Gentrification and Displacement in the San Francisco Bay Area: A Comparison of Measurement Approaches

The Influence of Gentrification on Adverse Birth Outcomes in California

Evidence has documented the effects of place on perinatal outcomes, but less is known about the sociopolitical mechanisms, such as gentrification, that shape neighborhood context and produce spatialized inequities in adverse birth outcomes. Leveraging a diverse sample in California, we assessed the associations between gentrification and birth outcomes: preterm birth, small-for-gestational-age, and low birth weight. Gentrification was measured using the Freeman method and the Displacement and Gentrification Typology. Descriptive analysis assessed outcome prevalence and race and ethnicity distribution by exposure and participant characteristics. Overall and race and ethnicity-stratified mixed effects logistic models examined associations between gentrification and birth outcomes, sequentially adjusting for sociodemographic status and pregnancy factors, with a random intercept to account for clustering by census tract. In a sample of 5,116,131 births, outcome prevalence ranged from 1.0% for very preterm birth, 5.0% for low birth weight, 7.9% for preterm birth, and 9.4% for small-for-gestational-age. Adjusting for individual-level factors, gentrification was associated with increased odds of preterm birth (Freeman OR = 1.09, 95% CI 1.07-1.10; Displacement and Gentrification Typology OR = 1.11, 95% CI 1.09-1.13). While Displacement and Gentrification Typology-measured gentrification was consistently associated with greater odds of adverse outcomes, Freeman-measured gentrification was associated with slightly lower odds of small-for-gestational-age and low birth weight. Furthermore, gentrification was associated with birth outcome odds across multiple racial and ethnic groups, but the directions and magnitudes of the associations varied depending on the gentrification assessment methodology and the outcome assessed. Results demonstrate that gentrification plays a role in shaping adverse birth outcomes in California.

Historical Redlining, Contemporary Gentrification, and Severe Maternal Morbidity in California, 2005-2018

Importance

Historically redlined neighborhoods may experience disinvestment, influencing their likelihood of gentrification, a process of neighborhood (re-)development that unequally distributes harms and benefits by race and class. Understanding the combined outcomes of redlining and gentrification informs how the mutually constitutive systems of structural racism and racial capitalism affect pregnancy outcomes.

Objective

To examine if historical redlining and contemporary gentrification is associated with increased severe maternal morbidity (SMM) odds.

Design, Setting, and Participants

This cross-sectional study used data from a statewide population-based sample of all live hospital births at 20 weeks' gestation or more between 2005 and 2018 in California. Analysis was conducted from March 2023 to January 2024.

Exposure

Redlining (as characterized by the federal Home Owners' Loan Corporation mortgage security maps) and displacement (using present-day sociodemographic and housing market information).

Main Outcomes and Measures

Mixed-effects logistic regression models were used to assess the association of census tract-level exposure to historical redlining and contemporary gentrification with increased SMM odds, adjusting for sociodemographic and pregnancy related factors. Outcome classification was based on the Centers for Disease Control and Prevention SMM index, which defines SMM as having any of the 21 procedures and diagnoses based on the International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes.

Results

The study sample included 1 554 837 births (median [SD] maternal age, 29.0 [6.4] years; 3464 American Indian or Alaskan Native [0.2%], 224 774 Asian [14.5%], 132 240 Black [8.5%], 880 104 Hispanic [56.6%], 312 490 White [20.1%]), with 22 993 cases of SMM (1.4%). Residents in historically redlined neighborhoods that were undergoing gentrification or displacement were more likely to be Black, Hispanic, and American Indian or Alaskan Native. Independent of individual-level characteristics, SMM odds were greater for individuals living in redlined neighborhoods that experienced displacement (OR, 1.21; 95% CI, 1.14-1.28) and in redlined neighborhoods undergoing gentrification (OR, 1.21; 95% CI, 1.13-1.29) compared with those in continuously advantaged neighborhoods.

Conclusions and Relevance

Findings from this cross-sectional study demonstrate that the legacies of redlining, intertwined with current dynamics of displacement and gentrification, affect SMM. Place-based sociopolitical mechanisms that inequitably distribute resources may be important intervention points to address structural drivers of adverse pregnancy outcomes and their racial inequities.

The impact of historical redlining on neurosurgeon distribution and reimbursement in modern neighborhoods

Background

This study examines the lasting impact of historical redlining on contemporary neurosurgical care access, highlighting the need for equitable healthcare in historically marginalized communities.

Objective

To investigate how redlining affects neurosurgeon distribution and reimbursement in U.S. neighborhoods, analyzing implications for healthcare access.

Methods

An observational study was conducted using data from the Center for Medicare and Medicaid Services (CMS) National File, Home Owner's Loan Corporation (HOLC) neighborhood grades, and demographic data to evaluate neurosurgical representation across 91 U.S. cities, categorized by HOLC Grades (A, B, C, D) and gentrification status.

Results

Of the 257 neighborhoods, Grade A, B, C, and D neighborhoods comprised 5.40%, 18.80%, 45.8%, and 30.0% of the sample, respectively. Grade A, B, and C neighborhoods had more White and Asian residents and less Black residents compared to Grade D neighborhoods (p < 0.001). HOLC Grade A (OR = 4.37, 95%CI: 2.08, 9.16, p < 0.001), B (OR = 1.99, 95%CI: 1.18, 3.38, p = 0.011), and C (OR = 2.37, 95%CI: 1.57, 3.59, p < 0.001) neighborhoods were associated with a higher representation of neurosurgeons compared to Grade D neighborhoods. Reimbursement disparities were also apparent: neurosurgeons practicing in HOLC Grade D neighborhoods received significantly lower reimbursements than those in Grade A neighborhoods ($109,163.77 vs. $142,999.88, p < 0.001), Grade B neighborhoods ($109,163.77 vs. $131,459.02, p < 0.001), and Grade C neighborhoods ($109,163.77 vs. $129,070.733, p < 0.001).

Conclusion

Historical redlining continues to shape access to highly specialized healthcare such as neurosurgery. Efforts to address these disparities must consider historical context and strive to achieve more equitable access to specialized care.

Racial Disparities in Health Care Use in Gentrifying Neighborhoods

Objective

Racial disparities in health outcomes are a persistent threat in gentrifying neighborhoods. A contributor to health outcomes is health services utilization, the extent to which people receive care from a medical professional. There are documented racial disparities in health services utilization in the general population. We aim to determine whether racial disparities in health services utilization exist in gentrifying neighborhoods.

Methods

We used data from the American Community Survey to identify gentrifying neighborhoods across the United States from 2006 to 2017. We collected data on three measures of healthcare services utilization (office-based physician visits, office-based nonphysician visits, and having a usual source of care) for 247 Black and 689 White non-Hispanic respondents of the 2014 Medical Expenditure Panel Survey living in gentrifying neighborhoods. We used modified Poisson models to determine whether there is a difference in the prevalence of health services utilization by race among residents of gentrifying neighborhoods.

Results

After adjusting for age, gender, education, income, employment, insurance, marital status, region, and self-rated health, Black residents of gentrifying neighborhoods demonstrated a similar prevalence of having an office-based physician visit, a lower prevalence of having an office-based nonphysician visit (prevalence ratio: 0.74; 95% confidence interval, 0.60 to 0.91), and a lower prevalence of having a usual source of care (prevalence ratio: 0.87; 95% confidence interval, 0.77 to 0.98) than White residents.

Conclusions

The existence of racial disparities in health services utilization in US gentrifying neighborhoods demonstrates a need for policy-relevant solutions to create a more equitable distribution of health resources.

Neighborhood gentrification, displacement, and severe maternal morbidity in California

Gentrification, a racialized and profit-driven process in which historically disinvested neighborhoods experience an influx of development that contributes to the improvement of physical amenities, increasing housing costs, and the dispossession and displacement of existing communities, may influence the risk of severe maternal morbidity (SMM). Leveraging a racially diverse population-based sample of all live hospital births in California between 2006 and 2017, we examined associations between neighborhood-level gentrification and SMM. SMM was defined as having one of 21 procedures and diagnoses, as described in the SMM index developed by Centers for Disease Control and Prevention. We compared three gentrification measures to determine which operationalization best captures aspects of gentrification most salient to SMM: Freeman, Landis 3-D, and Urban Displacement Project Gentrification and Displacement Typology. Descriptive analysis assessed bivariate associations between gentrification and birthing people's characteristics. Overall and race and ethnicity-stratified mixed-effects logistic models assessed associations between gentrification and SMM, adjusting for individual sociodemographic and pregnancy factors while accounting for clustering by census tract. The study sample included 5,256,905 births, with 72,718 cases of SMM (1.4%). The percentage of individuals living in a gentrifying neighborhood ranged from 5.7% to 11.7% across exposure assessment methods. Net of individual and pregnancy-related factors, neighborhood-level gentrification, as measured by the Freeman method, was protective against SMM (OR = 0.89, 95% CI: 0.86-0.93); in comparison, gentrification, as measured by the Gentrification and Displacement Typology, was associated with greater risk of SMM (OR = 1.18, 95% CI: 1.14-1.23). These associations were significant among non-Hispanic White, non-Hispanic Black, and Hispanic individuals. Findings demonstrate that gentrification plays a role in shaping the risk of SMM among birthing people in California. Differences in how gentrification is conceptualized and measured, such as an emphasis on housing affordability compared to a broader characterization of gentrification's multiple aspects, may explain the heterogeneity in the directions of observed associations.

Association of neighborhood gentrification and residential moves with hypertension and diabetes control in Los Angeles County, 2014-2019: A retrospective cohort study

OBJECTIVE

To examine whether gentrification exposure is associated with future hypertension and diabetes control.

METHODS

Linking records from an integrated health care system to census-tract characteristics, we identified adults with hypertension and/or diabetes residing in stably low-SES census tracts in 2014 (n = 69,524). We tested associations of census tract gentrification occurring between 2015 and 2019 with participants' disease control in 2019. Secondary analyses considered the role of residential moves (possible displacement), race and ethnicity, and age.

RESULTS

Gentrification exposure was associated with improved odds of hypertension control (aOR: 1.08; 95% CI: 1.00, 1.17), especially among non-Hispanic Whites and adults >65 years. Gentrification was not associated with diabetes control overall, but control improved in the Hispanic subgroup. Disease control was similar regardless of residential moves in the overall sample, but disparate associations emerged in models stratified by race and ethnicity.

CONCLUSIONS

Residents of newly gentrifying neighborhoods may experience modestly improved odds of hypertension and/or diabetes control, but associations may differ across population subgroups.

POLICY IMPLICATIONS

Gentrification may support-or at least not harm-cardiometabolic health for some residents. City leaders and health systems could partner with impacted communities to ensure that neighborhood development meets the goals and health needs of all residents and does not exacerbate health disparities.

Urban health inequality in shifting environment: systematic review on the impact of gentrification on residents' health

The impacts of changing neighborhoods, and the influence of neighborhood stability on residents' health have not received enough attention in the literature; one of the most important aspects is gentrification. Research on the impact of gentrification on residents' health has gradually increased in recent years, mainly from North America. Based on the guidelines of PRISMA 2020 and SCIE, 66 papers were included for analysis, six aspects of selected studies are discussed: the research design, theoretical framework, methods of analysis, definition and measurement of gentrification effects, and impact pathways. In general, most of the literature in this field can be seen as using an ecological research design, of which cross-sectional research accounts for a large proportion. The identified effects vary in their direction as well as strength due to difference in population, temporal, and geographical characteristics. Gentrification could affect health outcomes through the combination of economic, social, and physical environment factors. Existing research could be improved in the following aspects: (1) The definition and measurement of gentrification should be both generic and site-specific; Various measurement methods should be compared to enhance the robustness of the results. Furthermore, more consideration should be given to the impact of spatial issues; (2) As for health outcomes, it is suggested to expand the scope of the discussion of health outcomes and strengthen the biological explanation of the influencing mechanisms. It is also necessary to determine the research time points according to the characteristics of the incubation period of different diseases; (3) As for research design, applying longitudinal research design is more likely to improve the reliability; (4) Theoretical frameworks should be addressed to link the definition and measurement of gentrification, patterns of health outcomes, methodology and pathways.

Gentrification and Air Quality in a Large Urban County in the United States

Introduction: Increases in industrialization and manufacturing have led to worsening pollution in some components of air quality. In addition, gentrification is occurring in large cities throughout the world. As these socioeconomic and demographic changes occur, there have been no studies examining the association of gentrification with air quality. To investigate this association, we studied the trends of gentrification, changes in racial distribution and changes in air quality in each zip code of a large urban county over a 40-year period. Methods: We conducted a retrospective longitudinal study over 40 years in Wayne County, Michigan using socioeconomic and demographic data from the National Historical Geographic Information System (NHGIS) and air quality data from the United States Environmental Protection Agency (EPA). To assess gentrification, longitudinal analyses were performed to examine median household income, percentage with a college education, median housing value, median gross rent and employment level. The racial distribution was evaluated in each zip code during the time period. Gentrification was studied in relation to air quality using nonparametric 2-sample Wilcon-Mann-Whitney tests and Binomial Generalized Linear Regression models. Results: Although air quality improved overall over the 40-year period, there was a lesser rate of improvement in gentrified areas. Furthermore, gentrification was strongly associated with racial distribution. The most substantial gentrification occurred from 2010 to 2020, in which a specific cluster of adjacent zip codes in downtown Detroit experienced intense gentrification and a drop in the percentage of African-American residents. Conclusions: Gentrified areas seem to have a less pronounced improvement in air quality over time. This reduction in air quality improvement is likely associated with demolitions and the construction of new buildings, such as sporting arenas and accompanying traffic density. Gentrification is also strongly associated with an increase in non-minority residents in an area. Although previous definitions of gentrification in the literature have not included racial distribution, we suggest that future definitions should include this metric given the strong association. Minority residents who are displaced as a result of gentrification do not experience the improvements in housing quality, accessibility to healthy foods and other associations of gentrification.

Race and obesity disparities among adults living in gentrifying neighborhoods

There is a paucity of research seeking to understand race disparities in obesity among individuals living in a gentrifying neighborhood. American Community Survey data were used to identify gentrifying neighborhoods. In a cross-sectional analysis, these data were then linked to the 2014 Medical Expenditure Panel Survey, yielding an analytic sample of 887 Black and White adults. Obesity was based on body mass index ≥ 30 kg/m2. After controlling for potential confounders, Black adults living in gentrifying neighborhoods had a higher prevalence of obesity (PR: 1.39; 95% CI: 1.03, 1.88) than White adults living in gentrifying neighborhoods. Gentrification may have no impact on reducing Black-White obesity disparities in the US.

Racial/ethnic disparities in severe maternal morbidity: An intersectional lifecourse approach

Despite long-existing calls to address alarming racial/ethnic gaps in severe maternal morbidity (SMM), research that considers the impact of intersecting social inequities on SMM risk remains scarce. Invoking intersectionality theory, we sought to assess SMM risk at the nexus of racial/ethnic marginalization, weathering, and neighborhood/individual socioeconomic disadvantage. We used birth hospitalization records from California across 20 years (1997-2017, N = 9,806,406) on all live births ≥20 weeks gestation. We estimated adjusted average predicted probabilities of SMM at the combination of levels of race/ethnicity, age, and neighborhood deprivation or individual socioeconomic status (SES). The highest risk of SMM was observed among Black birthing people aged ≥35 years who either resided in the most deprived neighborhoods or had the lowest SES. Black birthing people conceptualized to be better off due to their social standing (aged 20-34 years and living in the least deprived neighborhoods or college graduates) had comparable and at times worse risk than White birthing people conceptualized to be worse off (aged ≥35 years and living in the most deprived neighborhoods or had a high-school degree or less). Our findings highlight the need to explicitly address structural racism as the driver of racial/ethnic health inequities and the imperative to incorporate intersectional approaches.

Inequitable Housing Practices and Youth Internalizing Symptoms: Mediation Via Perceptions of Neighborhood Cohesion

Disordered urban environments negatively impact mental health symptoms and disorders. While many aspects of the built environment have been studied, one influence may come from inequitable, discriminatory housing practices such as redlining, blockbusting, and gentrification. The patterns of disinvestment and reinvestment that follow may be an underlying mechanism predicting poor mental health. In this study, we examine pathways between such practices and internalizing symptoms (i.e., anxiety and depression) among a sample of African American youth in Baltimore, Maryland, considering moderation and mediation pathways including neighborhood social cohesion and sex. In our direct models, the inequitable housing practices were not significant predictors of social cohesion. In our sex moderation model, however, we find negative influences on social cohesion: for girls from gentrification, and for boys from blockbusting. Our moderated mediation model shows that girls in gentrifying neighborhoods who experience lower social cohesion have higher levels of internalizing symptoms. Likewise for boys, living in a formerly blockbusted neighborhood generates poorer social cohesion, which in turn drives higher rates of internalizing symptoms. A key implication of this work is that, in addition to standard measures of the contemporary built environment, considering other invisible patterns related to discriminatory and inequitable housing practices is important in understanding the types of neighborhoods where anxiety and depression are more prevalent. And while some recent work has discussed the importance of considering phenomena like redlining in considering long-term trajectories of neighborhoods, other patterns such as blockbusting and gentrification may be equally important.

Examining Neighborhood Socioeconomic Status as a Mediator of Racial/Ethnic Disparities in Hypertension Control Across Two San Francisco Health Systems

BACKGROUND

A contextual understanding of hypertension control can inform population health management strategies to mitigate cardiovascular disease events. This retrospective cohort study links neighborhood-level data with patients' health records to describe racial/ethnic differences in uncontrolled hypertension and determine if and to what extent these differences are mediated by neighborhood socioeconomic status (nSES).

METHODS

We conducted a mediation analysis using a sample of patients with hypertension from 2 health care delivery systems in San Francisco over 2 years (n=47 031). We used generalized structural equation modeling, adjusted for age, sex, and health care system, to estimate the contribution of nSES to disparities in uncontrolled hypertension between White patients and Black, Hispanic/Latino, and Asian patients, respectively. Sensitivity analysis removed adjustment for health care system.

RESULTS

Over half the cohort (62%) experienced uncontrolled hypertension during the study period. Racial/ethnic groups showed substantial differences in prevalence of uncontrolled hypertension and distribution of nSES quintiles. Compared with White patients, Black, and Hispanic/Latino patients had higher adjusted odds of uncontrolled hypertension: odds ratio, 1.79 [95% CI, 1.67-1.91] and odds ratio, 1.38 [95% CI, 1.29-1.47], respectively and nSES accounted for 7% of the disparity in both comparisons. Asian patients had slightly lower adjusted odds of uncontrolled hypertension when compared with White patients: odds ratio, 0.95 [95% CI, 0.89-0.99] and the mediating effect of nSES did not change the direction of the relationship. Sensitivity analysis increased the proportion mediated by nSES to 11% between Black and White patients and 13% between Hispanic/Latino and White patients, but did not influence differences between Asian and White patients.

CONCLUSIONS

Among patients with hypertension in this study, nSES mediated a small proportion of racial/ethnic disparities in uncontrolled hypertension. Population health management strategies may be most effective by focusing on additional structural and interpersonal pathways such as racism and discrimination in health care settings.

Associations Between Residential Segregation and Incident Hypertension: The Multi-Ethnic Study of Atherosclerosis

Background Residential segregation, a geospatial manifestation of structural racism, is a fundamental driver of racial and ethnic health inequities, and longitudinal studies examining segregation's influence on cardiovascular health are limited. This study investigates the impact of segregation on hypertension in a multiracial and multiethnic cohort and explores whether neighborhood environment modifies this association. Methods and Results Leveraging data from a diverse cohort of adults recruited from 6 sites in the United States with 2 decades of follow-up, we used race- and ethnicity-stratified Cox models to examine the association between time-varying segregation with incident hypertension in 1937 adults free of hypertension at baseline. Participants were categorized as residing in segregated and nonsegregated neighborhoods using a spatial-weighted measure. We used a robust covariance matrix estimator to account for clustering within neighborhoods and assessed effect measure modification by neighborhood social or physical environment. Over an average follow-up of 7.35 years, 65.5% non-Hispanic Black, 48.1% Chinese, and 53.7% Hispanic participants developed hypertension. Net of confounders, Black and Hispanic residents in segregated neighborhoods were more likely to develop hypertension relative to residents in nonsegregated neighborhoods (Black residents: hazard ratio [HR], 1.33; 95% CI, 1.09-1.62; Hispanic residents: HR, 1.33; 95% CI, 1.04-1.70). Results were similar but not significant among Chinese residents (HR, 1.20; 95% CI, 0.83-1.73). Among Black residents, neighborhood social environment significantly modified this association such that better social environment was associated with less pronounced impact of segregation on hypertension. Conclusions This study underscores the importance of continued investigations of groups affected by the health consequences of racial residential segregation while taking contextual neighborhood factors, such as social environment, into account.

Factors delaying chemotherapy in patients with breast cancer at a safety-net hospital

BACKGROUND

Despite advances in healthcare and improved chemotherapy, disparities in breast cancer outcomes continue to persist. Our aim was to evaluate socioeconomic factors that may impact timing of treatment for patients receiving chemotherapy in underserved communities.

METHODS

A review of patients with breast cancer who received neoadjuvant or adjuvant chemotherapy from 2015-2019 was conducted at a safety-net hospital. The primary outcomes were times from diagnosis to chemotherapy and surgery. Clinicodemographic factors including race, age, clinical stage, primary language, comorbidities, and median income by zip code were collected. Multivariable regression analysis was performed to evaluate for factors associated with the primary outcomes.

RESULTS

One hundred patients were identified. For the neoadjuvant group, median time from diagnosis to chemotherapy and surgery was 52 ± 34 days and 256 ± 59 days, respectively. For the adjuvant group, median time from diagnosis to surgery and chemotherapy was 24.5 ± 18 days and 94.5 ± 53 days, respectively. Non-English language and older age were associated with increased time to chemotherapy in the adjuvant group (p < 0.05). Language and age were not associated with increased time to surgery in both groups. Race, age, comorbidities, and income were not associated with delay in treatment in either groups.

CONCLUSIONS

Older age and non-English language were associated with prolonged time from surgery to adjuvant chemotherapy. Targeted interventions directed at patient education and decreasing language barriers especially post-operatively may decrease delays in treatment and subsequently reduce disparities seen in the breast cancer population.

Firearm Violence, Access to Care, and Gentrification: A Moving Target for American Trauma Systems

OBJECTIVE

We aimed to determine whether gentrification predicts the movement of shooting victims over time and if this process has decreased access to care.

BACKGROUND

Trauma centers remain fixed in space, but the populations they serve do not. Nationally, gentrification has displaced disadvantaged communities most at risk for violent injury, potentially decreasing access to care. This process has not been studied, but an increase of only 1 mile from a trauma center increases shooting mortality up to 22%.

METHODS

We performed a cross-sectional study utilizing Philadelphia Police Department (PPD) and Pennsylvania trauma systems outcome (PTOS) data 2006-2018. Shootings were mapped and grouped into census tracts. They were then cross-mapped with gentrification data and hospital location. PPD and PTOS shooting data were compared to ensure patients requiring trauma care were captured. Census tracts with ≥500 residents with income and median home values in the bottom 40th percentile of the metropolitan area were eligible to gentrify. Tracts were gentrified if residents ≥25 with a bachelor's degree increased and home price increased to the top third in the metropolitan area. Change in distribution of shootings and its relation to gentrification was our primary outcome while proximity of shootings to a trauma center was our secondary outcome.

RESULTS

Thirty-two percent (123/379) of eligible tracts gentrified and 31,165 shootings were captured in the PPD database. 9090 (29.2%) patients meeting trauma criteria were captured in PTOS with an increasing proportion over time. The proportion of shootings within gentrifying tracts significantly dropped 2006-2018 (40%-35%, P < 0.001) and increased in non-gentrifying tracts (52%-57%, P < 0.001). In evaluation of shooting densities, a predictable redistribution occurred 2006-2018 with incident density decreasing in gentrified areas and increasing in non-gentrified areas. Shootings within 1 mile of a trauma center increased overall, but proportional access decreased in gentrified areas.

CONCLUSIONS

Shootings in Philadelphia predictably moved out of gentrified areas and concentrated in non-gentrified ones. In this case study of a national crisis, the pattern of change paradoxically resulted in an increased clustering of shootings around trauma centers in non-gentrified areas. Repetition of this work in other cities can guide future resource allocation and be used to improve access to trauma care.

Associations between Greenspace and Gentrification-Related Sociodemographic and Housing Cost Changes in Major Metropolitan Areas across the United States

Neighborhood greenspace may attract new residents and lead to sociodemographic or housing cost changes. We estimated relationships between greenspace and gentrification-related changes in the 43 largest metropolitan statistical areas (MSAs) of the United States (US). We used the US National Land Cover and Brown University Longitudinal Tracts databases, as well as spatial lag models, to estimate census tract-level associations between percentage greenspace (years 1990, 2000) and subsequent changes (1990–2000, 2000–2010) in percentage college-educated, percentage working professional jobs, race/ethnic composition, household income, percentage living in poverty, household rent, and home value. We also investigated effect modification by racial/ethnic composition. We ran models for each MSA and time period and used random-effects meta-analyses to derive summary estimates for each period. Estimates were modest in magnitude and heterogeneous across MSAs. After adjusting for census-tract level population density in 1990, compared to tracts with low percentage greenspace in 1992 (defined as ≤50th percentile of the MSA-specific distribution in 1992), those with high percentage greenspace (defined as >75th percentile of the MSA-specific distribution) experienced higher 1990–2000 increases in percentage of the employed civilian aged 16+ population working professional jobs (β: 0.18, 95% confidence interval (CI): 0.11, 0.26) and in median household income (β: 0.23, 95% CI: 0.15, 0.31). Adjusted estimates for the 2000–2010 period were near the null. We did not observe evidence of effect modification by race/ethnic composition. We observed evidence of modest associations between greenspace and gentrification trends. Further research is needed to explore reasons for heterogeneity and to quantify health implications.

The last Black man with HIV in San Francisco: the potential role of gentrification on HIV getting to zero achievements

San Francisco was the first city in the USA to develop a Getting to Zero HIV elimination strategy. The cause of decreased HIV incidence has been attributed to the use of biomedical prevention methods, such as pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP). These strategies have benefitted White men who have sex with men (MSM), whose population has increased over the past decade. However, Black MSM in San Francisco continue to have higher HIV incidence and outmigration rates. We posit that the declining overall HIV incidence, including among White MSM, is not only explained by the use of TaSP and PrEP, but is also due to the declining Black population and rising HIV incidence among Black MSM, who have historically been more likely to acquire HIV due to structural, racial, and criminal justice-related factors than have White MSM.

What explains the concentration of off-premise alcohol outlets in Black neighborhoods?

INTRODUCTION

Greater availability of commercial alcohol is associated with increased alcohol use and related public health problems. Greater alcohol outlet density, a marker of alcohol availability, is associated with poorer and predominantly minority neighborhoods. However, poorer populations, African Americans, and Latinxs report using less alcohol compared to Whites and wealthier groups. We consider the role of structural racism in the social ecology of alcohol availability. Specifically we examine racist urban land use practices in the USA which became codified in the 1930s through Federal Home Owner Lending Corporation (HOLC) designations for assigning parcel values, known as "redlining." Redlining demarcated low-density residential zones for wealthy Whites which excluded poor and non-White people as well as certain businesses, including alcohol retailers. We assessed the impacts of historic redlining on present day risks for exposure to retail alcohol availability in urban Northern California.

METHODS

For six contiguous and demographically diverse Northern California cities we obtained digital renderings of HOLC maps (1937) which demarcated exclusions of people and businesses for 119 neighborhood areas across four land valuation zones. We then identified the most prevalent HOLC rating for each of 520 current Census block groups in the six cities, including a residual category for areas not rated by HOLC. We geolocated all current (2016) off-premise alcohol sales outlets operating in the six cities (N = 401). We used Bayesian spatial Poisson models to relate current alcohol outlet densities and Census-based estimates of neighborhood characteristics to historic HOLC classifications.

RESULTS

Spatial Poisson analyses found far greater contemporary off-premise outlet densities in the lowest-valued HOLC zones than in the highest (median relative rate [RR] 9.6, 95% CI 4.8-22.1). The lowest-valued HOLC zones were also characterized by far higher current percentages of both Black residents (RR 30.4, 95% CI 17.0-54.6) and Hispanic residents (RR 9.7, 95% CI 7.2-12.9).

CONCLUSIONS

Present day risks for exposure to retail alcohol availability were delimited by historic exclusionary land use practices. Current inequitable health risks may be founded on racist spatial projects of past decades.

Impacts of Gentrification on Health in the US: a Systematic Review of the Literature

Gentrification in the largest 50 US cities has more than doubled since the 1990s. The process of gentrification can bring about improved neighborhood conditions, reduced rates of crime, and property value increases. At the same time, it can equally foster negative conditions associated with poorer health outcomes, such as disrupted social networks from residential displacement and increases in stress. While neighborhood environment is consistently implicated in health outcomes research, gentrification is rarely conceptualized as a public health issue. Though research on gentrification is growing, empirical studies evaluating the health impacts of gentrification in the US are poorly understood. Here we systematically review US population-based empirical studies examining relationships between gentrification and health. Electronic databases (PubMed, Embase, CINAHL, PsycINFO, Scopus, Web of Science, and Academic Search Complete) were searched using a combination of terms to identify peer-reviewed studies published on or before July 9, 2018, reporting associations between gentrification and health. Study title and abstract screenings were followed by full-text review of all studies meeting the following inclusion criteria of: ≥ 1 quantitative measure of association for a health outcome, within the context of gentrification; peer-reviewed research; located in the US; and English language. Of 8937 studies identified, 6152 underwent title and abstract screening, and 50 studies underwent full-text screening, yielding six studies for review. Gentrification exposure measures and health outcomes examined varied widely. Most studies reported little to no overall association between gentrification and health outcomes; however, gentrification was repeatedly associated with undesirable health effects among Black and economically vulnerable residents. Despite seemingly overall null associations between gentrification and health, evidence suggests that gentrification may negatively impact the health of certain populations, particularly Black and low-income individuals. Complexities inherent in operationalizing gentrification point toward the need for validated measures. Additionally, understanding how gentrification-health associations differ across health endpoints, race/ethnicities, socioeconomic status, and life course can provide insight into whether this process contributes to urban inequality and health disparities. As gentrification occurs across the US, it is important to understand how this process impacts health. While aging cities reinvest in the revitalization of communities, empirical research examining relationships between gentrification and health can help inform policy decisions.

Evaluation of Neighborhood Socioeconomic Characteristics and Advance Care Planning Among Older Adults

IMPORTANCE

Advance care planning (ACP) is low among older adults with socioeconomic disadvantage. There is a need for tailored community-based approaches to increase ACP, but community patterns of ACP are poorly understood.

OBJECTIVE

To examine the association between neighborhood socioeconomic status (nSES) and ACP and to identify communities with both low nSES and low rates of ACP.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study examined University of California San Francisco electronic health record (EHR) data and place-based data from 9 San Francisco Bay Area counties. Participants were primary care patients aged 65 years or older and living in the San Francisco Bay Area in July 2017. Statistical analysis was performed from May to June 2020.

EXPOSURES

Patients' home addresses were geocoded and assigned to US Census tracts. The primary factor, nSES, an index combining area-level measures of income, education, poverty, employment, occupation, and housing or rent values, was divided into quintiles scaled to the distribution of all US Census tracts in the Bay Area (Q1 = lowest nSES). Covariates were from the EHR and included health care use (primary care, outpatient specialty, emergency department, and inpatient encounters in the prior year).

MAIN OUTCOMES AND MEASURES

ACP was defined as a scanned document (eg, advance directive), ACP Current Procedural Terminology code, or ACP note type in the EHR.

RESULTS

There were 13 104 patients included in the cohort-mean (SD) age was 75 (8) years, with 7622 female patients (58.2%), 897 patients (6.8%) identified as Black, 913 (7.0%) as Latinx, 3788 (28.9%) as Asian/Pacific Islander, and 748 (5.7%) as other minority race/ethnicity, and 2393 (18.3%) self-reported that they preferred to speak a non-English language. Of these, 3827 patients (29.2%) had documented ACP. The cohort was distributed across all 5 quintiles of nSES (Q1: 1426 patients [10.9%]; Q2: 1792 patients [13.7%]; Q3: 2408 patients [18.4%]; Q4: 3330 patients [25.4%]; Q5: 4148 patients [31.7%]). Compared with Q5 and after adjusting for health care use, all lower nSES quintiles showed a lower odds of ACP in a graded fashion (Q1: adjusted odds ratio [aOR] = 0.71 [95% CI, 0.61-0.84], Q2: aOR = 0.74 [95% CI, 0.64-0.86], Q3: aOR = 0.81 [95% CI, 0.71-0.93], Q4: aOR = 0.82 [95% CI, 0.72-0.93]. A bivariable map of ACP by nSES allowed identification of 5 neighborhoods with both low nSES and ACP.

CONCLUSIONS AND RELEVANCE

In this study, lower nSES was associated with lower ACP documentation after adjusting for health care use. Using EHR and place-based data, communities of older adults with both low nSES and low ACP were identified. This is a first step in partnering with communities to develop targeted, community-based interventions to meaningfully increase ACP.

Racial Disparities in Hypertension Prevalence within US Gentrifying Neighborhoods

Racial disparities in hypertension remain a persistent public health concern in the US. While several studies report Black–White differences in the health impacts of gentrification, little is known concerning the impact of living in a gentrifying neighborhood on hypertension disparities. Data from the American Community Survey were used to identify gentrifying neighborhoods across the US from 2006 to 2017. Health and demographic data were obtained for non-Hispanic Black and White respondents of the 2014 Medical Expenditure Panel Survey (MEPS) residing in gentrifying neighborhoods. Modified Poisson models were used to determine whether there is a difference in the prevalence of hypertension of individuals by their race/ethnicity for those that live in gentrifying neighborhoods across the US. When compared to Whites living within gentrifying neighborhoods, Blacks living within gentrifying neighborhoods had a similar prevalence of hypertension. The non-existence of Black–White hypertension disparities within US gentrifying neighborhoods underscores the impact of neighborhood environment on race differences in hypertension.

Case-comparison study protocol for gauging effects of neighbourhood trends and sickness: examining the perceptions of transit-Induced gentrification in Prince George's County

INTRODUCTION

Impoverished neighbourhoods and communities of colour often bear the brunt of unintended transit-oriented development (TOD) impacts. These impacts have been known to come in the form of transit-induced gentrification (TIG), a socioeconomic by-product of TOD defined as a phenomenon that occurs when the provision of transit service, particularly light rail transit (LRT), 'up-scales' nearby neighbourhood(s) and displaces existing residents. Consequently, TIG or even the perception of TIG can impact health outcomes (eg, anxiety) and social determinants of health (SDOH) (eg, crime).

METHODS/ANALYSIS

In 2022, the purple line (PL), a 16.2 mile LRT line, is opening in Prince George's County, Maryland, a suburb of Washington, DC, comprised of over 80% African American and Hispanic residents. By taking advantage of this natural experiment, we are proposing the GENTS (Gauging Effects of Neighborhood Trends and Sickness: Examining the Perceptions of Transit-Induced Gentrification in Prince George's County) Study in order to evaluate perceived TIG and associated health outcome and SDOH changes, at two points in time, among Prince George's County adults in a prospective case-comparison design during the pre-PL LRT period. Descriptive analysis and latent growth curve modelling will be used to examine these changes over time.

ETHICS AND DISSEMINATION

Ethics approval has been granted by the University of Maryland Institutional Review Board. The GENTS Study will identify temporal changes in perceived TIG, health outcomes and SDOH among case and comparison residents before the completion and operation of the PL LRT, an under researched period of TOD. The dissemination of GENTS Study findings will be able to address research questions and policy issues that are specifically tailored to PG County while also providing more effective procedural solutions for other regions undergoing TOD and TIG risks.

Gentrification: A Priority for Environmental Justice and Health Equity Research

Although gentrification is occurring at increasing rates across the United States, our understanding of what this means for public health is limited. While positive changes, such as increases in property values and reduced crime rates occur, negative consequences, such as residential displacement, also ensue. Individuals living through gentrification experience major changes in social and environmental conditions often in short periods of time, which can result in disrupted social networks and stress, both associated with decrements in health. As neighborhoods across the United States undergo revitalization, understanding health effects of gentrification, positive and negative, is paramount. We posit that gentrification may be beneficial in some aspects of health and detrimental in others. To address current challenges in the gentrification-health literature, we recommend future research: 1) examine the gentrification processes and stages; 2) integrate built, natural, and social environment metrics; and 3) assess mediating and moderating associations. As gentrification expands across the United States, research conducted in this area is poised for timely contributions to equitable development and urban planning policies.

Perceived pathways between tourism gentrification and health: A participatory Photovoice study in the Gòtic neighborhood in Barcelona

Tourism gentrification is as process of urban change and neighborhoods transformation, according to the needs of affluent visitors, increasing in some global cities. However, the link between tourism gentrification and resident's health is still an understudied topic. Using Photovoice, a participatory action research method, the aim of this study was to identify the perceived pathways that underlie the relationship between tourism gentrification and health among residents of Gòtic neighborhood, in Barcelona. The study was conducted between January 2018 and January 2019. Thirteen residents, recruited from two neighborhood organizations, took photographs of how tourism gentrification of the neighborhood was affecting their health. Participants analyzed and critically discussed their photographs in small group sessions. Through a consensus-building process, participants categorized 35 photographs and identified 7 emerging categories acknowledged as possible pathways between tourism gentrification and health, in Gòtic neighborhood: 1) decline of social networks; 2) loss of identity; 3) environmental changes; 4) pollution; 5) changes in services and stores; 6) property speculation/eviction and; 7) activism by residents. This Photovoice study recognizes important pathways underlying the relationship between tourism gentrification in the Gòtic neighborhood and the health of its residents, by altering the built environment, the social environment or psychological factors. Among them, six pathways were related to negative health outcomes, both physical and mental (respiratory diseases; worse nutrition habits; sleep deprivation; stress, anxiety and depression). 'Activism by residents' was perceived to buffer the negative health effects of living in a touristic area. The study also provides recommendations to tackle this serious urban health issue.

Causally speaking: Challenges in measuring gentrification for population health research in the United States and Canada

The planet is rapidly urbanizing, the need for actionable evidence to guide the design of cities that help (not hinder) our health has never felt more urgent. One essential component of healthy city design is improving neighborhood conditions in previously disinvested areas. To ensure equitable city design, policy makers, city planners, health practitioners, and researchers are interested in understanding the complex relationship between urban change, gentrification, and population health. Yet, the causal link between gentrification and health outcomes remain unclear. Without clear and consistent gentrification measures, researchers struggle to identify populations who are exposed to gentrification, and to compare health outcomes between exposed and unexposed populations. To move the science forward, this paper summarizes the challenges related to gentrification measurement in the United States and Canada when aspiring to conduct studies to analyze causal relationships between gentrification and health. The paper concludes with a series of recommendations for studies aimed at examining both causes and consequences of gentrification and health.

Application of Spatiotemporal Hybrid Model of Deformation in Safety Monitoring of High Arch Dams: A Case Study

As an important feature, deformation analysis is of great significance to ensure the safety and stability of arch dam operation. In this paper, Jinping-I arch dam with a height of 305 m, which is the highest dam in the world, is taken as the research object. The deformation data representation method is analyzed, and the processing method of deformation spatiotemporal data is discussed. A deformation hybrid model is established, in which the hydraulic component is calculated by the finite element method, and other components are still calculated by the statistical model method. Since the relationship among the measuring points is not taken into account and the overall situation cannot be fully reflected in the hybrid model, a spatiotemporal hybrid model is proposed. The measured values and coordinates of all the typical points with pendulums of the arch dam are included in one spatiotemporal hybrid model, which is feasible, convenient, and accurate. The model can predict the deformation of any position on the arch dam. This is of great significance for real-time monitoring of deformation and stability of Jinping-I arch dam and ensuring its operation safety.