrative health datasets linked with geospatial datasets among the population aged 1 and over in the province of New Brunswick, Canada. We used multinomial logistic regression to examine associations between neighbourhood characteristics with risk of service contacts for mood and anxiety disorders in 2015/2016, characterizing the areal measures among all residents (gender neutral) and by males and females separately (gender specific), and controlling for age group. Results: Among the province’s 707,575 eligible residents, 10.7% (females: 14.0%; males: 7.3%) used mental health services in the year of observation. In models adjusted for gender-neutral neighbourhood characteristics, service contacts were significantly more likely among persons residing in the most materially deprived areas compared with the least (OR = 1.09 [95% CI: 1.05–1.12]); when stratified by individuals’ sex, the risk pattern held for females (OR = 1.13 [95% CI: 1.09–1.17]) but not males (OR = 1.00 [95% CI: 0.96–1.05]). Residence in the most female-specific materially deprived neighbourhoods was independently associated with higher risk of mental health service use among individual females (OR = 1.08 [95% CI: 1.02–1.14]) but not among males (OR = 1.02 [95% CI: 0.95–1.10]). Conclusion: These findings emphasize that research needs to better integrate sex and gender in contextual measures aiming to inform community interventions and neighbourhood designs, notably in small urban and rural settings, to reduce socioeconomic inequalities in the burden of mental disorders.

Healthcare Service Use for Mood and Anxiety Disorders Following Acute Myocardial Infarction: A Cohort Study of the Role of Neighbourhood Socioenvironmental Characteristics in a Largely Rural Population

Depression and other mood and anxiety disorders are recognized as common complications following cardiac events. Some studies report poorer cardiac outcomes among patients in socioeconomically marginalized neighbourhoods. This study aimed to describe associations between socioeconomic and built environment characteristics of neighbourhood environments and mental health service contacts following an acute myocardial infarction (AMI or heart attack) among adults in the province of New Brunswick, Canada. This province is characterized largely by residents in small towns and rural areas. A cohort of all adults aged 45 and over surviving AMI and without a recent record of mental disorders was identified by linking provincial medical-administrative datasets. Residential histories were tracked over time to assign neighbourhood measures of marginalization, local climate zones, and physical activity friendliness (i.e., walkability). Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of healthcare use for mood and anxiety disorders over the period 2003/04-2015/16 by neighbourhood characteristics. The baseline cohort included 13,330 post-AMI patients, among whom 32.5% were found to have used healthcare services for a diagnosed mood or anxiety disorder at least once during the period of observation. Among men, an increased risk of mental health service use was found among those living in areas characterized by high ethnic concentration (HR: 1.14 (95%CI: 1.03-1.25)). Among women, the risk was significantly higher among those in materially deprived neighbourhoods (HR: 1.16 (95%CI: 1.01-1.33)). We found no convincing evidence of associations between this outcome and the other neighbourhood characteristics considered here. These results suggest that selected features of neighbourhood environments may increase the burden on the healthcare system for mental health comorbidities among adults with cardiovascular disease. Further research is needed to understand the differing needs of socioeconomically marginalized populations to improve mental health outcomes following an acute cardiac event, specifically in the context of smaller and rural communities and of universal healthcare coverage.