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Gouveia N, Rodriguez-Hernandez JL, Kephart JL, Ortigoza A, Betancourt RM, Sangrador JLT, Rodriguez DA, Diez Roux AV, Sanchez B, Yamada G. Short-term associations between fine particulate air pollution and cardiovascular and respiratory mortality in 337 cities in Latin America. Sci Total Environ 2024; 920:171073. [PMID: 38382618 PMCID: PMC10918459 DOI: 10.1016/j.scitotenv.2024.171073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/29/2024] [Accepted: 02/16/2024] [Indexed: 02/23/2024]
Abstract
Ambient air pollution is a health concern in Latin America given its large urban population exposed to levels above recommended guidelines. Yet no studies have examined the mortality impact of air pollutants in the region across a wide range of cities. We assessed whether short-term levels of fine particulate matter (PM2.5) from modeled estimates, are associated with cardiovascular and respiratory mortality among adults in 337 cities from 9 Latin American countries. We compiled mortality, PM2.5 and temperature data for the period 2009-2015. For each city, we evaluated the association between monthly changes in PM2.5 and cardiovascular and respiratory mortality for sex and age subgroups using Poisson models, adjusted for seasonality, long-term trend, and temperature. To accommodate possibly different associations of mortality with PM2.5 by age, we included interaction terms between changes in PM2.5 and age in the models. We combined the city-specific estimates using a random effects meta-regression to obtain mortality relative risks for each sex and age group. We analyzed 3,026,861 and 1,222,623 cardiovascular and respiratory deaths, respectively, from a study population that represents 41 % of the total population of Latin America. We observed that a 10 μg/m3 increase in monthly PM2.5 is associated with an increase of 1.3 % (95 % confidence interval [CI], 0.4 to 2.2) in cardiovascular mortality and a 0.9 % increase (95 % CI -0.6 to 2.4) in respiratory mortality. Increases in mortality risk ranged between -0.5 % to 3.0 % across 6 sex-age groups, were larger in men, and demonstrated stronger associations with cardiovascular mortality as age increased. Socioeconomic, environmental and health contexts in Latin America are different than those present in higher income cities from which most evidence on air pollution impacts is drawn. Locally generated evidence constitutes a powerful instrument to engage civil society and help drive actions to mitigate and control ambient air pollution.
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Affiliation(s)
- Nelson Gouveia
- Department of Preventive Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil.
| | | | - Josiah L Kephart
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, USA; Department of Environmental and Occupational Health, Drexel Dornsife School of Public Health, Philadelphia, USA
| | - Ana Ortigoza
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, USA; Department of Environmental and Social determinants for Health Equity, Pan American Health Organization, USA
| | | | | | - Daniel A Rodriguez
- Institute of Transportation Studies, University of California, Berkeley, CA, USA; Department of City and Regional Planning and Institute Transportation Studies, University of California, Berkeley, USA
| | - Ana V Diez Roux
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, USA; Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, USA
| | - Brisa Sanchez
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, USA
| | - Goro Yamada
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, USA
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Yamey G, Diez Roux AV, Clark J, Abbasi K. Pandemic lessons for the 2024 US presidential election. BMJ 2024; 384:q150. [PMID: 38286471 PMCID: PMC10844951 DOI: 10.1136/bmj.q150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Affiliation(s)
- Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Kershaw KN, Magnani JW, Diez Roux AV, Camacho-Rivera M, Jackson EA, Johnson AE, Magwood GS, Morgenstern LB, Salinas JJ, Sims M, Mujahid MS. Neighborhoods and Cardiovascular Health: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2024; 17:e000124. [PMID: 38073532 DOI: 10.1161/hcq.0000000000000124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
The neighborhoods where individuals reside shape environmental exposures, access to resources, and opportunities. The inequitable distribution of resources and opportunities across neighborhoods perpetuates and exacerbates cardiovascular health inequities. Thus, interventions that address the neighborhood environment could reduce the inequitable burden of cardiovascular disease in disenfranchised populations. The objective of this scientific statement is to provide a roadmap illustrating how current knowledge regarding the effects of neighborhoods on cardiovascular disease can be used to develop and implement effective interventions to improve cardiovascular health at the population, health system, community, and individual levels. PubMed/Medline, CINAHL, Cochrane Library reviews, and ClinicalTrials.gov were used to identify observational studies and interventions examining or targeting neighborhood conditions in relation to cardiovascular health. The scientific statement summarizes how neighborhoods have been incorporated into the actions of health care systems, interventions in community settings, and policies and interventions that involve modifying the neighborhood environment. This scientific statement presents promising findings that can be expanded and implemented more broadly and identifies methodological challenges in designing studies to evaluate important neighborhood-related policies and interventions. Last, this scientific statement offers recommendations for areas that merit further research to promote a deeper understanding of the contributions of neighborhoods to cardiovascular health and health inequities and to stimulate the development of more effective interventions.
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Krieger N, Testa C, Chen JT, Johnson N, Watkins SH, Suderman M, Simpkin AJ, Tilling K, Waterman PD, Coull BA, De Vivo I, Smith GD, Roux AVD, Relton C. Epigenetic aging & embodying injustice: US My Body My Story and Multi-Ethnic Atherosclerosis Study. medRxiv 2023:2023.12.13.23299930. [PMID: 38168159 PMCID: PMC10760288 DOI: 10.1101/2023.12.13.23299930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Importance Epigenetic accelerated aging is associated with exposure to social and economic adversity and may increase risk of premature morbidity and mortality. However, no studies have included measures of structural racism and few have compared estimates within or across the 1st and 2nd generation of epigenetic clocks (the latter additionally trained on phenotypic data). Objective To determine if accelerated epigenetic aging is associated with exposures to diverse measures of racialized, economic, and environmental injustice measured at different levels and time periods. Design Cross-sectional My Body My Story Study (MBMS; US, 2008-2010) and Exam 5 Multi-Ethnic Atherosclerosis Study (MESA; US, 2010-2012). MBMS DNA extraction: 2021; linkage of structural measures to MBMS and MESA: 2022. Setting MBMS recruited a random sample of US-born Black non-Hispanic (BNH) and white non-Hispanic (WNH) participants from 4 community health centers in Boston, MA. The MESA Exam 5 epigenetic component included 975 randomly selected US-born BNH, WNH, and Hispanic participants from four field sites: Baltimore, MD; Forsyth County, NC; New York City, NY; St. Paul, MN. Participants US-born persons (MBMS: 224 BNH, 69 WNH; MESA: 229 BNH, 555 WNH, 191 Hispanic). Main outcome and measures 10 epigenetic clocks (six 1st generation; four 2nd generation), computed using DNA methylation data (DNAm) from blood spots (MBMS; N = 293) and purified monocytes (MESA; N = 975). Results Among Black non-Hispanic MBMS participants, epigenetic age acceleration was associated with being born in a Jim Crow state by 0.14 standard deviations (95% confidence interval [CI] 0.00, 0.27) and with birth state conservatism (0.06, 95% CI 0.00, 0.05), pooling across all clocks, as was low parental education for both Black non-Hispanic and white non-Hispanic MBMS participants (respectively: 0.24, 95% CI 0.08, 0.39, and 0.27, 95% CI 0.03, 0.51. Adult impoverishment was positively associated with the pooled 2nd generation clocks among the MESA participants (Black non-Hispanic: 0.06, 95% CI 0.01, 0.12; white non-Hispanic: 0.05, 95% CI 0.01, 0.08; Hispanic: 0.07, 95% CI 0.01, 0.14). Conclusions and Relevance Epigenetic accelerated aging may be one of the biological mechanisms linking exposure to racialized and economic injustice to well-documented inequities in premature morbidity and mortality.
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Affiliation(s)
- Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Christian Testa
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Jarvis T. Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Nykesha Johnson
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Sarah H. Watkins
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Matthew Suderman
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Andrew J. Simpkin
- School of Mathematical and Statistical Sciences, National University of Ireland, Galway, Ireland
| | - Kate Tilling
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Pamela D. Waterman
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Brent A. Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Immaculata De Vivo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Ana V. Diez Roux
- Urban Health Collective and Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Caroline Relton
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
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Kephart JL, Gouveia N, Rodríguez DA, Indvik K, Alfaro T, Texcalac-Sangrador JL, Miranda JJ, Bilal U, Diez Roux AV. Ambient nitrogen dioxide in 47 187 neighbourhoods across 326 cities in eight Latin American countries: population exposures and associations with urban features. Lancet Planet Health 2023; 7:e976-e984. [PMID: 38056968 PMCID: PMC10716820 DOI: 10.1016/s2542-5196(23)00237-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Health research on ambient nitrogen dioxide (NO2) is sparse in Latin America, despite the high prevalence of NO2-associated respiratory diseases in the region. This study describes within-city distributions of ambient NO2 concentrations at high spatial resolution and urban characteristics associated with neighbourhood ambient NO2 in 326 Latin American cities. METHODS We aggregated estimates of annual surface NO2 at 1 km2 spatial resolution for 2019, population counts, and urban characteristics compiled by the SALURBAL project to the neighbourhood level (ie, census tracts). We described the percentage of the urban population living with ambient NO2 concentrations exceeding WHO air quality guidelines. We used multilevel models to describe associations of neighbourhood ambient NO2 concentrations with population and urban characteristics at the neighbourhood and city levels. FINDINGS We examined 47 187 neighbourhoods in 326 cities from eight Latin American countries. Of the roughly 236 million urban residents observed, 85% lived in neighbourhoods with ambient annual NO2 above WHO guidelines. In adjusted models, higher neighbourhood-level educational attainment, closer proximity to the city centre, and lower neighbourhood-level greenness were associated with higher ambient NO2. At the city level, higher vehicle congestion, population size, and population density were associated with higher ambient NO2. INTERPRETATION Almost nine out of every ten residents of Latin American cities live with ambient NO2 concentrations above WHO guidelines. Increasing neighbourhood greenness and reducing reliance on fossil fuel-powered vehicles warrant further attention as potential actionable urban environmental interventions to reduce population exposure to ambient NO2. FUNDING Wellcome Trust, National Institutes of Health, Cotswold Foundation.
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Affiliation(s)
- Josiah L Kephart
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
| | - Nelson Gouveia
- Department of Preventive Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Daniel A Rodríguez
- Department of City and Regional Planning and Institute for Transportation Studies, University of California, Berkeley, CA, USA
| | - Katherine Indvik
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Tania Alfaro
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - José Luis Texcalac-Sangrador
- Department of Environmental Health, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Schinasi LH, Bakhtsiyarava M, Sanchez BN, Kephart JL, Ju Y, Arunachalam S, Gouveia N, Teixeira Caiaffa W, O'Neill MS, Dronova I, Diez Roux AV, Rodriguez DA. Greenness and excess deaths from heat in 323 Latin American cities: Do associations vary according to climate zone or green space configuration? Environ Int 2023; 180:108230. [PMID: 37776620 PMCID: PMC10594062 DOI: 10.1016/j.envint.2023.108230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/19/2023] [Accepted: 09/23/2023] [Indexed: 10/02/2023]
Abstract
Green vegetation may protect against heat-related death by improving thermal comfort. Few studies have investigated associations of green vegetation with heat-related mortality in Latin America or whether associations are modified by the spatial configuration of green vegetation. We used data from 323 Latin American cities and meta-regression models to estimate associations between city-level greenness, quantified using population-weighted normalized difference vegetation index values and modeled as three-level categorical terms, and excess deaths from heat (heat excess death fractions [heat EDFs]). Models were adjusted for city-level fine particulate matter concentration (PM2.5), social environment, and country group. In addition to estimating overall associations, we derived estimates of association stratified by green space clustering by including an interaction term between a green space clustering measure (dichotomized at the median of the distribution) and the three-level greenness variable. We stratified analyses by climate zone (arid vs. temperate and tropical combined). Among the 79 arid climate zone cities, those with moderate and high greenness levels had modestly lower heat EDFs compared to cities with the lowest greenness, although protective associations were more substantial in cities with moderate versus high greenness levels and confidence intervals (CI) crossed the null (Beta: -0.41, 95% CI: -1.06, 0.25; Beta -0.23, 95% CI: -0.95, 0.49, respectively). In 244 non-arid climate zone cities, associations were approximately null. We did not observe evidence of effect modification by green space clustering. Our results suggest that greenness may offer modest protection against heat-related mortality in arid climate zone Latin American cities.
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Affiliation(s)
- Leah H Schinasi
- Department of Environmental and Occupational Health, Drexel Dornsife School of Public Health, Philadelphia, USA; Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, USA.
| | - Maryia Bakhtsiyarava
- Institute of Transportation Studies, University of California, Berkeley, CA, USA
| | - Brisa N Sanchez
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, USA; Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, USA
| | - Josiah L Kephart
- Department of Environmental and Occupational Health, Drexel Dornsife School of Public Health, Philadelphia, USA; Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, USA
| | - Yang Ju
- School of Architecture and Urban Planning, Nanjing University, Nanjing, China
| | - Sarav Arunachalam
- Institute for the Environment, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Nelson Gouveia
- Department of Preventive Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Waleska Teixeira Caiaffa
- Observatory for Urban Health in Belo Horizonte, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Marie S O'Neill
- Departments of Epidemiology and Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, USA
| | - Iryna Dronova
- Department of Environmental Science, Policy & Management, University of California, Berkeley, USA; Department of Landscape Architecture & Environmental Planning, University of California, Berkeley, USA
| | - Ana V Diez Roux
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, USA; Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, USA
| | - Daniel A Rodriguez
- Institute of Transportation Studies, University of California, Berkeley, CA, USA; Department of City and Regional Planning and Institute of Transportation Studies, University of California, Berkeley, USA
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Perner MS, Trotta A, Bilal U, Acharya B, Quick H, Pacífico N, Berazategui R, Alazraqui M, Diez Roux AV. Social inequalities and COVID-19 mortality between neighborhoods of Bariloche city, Argentina. Int J Equity Health 2023; 22:198. [PMID: 37770868 PMCID: PMC10537962 DOI: 10.1186/s12939-023-02019-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has shown how intraurban inequalities are likely to reinforce health and social inequalities. Studies at small area level help to visualize social inequialities hidden in large areas as cities or regions. AIM To describe the spatial patterning of COVID-19 death rates in neighborhoods of the medium-sized city of Bariloche, Argentina, and to explore its relationship with the socioeconomic characteristics of neighborhoods. METHODS We conducted an ecological study in Bariloche, Argentina. The outcome was counts of COVID-19 deaths between June 2020 and May 2022 obtained from the surveillance system and georeferenced to neighborhoods. We estimated crude- and age-adjusted death rates by neighborhood using a Bayesian approach through a Poisson regression that accounts for spatial-autocorrelation via Conditional Autoregressive (CAR) structure. We also analyzed associations of age-adjusted death rates with area-level socioeconomic indicators. RESULTS Median COVID-19 death rate across neighborhoods was 17.9 (10th/90th percentile of 6.3/35.2) per 10,000 inhabitants. We found lower age-adjusted rates in the city core and western part of the city. The age-adjusted death rate in the most deprived areas was almost double than in the least deprived areas, with an education-related relative index of inequality (RII) of 2.14 (95% CI 1.55 to 2.96). CONCLUSION We found spatial heterogeneity and intraurban variability in age-adjusted COVID-19 death rates, with a clear social gradient, and a higher burden in already deprived areas. This highlights the importance of studying inequalities in health outcomes across small areas to inform placed-based interventions.
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Affiliation(s)
- Mónica Serena Perner
- Institute of Collective Health, National University of Lanus, Buenos Aires, Argentina.
- CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina.
| | - Andrés Trotta
- Institute of Collective Health, National University of Lanus, Buenos Aires, Argentina
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Binod Acharya
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Harrison Quick
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Natalia Pacífico
- Institute of Collective Health, National University of Lanus, Buenos Aires, Argentina
| | | | - Marcio Alazraqui
- Institute of Collective Health, National University of Lanus, Buenos Aires, Argentina
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
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Baquero S, Montes F, Stankov I, Sarmiento OL, Medina P, Slesinski SC, Diez-Canseco F, Kroker-Lobos MF, Caiaffa WT, Vives A, Alazraqui M, Barrientos-Gutiérrez T, Roux AVD. Author Correction: Assessing cohesion and diversity in the collaboration network of the SALURBAL project. Sci Rep 2023; 13:13676. [PMID: 37607957 PMCID: PMC10444870 DOI: 10.1038/s41598-023-40860-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Affiliation(s)
- Sofía Baquero
- Department of Industrial Engineering, Social and Health Complexity Center, Universidad de los Andes, Crr 1 Este No.19ª-40 Piso 8, 111711, Bogotá, Colombia.
| | - Felipe Montes
- Department of Industrial Engineering, Social and Health Complexity Center, Universidad de los Andes, Crr 1 Este No.19ª-40 Piso 8, 111711, Bogotá, Colombia
| | - Ivana Stankov
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, 5000, Australia
| | - Olga L Sarmiento
- School of Medicine, Universidad de los Andes, 111711, Bogotá, Colombia
| | - Pablo Medina
- Department of Industrial Engineering, Social and Health Complexity Center, Universidad de los Andes, Crr 1 Este No.19ª-40 Piso 8, 111711, Bogotá, Colombia
| | - S Claire Slesinski
- Pettenkofer School of Public Health, Ludwig-Maximilians-Universität München, 81377, Munich, Germany
| | - Francisco Diez-Canseco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, 15074, Peru
| | - Maria F Kroker-Lobos
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, 01011, Guatemala
| | - Waleska Teixeira Caiaffa
- Observatory for Urban Health in Belo Horizonte (OSUBH), Universidade Federal de Minas Gerais, Brazil, Belo Horizonte, MG, 30130-100, Brazil
| | - Alejandra Vives
- Department of Public Health, CEDEUS, Universidad Católica de Chile, 8330077, Santiago, Chile
| | - Marcio Alazraqui
- Institute of Collective Health, National University of Lanús, Buenos Aires, Argentina
| | | | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA
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Watkins SH, Testa C, Chen JT, De Vivo I, Simpkin AJ, Tilling K, Diez Roux AV, Davey Smith G, Waterman PD, Suderman M, Relton C, Krieger N. Epigenetic clocks and research implications of the lack of data on whom they have been developed: a review of reported and missing sociodemographic characteristics. Environ Epigenet 2023; 9:dvad005. [PMID: 37564905 PMCID: PMC10411856 DOI: 10.1093/eep/dvad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/17/2023] [Accepted: 07/13/2023] [Indexed: 08/12/2023]
Abstract
Epigenetic clocks are increasingly being used as a tool to assess the impact of a wide variety of phenotypes and exposures on healthy ageing, with a recent focus on social determinants of health. However, little attention has been paid to the sociodemographic characteristics of participants on whom these clocks have been based. Participant characteristics are important because sociodemographic and socioeconomic factors are known to be associated with both DNA methylation variation and healthy ageing. It is also well known that machine learning algorithms have the potential to exacerbate health inequities through the use of unrepresentative samples - prediction models may underperform in social groups that were poorly represented in the training data used to construct the model. To address this gap in the literature, we conducted a review of the sociodemographic characteristics of the participants whose data were used to construct 13 commonly used epigenetic clocks. We found that although some of the epigenetic clocks were created utilizing data provided by individuals from different ages, sexes/genders, and racialized groups, sociodemographic characteristics are generally poorly reported. Reported information is limited by inadequate conceptualization of the social dimensions and exposure implications of gender and racialized inequality, and socioeconomic data are infrequently reported. It is important for future work to ensure clear reporting of tangible data on the sociodemographic and socioeconomic characteristics of all the participants in the study to ensure that other researchers can make informed judgements about the appropriateness of the model for their study population.
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Affiliation(s)
- Sarah Holmes Watkins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK
- Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK
| | - Christian Testa
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Jarvis T Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Immaculata De Vivo
- Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Andrew J Simpkin
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Ireland
| | - Kate Tilling
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK
- Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK
| | - Ana V Diez Roux
- Department of Epidemiology and Biostatistics and Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
| | - George Davey Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK
- Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK
| | - Pamela D Waterman
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Matthew Suderman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK
- Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK
| | - Caroline Relton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK
- Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK
| | - Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
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Braverman-Bronstein A, Vidaña-Pérez D, Diez Roux AV, Pérez Ferrer C, Sánchez BN, Barrientos-Gutiérrez T. Association of service facilities and amenities with adolescent birth rates in Mexican cities. BMC Public Health 2023; 23:1321. [PMID: 37430299 DOI: 10.1186/s12889-023-16251-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 07/05/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND The association of the built environment and the structural availability of services/amenities with adolescent birth rates (ABR) has been overlooked in Latin America. We investigated the association of the availability, and changes in the availability, of services/amenities with ABR in 92 Mexican cities. METHODS We estimated ABR using data on live birth registration linked to municipality of residence at the time of birth from 2008-2017. The number of services/amenities were obtained from the National Statistical Directory of Economic Units in 2010, 2015, and 2020 and grouped as follows: education, health care, pharmacies, recreation, and on- and off-premises alcohol outlets. Data were linearly interpolated to obtain yearly estimates. We estimated densities per square km by municipality. We fitted negative binomial hybrid models, including a random intercept for municipality and city, and adjusted for other social environment variables. RESULTS After adjustment a 1-unit increase in the density of recreation facilities, pharmacies, and off-premises alcohol outlets within municipalities was associated with a 5%, 4% and 12% decrease in ABR, respectively. Municipalities with higher density of education, recreational and health care facilities had a lower ABR; in contrast, municipalities with a higher density of on-premises alcohol experienced a higher ABR. CONCLUSION Our findings highlight the importance of economic drivers and the need to invest in infrastructure, such as pharmacies, medical facilities, schools, and recreation areas and limit the availability of alcohol outlets to increase the impact of current adolescent pregnancy prevention programs.
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Affiliation(s)
- Ariela Braverman-Bronstein
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Dèsirée Vidaña-Pérez
- Center for Survey Research and Evaluation, National Institute of Public Health, Cuernavaca, Mexico
| | - Ana V Diez Roux
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | | | - Brisa N Sánchez
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Tonatiuh Barrientos-Gutiérrez
- Center for Population Health Research, National Institute of Public Health, Av. Universidad 655, 62100, Cuernavaca, Mexico.
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Baquero S, Montes F, Stankov I, Sarmiento OL, Medina P, Slesinski SC, Diez-Canseco F, Kroker-Lobos MF, Caiaffa WT, Vives A, Alazraqui M, Barrientos-Gutiérrez T, Roux AVD. Assessing cohesion and diversity in the collaboration network of the SALURBAL project. Sci Rep 2023; 13:7590. [PMID: 37165002 PMCID: PMC10172186 DOI: 10.1038/s41598-023-33641-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/16/2023] [Indexed: 05/12/2023] Open
Abstract
The SALURBAL (Urban Health in Latin America) Project is an interdisciplinary multinational network aimed at generating and disseminating actionable evidence on the drivers of health in cities of Latin America. We conducted a temporal multilayer network analysis where we measured cohesion over time using network structural properties and assessed diversity within and between different project activities according to participant attributes. Between 2017 and 2020 the SALURBAL network comprised 395 participants across 26 countries, 23 disciplines, and 181 institutions. While the cohesion of the SALURBAL network fluctuated over time, overall, an increase was observed from the first to the last time point of our analysis (clustering coefficient increased [0.83-0.91] and shortest path decreased [1.70-1.68]). SALURBAL also exhibited balanced overall diversity within project activities (0.5-0.6) by designing activities for different purposes such as capacity building, team-building, research, and dissemination. The network's growth was facilitated by the creation of new diverse collaborations across a range of activities over time, while maintaining the diversity of existing collaborations (0.69-0.75 between activity diversity depending on the attribute). The SALURBAL experience can serve as an example for multinational research projects aiming to build cohesive networks while leveraging heterogeneity in countries, disciplines, career stage, and across sectors.
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Affiliation(s)
- Sofía Baquero
- Department of Industrial Engineering, Social and Health Complexity Center, Universidad de los Andes, Crr 1 Este No.19ª-40 Piso 8, 111711, Bogotá, Colombia.
| | - Felipe Montes
- Department of Industrial Engineering, Social and Health Complexity Center, Universidad de los Andes, Crr 1 Este No.19ª-40 Piso 8, 111711, Bogotá, Colombia
| | - Ivana Stankov
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, 5000, Australia
| | - Olga L Sarmiento
- School of Medicine, Universidad de los Andes, 111711, Bogotá, Colombia
| | - Pablo Medina
- Department of Industrial Engineering, Social and Health Complexity Center, Universidad de los Andes, Crr 1 Este No.19ª-40 Piso 8, 111711, Bogotá, Colombia
| | - S Claire Slesinski
- Pettenkofer School of Public Health, Ludwig-Maximilians-Universität München, 81377, Munich, Germany
| | - Francisco Diez-Canseco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, 15074, Peru
| | - Maria F Kroker-Lobos
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, 01011, Guatemala
| | - Waleska Teixeira Caiaffa
- Observatory for Urban Health in Belo Horizonte (OSUBH), Universidade Federal de Minas Gerais, Brazil, Belo Horizonte, MG, 30130-100, Brazil
| | - Alejandra Vives
- Department of Public Health, CEDEUS, Universidad Católica de Chile, 8330077, Santiago, Chile
| | - Marcio Alazraqui
- Institute of Collective Health, National University of Lanús, Buenos Aires, Argentina
| | | | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA
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12
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Rengifo-Reina H, Barrientos-Gutiérrez T, López-Olmedo N, Sánchez BN, Diez Roux AV. Frailty in Older Adults and Internal and Forced Migration in Urban Neighborhood Contexts in Colombia. Int J Public Health 2023; 68:1605379. [PMID: 37215649 PMCID: PMC10196000 DOI: 10.3389/ijph.2023.1605379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 04/20/2023] [Indexed: 05/24/2023] Open
Abstract
Objective: We investigated the association between the density of internal human migration, in the urban neighborhood, on frailty in the older adult population in Colombia. Methods: The data used in this study are from four Colombian population surveys. We analyzed 633 census tracts with a sample of 2,194 adults 60 years and over for frailty (measured using the Fried criteria). We considered the proportion of inhabitants in a census tract with a history of internal migration as the exposure variable considering three temporalities. For contextual forced migration, we identified two types: 5-year, and 1-year. Poisson multivariable regression models with two hierarchical levels (individual and census tracts) were estimated. Results: The prevalence of pre-fragile/frailty was 80.63% [CI 95%: 77.67, 83.28]. The prevalence ratio were significantly higher for the older adults who live in neighborhoods where a higher proportion of internal migrants reside. Conclusion: We conclude that older adults who lived in neighborhoods with a high proportion of internal migrants experience more frailty. Potential explanations are that neighborhoods with high internal migration could experience social (l increase in cultural heterogeneity, in the perception of insecurity, violence and physical conditions (pressure on local economies and services, leading elderly residents to compete for neighborhood resources), translated into social stress.
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Affiliation(s)
- Herney Rengifo-Reina
- Center for Population Health Research, National Institute of Public Health (Mexico), Cuernavaca, Mexico
| | | | - Nancy López-Olmedo
- Center for Population Health Research, National Institute of Public Health (Mexico), Cuernavaca, Mexico
| | - Brisa N. Sánchez
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA, United States
| | - Ana V. Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
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13
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Kephart JL, Gouveia N, Rodriguez DA, Indvik K, Alfaro T, Texcalac JL, Miranda JJ, Bilal U, Roux AVD. Ambient nitrogen dioxide in 47,187 neighborhoods across 326 cities in eight Latin American countries: population exposures and associations with urban features. medRxiv 2023:2023.05.02.23289390. [PMID: 37205591 PMCID: PMC10187449 DOI: 10.1101/2023.05.02.23289390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Background Health research on ambient nitrogen dioxide (NO2) is sparse in Latin America, despite the high prevalence of NO2-associated respiratory diseases in the region. This study describes within-city distributions of ambient NO2 concentrations at high spatial resolution and urban characteristics associated with neighborhood ambient NO2 in 326 Latin American cities. Methods We aggregated estimates of annual surface NO2 at 1 km2 spatial resolution for 2019, population counts, and urban characteristics compiled by the SALURBAL project to the neighborhood level (i.e., census tracts). We described the percent of the urban population living with ambient NO2 levels exceeding WHO Air Quality Guidelines. We used multilevel models to describe associations of neighborhood ambient NO2 concentrations with population and urban characteristics at the neighborhood and city levels. Findings We examined 47,187 neighborhoods in 326 cities from eight Latin American countries. Of the ≈236 million urban residents observed, 85% lived in neighborhoods with ambient annual NO2 above WHO guidelines. In adjusted models, higher neighborhood-level educational attainment, closer proximity to the city center, and lower neighborhood-level greenness were associated with higher ambient NO2. At the city level, higher vehicle congestion, population size, and population density were associated with higher ambient NO2. Interpretation Almost nine out of every 10 residents of Latin American cities live with ambient NO2 concentrations above WHO guidelines. Increasing neighborhood greenness and reducing reliance on fossil fuel-powered vehicles warrant further attention as potential actionable urban environmental interventions to reduce population exposure to ambient NO2. Funding Wellcome Trust, National Institutes of Health, Cotswold Foundation.
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Affiliation(s)
- Josiah L. Kephart
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Nelson Gouveia
- Department of Preventive Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Daniel A. Rodriguez
- Department of City and Regional Planning and Institute for Transportation Studies, University of California, Berkeley, California, USA
| | - Katy Indvik
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Tania Alfaro
- Escuela de Salud Pública, Universidad de Chile, Santiago de Chile, Chile
| | - José Luis Texcalac
- Department of Environmental Health, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - J. Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Ana V. Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
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14
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Lawrence WR, Jones GS, Johnson JA, Ferrell KP, Johnson JN, Shiels MS, Diez Roux AV, Forde AT. Discrimination Experiences and All-Cause and Cardiovascular Mortality: Multi-Ethnic Study of Atherosclerosis. Circ Cardiovasc Qual Outcomes 2023; 16:e009697. [PMID: 37017086 PMCID: PMC10106108 DOI: 10.1161/circoutcomes.122.009697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
BACKGROUND Epidemiologic studies have documented the associations between experiences of discrimination and adverse health outcomes. However, the relationship between discrimination and mortality, and the factors that may moderate this relationship are not well understood. This study examined whether lifetime and everyday discrimination were associated with all-cause and cardiovascular mortality and whether these associations differed by race and ethnicity, gender, and racial and ethnic residential segregation. METHODS The study included 1633 Black, 1403 Hispanic/Latino, and 2473 White participants aged 45 to 84 years from the Multi-Ethnic Study of Atherosclerosis, enrolled from 2000 to 2002 and followed across 5 exams (2002-2018). Discrimination was measured using the lifetime discrimination (major experiences of unfair treatment) and everyday discrimination (day-to-day experiences of unfair treatment) scales. Racial and ethnic residential segregation was measured using the Gi* statistic. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs, adjusting for sociodemographic characteristics, health behaviors, and clinical risk factors. RESULTS Each increase in reports of lifetime discrimination was associated with increased all-cause (HR, 1.06 [95% CI, 1.00-1.11]) and cardiovascular (HR, 1.15 [95% CI, 1.04-1.27]) mortality, adjusting for sociodemographic factors, health behaviors, and clinical risk factors. Associations between lifetime discrimination and cardiovascular mortality were observed across all racial and ethnic groups but were strongest and only statistically significant among Black participants (HR, 1.18 [95% CI, 1.02-1.37]). Additionally, in the fully adjusted model, each increase in reports of everyday discrimination was strongly associated with increased cardiovascular mortality (HR, 1.21 [95% CI, 1.03-1.43]). Associations for lifetime and everyday discrimination with all-cause and cardiovascular mortality were not modified by race and ethnicity, gender, or racial and ethnic residential segregation. CONCLUSIONS These findings suggest that experiences of discrimination are associated with increased all-cause and cardiovascular mortality.
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Affiliation(s)
- Wayne R Lawrence
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD (W.R.L., G.S.J., M.S.S.)
| | - Gieira S Jones
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD (W.R.L., G.S.J., M.S.S.)
| | | | - Koya P Ferrell
- Division of Intramural Research (K.P.F., J.N.J., A.T.F.)
| | | | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD (W.R.L., G.S.J., M.S.S.)
| | - Ana V Diez Roux
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Dornsife School of Public Health, Drexel University, Philadelphia, PA (A.V.D.R.)
| | - Allana T Forde
- Division of Intramural Research (K.P.F., J.N.J., A.T.F.)
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15
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Lawrence WR, Jones GS, Johnson JA, Ferrell KP, Johnson JN, Shiels MS, Diez Roux AV, Forde AT. Abstract 06: Discrimination Experiences and All-Cause and Cardiovascular Mortality: The Multi-Ethnic Study of Atherosclerosis. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Introduction:
Epidemiologic studies have documented the associations between experiences of discrimination and adverse health outcomes. However, the relationship between discrimination and mortality, and the factors that may moderate this relationship are not well understood. This study examined whether lifetime and everyday discrimination were associated with all-cause and cardiovascular mortality, and whether these associations differed by race/ethnicity, gender, and racial/ethnic residential segregation.
Hypothesis:
We hypothesized that greater exposure to lifetime and everyday discrimination would be associated with increased risk of cardiovascular mortality, and that these associations would be modified by race/ethnicity, gender, and racial/ethnic residential segregation.
Methods:
The study included 1,633 Black, 1,403 Hispanic/Latino, and 2,473 White participants aged 45 to 84 years from the Multi-Ethnic Study of Atherosclerosis, enrolled from 2000-2002 and followed across 5 exams (2002-2018). In addition to exams, follow-up for mortality involved phone calls and linkage with the National Death Index. Discrimination was measured using the lifetime discrimination (major experiences of unfair treatment) and everyday discrimination (day-to-day experiences of unfair treatment) scales. Racial/ethnic residential segregation was measured using the
Gi*
statistic. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (95%CIs), adjusting for sociodemographic characteristics, health behaviors, and clinical risk factors.
Results:
Each increase in reports of lifetime discrimination was associated with increased all-cause (HR=1.06; 95%CI 1.00,1.11,) and cardiovascular (HR=1.15; 95%CI 1.04, 1.27) mortality, adjusting for sociodemographic factors, health behaviors, and clinical risk factors. Associations between lifetime discrimination and cardiovascular mortality were observed across all racial/ethnic groups but were strongest and only statistically significant among Black participants (HR=1.18; 95%CI 1.02, 1.37). Additionally, in the fully adjusted model, each increase in reports of everyday discrimination was marginally associated with increased all-cause mortality (HR=1.07; 95%CI 0.98-1.17) and strongly associated with increased cardiovascular mortality (HR=1.21; 95%CI 1.03, 1.43). Associations for lifetime and everyday discrimination with all-cause and cardiovascular mortality were not modified by race/ethnicity, gender, or racial/ethnic residential segregation.
Conclusion:
These findings suggest that experiences of discrimination are associated with increased all-cause and cardiovascular mortality. Our results underscore the need for interventions aimed at preventing and mitigating the adverse health effects of discrimination.
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Affiliation(s)
| | | | - Jarrett A Johnson
- National Institute on Minority Health and Health Disparities, Bethesda, MD
| | - Koya P Ferrell
- National Institute on Minority Health and Health Disparities, Bethesda, MD
| | - Jacquita N Johnson
- National Institute on Minority Health and Health Disparities, Bethesda, MD
| | | | | | - Allana T Forde
- National Institute on Minority Health and Health Disparities, Bethesda, MD
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16
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Quintero Valverde C, Perez-Ferrer C, Chías Becerril L, Martínez Santiago A, Reséndiz Lopez H, Prado Galbarro J, Quistberg DA, Diez Roux AV, Barrientos-Gutierrez T. Evaluation of road safety policies and their enforcement in Mexico City, 2015-2019: an interrupted time-series study. Inj Prev 2023; 29:35-41. [PMID: 36096653 PMCID: PMC7614109 DOI: 10.1136/ip-2022-044590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/21/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Mexico City approved new road safety policies in 2015, which included lower speed limits and higher fines for traffic offences. In 2019, economic fines were replaced by a point penalty system among other changes. This study evaluates these policies on road traffic collisions, injuries and deaths. METHODS Collisions data came from insurance collision claims (January 2015 to December 2019) and road traffic deaths from vital registrations (January 2013 to December 2019). We conducted an interrupted time series analysis for each outcome using negative binomial regression models with an offset of insured vehicles (collisions) or total population (deaths). Then, we classified the 16 municipalities in the city into enforcement and no-enforcement groups based on presence or absence of automated traffic enforcement devices and conducted a controlled interrupted time series analysis. RESULTS The 2015 road safety policies had no effect on total collisions and collisions resulting in injury but were associated with a 0.2% (95% CI -0.3 to 0.0) decline in the mortality trend. The 2019 policies had no effect on total collisions but were associated with a 1.5% increase in the trend of collisions resulting in injuries and with a 2.7% (95% CI 1.0 to 4.5) increase in the mortality trend. Postpolicy trends in enforcement versus no-enforcement municipalities were not significantly different. CONCLUSION Policies that included high economic penalties for speeding and dangerous behaviours were effective in decreasing traffic mortality while removing economic penalties and replacing them with a point penalty system were associated with an increase in collisions, resulting in injury and mortality.
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Affiliation(s)
| | - Carolina Perez-Ferrer
- Center for Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
- Programa Investigadores por México, National Council of Science and Technology (CONACYT), Mexico City, Mexico
| | - Luis Chías Becerril
- Institute of Geography, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | | | - Héctor Reséndiz Lopez
- Institute of Geography, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Javier Prado Galbarro
- Center for Research in Population Health, National Institute of Public Health, Cuernavaca, Mexico
| | - D Alex Quistberg
- Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA
- Environmental & Occupational Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Ana V Diez Roux
- Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Epidemiology & Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
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17
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Ortigoza A, Braverman A, Hessel P, Di Cecco V, Friche AA, Teixeira Caiaffa W, Diez Roux AV. Women's empowerment and infant mortality in Latin America: evidence from 286 cities. Cities Health 2023; 7:93-101. [PMID: 36818398 PMCID: PMC7614198 DOI: 10.1080/23748834.2021.1908794] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Levels of women's empowerment (WE) can contribute to differences in infant mortality rates (IMRs) across cities. We used a cross-sectional multilevel study to examine associations of WE with IMRs across 286 cities in seven Latin American countries. We estimated IMRs for 2014-2016 period and combined city socioeconomic indicators into factors reflecting living conditions and service provision. WE was operationalized: (1) in cities, by using scores for women's labor force participation (WLFP) and educational attainment among women derived from education and employment indicators disaggregated by sex; (2) in countries, by including a scale of enforcements of laws related to women's rights. We estimated adjusted percent differences in IMRs associated with higher WE scores across all cities and stratified by country GDP. We found substantial heterogeneity in IMRs and WE across cities. Higher WLFP was associated with lower IMRs. Higher women's educational attainment was associated with lower IMRs only in cities from countries with lower GDP. Poorer national enforcement of laws protecting women's rights was associated with higher IMRs in all countries. Women's empowerment could have positive implications for population health. Fostering women's socioeconomic development and girls' education should be part of strategies to reduce IMRs in cities of Global South.
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Affiliation(s)
- Ana Ortigoza
- Urban Health Collaborative, Drexel University, Philadelphia, PA, USA,CONTACT Ana Ortigoza Urban Health Collaborative, Drexel University, 3600 Market Street, Room 717E, Philadelphia19104, USA
| | - Ariela Braverman
- Urban Health Collaborative, Drexel University, Philadelphia, PA, USA
| | - Philipp Hessel
- Escuela de Gobierno Alberto Lleras Camargo, Universidad de los Andes, Bogotá, Colombia
| | - Vanessa Di Cecco
- Instituto Salud Colectiva, Universidad Nacional de Lanus, Buenos Aires, Argentina
| | - Amélia Augusta Friche
- Observatório de Saúde Urbana em Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Waleska Teixeira Caiaffa
- Observatório de Saúde Urbana em Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ana V. Diez Roux
- Urban Health Collaborative, Drexel University, Philadelphia, PA, USA
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18
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Braverman-Bronstein A, Ortigoza AF, Vidaña-Pérez D, Barrientos-Gutiérrez T, Baldovino-Chiquillo L, Bilal U, Friche AADL, Diez-Canseco F, Maslowsky J, Vives V. A, Diez Roux AV. Gender inequality, women's empowerment, and adolescent birth rates in 363 Latin American cities. Soc Sci Med 2023; 317:115566. [PMID: 36446141 PMCID: PMC7613905 DOI: 10.1016/j.socscimed.2022.115566] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/10/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gender inequality is high in Latin America (LA). Empowering girls and young women and reducing gender gaps has been proposed as a pathway to reduce adolescent pregnancy. We investigated the associations of urban measures of women's empowerment and gender inequality with adolescent birth rates (ABR) in 366 Latin American cities in nine countries. METHODS We created a gender inequality index (GII) and three Women Achievement scores reflecting domains of women's empowerment (employment, education, and health care access) using censuses, surveys, and political participation data at city and sub-city levels. We used 3-level negative binomial models (sub-city-city-countries) to assess the association between the GII and scores, with ABR while accounting for other city and sub-city characteristics. RESULTS We found within country heterogeneity in gender inequality and women's empowerment measures. The ABR was 4% higher for each 1 standard deviation (1-SD) higher GII (RR 1.04; 95%CI 1.01,1.06), 8% lower for each SD higher autonomy score (RR 0.92; 95%CI 0.86, 0.99), and 12% lower for each SD health care access score (RR 0.88; 95%CI 0.82,0.95) after adjustment for city level population size, population growth, homicide rates, and sub-city population educational attainment and living conditions scores. CONCLUSION Our findings show the key role cities have in reducing ABR through the implementation of strategies that foster women's socioeconomic progress such as education, employment, and health care access.
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Affiliation(s)
- Ariela Braverman-Bronstein
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA.
| | - Ana F. Ortigoza
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Dèsirée Vidaña-Pérez
- Center for Survey Research and Evaluation, National Institute of Public Health Cuernavaca, Mexico
| | | | | | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA,Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Amélia Augusta de Lima Friche
- Observatory for Urban Health in Belo Horizonte, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Julie Maslowsky
- Center of Excellence in Maternal and Child Health School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alejandra Vives V.
- Department of Public Health, School of Medicine / CEDEUS. Pontificia Universidad Católica de Chile. Santiago de Chile, Chile
| | - Ana V. Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA,Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
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D'Adamo A, Schnake-Mahl A, Mullachery PH, Lazo M, Diez Roux AV, Bilal U. Health disparities in past influenza pandemics: A scoping review of the literature. SSM Popul Health 2022; 21:101314. [PMID: 36514788 PMCID: PMC9733119 DOI: 10.1016/j.ssmph.2022.101314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/14/2022] [Accepted: 12/08/2022] [Indexed: 12/13/2022] Open
Abstract
Objective The COVID-19 pandemic has exacerbated existing health disparities. To provide a historical perspective on health disparities for pandemic acute respiratory viruses, we conducted a scoping review of the public health literature of health disparities in influenza outcomes during the 1918, 1957, 1968, and 2009 influenza pandemics. Methods We searched for articles examining socioeconomic or racial/ethnic disparities in any population, examining any influenza-related outcome (e.g., incidence, hospitalizations, mortality), during the 1918, 1957, 1968, and 2009 influenza pandemics. We conducted a structured search of English-written articles in PubMed supplemented by a snowball of articles meeting inclusion criteria. Results A total of 29 articles met inclusion criteria, all but one focusing exclusively on the 1918 or 2009 pandemics. Individuals of low socioeconomic status, or living in low socioeconomic status areas, experienced higher incidence, hospitalizations, and mortality in the 1918 and 2009 pandemics. There were conflicting results regarding racial/ethnic disparities during the 1918 pandemic, with differences in magnitude and direction by outcome, potentially due to issues in data quality by race/ethnicity. Racial/ethnic minorities had generally higher incidence, mortality, and hospitalization rates in the 1957 and 2009 pandemics. Conclusion Individuals of low socioeconomic status and racial/ethnic minorities have historically experienced worse influenza outcomes during pandemics. These historical patterns can inform current research to understand disparities in the ongoing COVID-19 pandemic and future pandemics.
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Affiliation(s)
- Angela D'Adamo
- Edward J. Bloustein School of Planning and Public Policy, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alina Schnake-Mahl
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA,Department of Health Management and Policy, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Pricila H. Mullachery
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Mariana Lazo
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA,Department of Community Health and Prevention, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Ana V. Diez Roux
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA,Corresponding author. Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St. Suite 730, Philadelphia, PA, USA
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20
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Hirsch JA, Michael YL, Moore KA, Melly S, Hughes TM, Hayden K, Luchsinger JA, Jimenez MP, James P, Besser LM, Sánchez B, Diez Roux AV. Longitudinal neighbourhood determinants with cognitive health and dementia disparities: protocol of the Multi-Ethnic Study of Atherosclerosis Neighborhoods and Aging prospective cohort study. BMJ Open 2022; 12:e066971. [PMID: 36368762 PMCID: PMC9660618 DOI: 10.1136/bmjopen-2022-066971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The burden of Alzheimer's disease (AD) and AD-related dementias (ADRD) is increasing nationally and globally, with disproportionate impacts on lower-income, lower education and systematically marginalised older adults. Presence of inequalities in neighbourhood factors (eg, social context, physical and built environments) may affect risk of cognitive decline and be key for intervening on AD/ADRD disparities at the population level. However, existing studies are limited by a dearth of longitudinal, detailed neighbourhood measures linked to rich, prospective cohort data. Our main objective is to identify patterns of neighbourhood change related to prevalence of-and disparities in-cognitive decline and dementia. METHODS AND ANALYSES We describe the process of collecting, processing and linking extensive neighbourhood data to the Multi-Ethnic Study of Atherosclerosis (MESA), creating a 25+ years dataset. Within the MESA parent study, the MESA Neighborhoods and Aging cohort study will characterise dynamic, longitudinal neighbourhood social and built environment variables relevant to cognition for residential addresses of MESA participants. This includes administering new surveys, expanding residential address histories, calculating new measures derived from spatial data and implementing novel deep learning algorithms on street-level imagery. Applying novel statistical techniques, we will examine associations of neighbourhood environmental characteristics with cognition and clinically relevant AD/ADRD outcomes. We will investigate determinants of disparities in outcomes by socioeconomic position and race/ethnicity and assess the contribution of neighbourhood environments to these disparities. This project will provide new evidence about pathways between neighbourhood environments and cognitive outcomes, with implications for policies to support healthy ageing. ETHICS AND DISSEMINATION This project was approved by the University of Washington and Drexel University Institutional Review Boards (protocols #00009029 and #00014523, and #180900605). Data will be distributed through the MESA Coordinating Center. Findings will be disseminated in peer-reviewed scientific journals, briefs, presentations and on the participant website.
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Affiliation(s)
- Jana A Hirsch
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Yvonne L Michael
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Kari A Moore
- Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA
| | - Steven Melly
- Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA
| | - Timothy M Hughes
- Department of Internal Medicine, Medical Center Boulevard, Winston-Salem, Carolina, USA
| | - Kathleen Hayden
- Department of Social Sciences and Health Policy, Bowman Gray Center for Medical Education, Winston-Salem, Carolina, USA
| | - Jose A Luchsinger
- Department of Medicine, Columbia University, New York, New York, USA
| | - Marcia P Jimenez
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Peter James
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Population Medicine, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Lilah M Besser
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Brisa Sánchez
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Ana V Diez Roux
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
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21
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Avila-Palencia I, Sánchez BN, Rodríguez DA, Perez-Ferrer C, Miranda JJ, Gouveia N, Bilal U, Useche AF, Wilches-Mogollon MA, Moore K, Sarmiento OL, Diez Roux AV. Health and Environmental Co-Benefits of City Urban Form in Latin America: An Ecological Study. Sustainability 2022; 14:14715. [PMID: 36926000 PMCID: PMC7614319 DOI: 10.3390/su142214715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
We investigated the association of urban landscape profiles with health and environmental outcomes, and whether those profiles are linked to environmental and health co-benefits. In this ecological study, we used data from 208 cities in 8 Latin American countries of the SALud URBana en América Latina (SALURBAL) project. Four urban landscape profiles were defined with metrics for the fragmentation, isolation, and shape of patches (contiguous area of urban development). Four environmental measures (lack of greenness, PM2.5, NO2, and carbon footprint), two cause-specific mortality rates (non-communicable diseases and unintentional injury mortality), and prevalence of three risk factors (hypertension, diabetes, and obesity) for adults were used as the main outcomes. We used linear regression models to evaluate the association of urban landscape profiles with environmental and health outcomes. In addition, we used finite mixture modeling to create co-benefit classes. Cities with the scattered pixels profile (low fragmentation, high isolation, and compact shaped patches) were most likely to have positive co-benefits. Profiles described as proximate stones (moderate fragmentation, moderate isolation, and irregular shape) and proximate inkblots (moderate-high fragmentation, moderate isolation, and complex shape) were most likely to have negative co-benefits. The contiguous large inkblots profile (low fragmentation, low isolation, and complex shape) was most likely to have mixed benefits.
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Affiliation(s)
- Ione Avila-Palencia
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast BT12 6BA, Northern Ireland, UK
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
| | - Brisa N. Sánchez
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
| | - Daniel A. Rodríguez
- Department of City and Regional Planning, University of California—Berkeley, Berkeley, CA 94720, USA
- Institute for Transportation Studies, University of California—Berkeley, Berkeley, CA 94720, USA
| | | | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima 15074, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | - Nelson Gouveia
- Department of Preventive Medicine, University of São Paulo Medical School, São Paulo 01246-903, Brazil
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
| | - Andrés F. Useche
- Department of Industrial Engineering, School of Engineering, Universidad de los Andes, Bogotá 111711, Colombia
| | - Maria A. Wilches-Mogollon
- Department of Industrial Engineering, School of Engineering, Universidad de los Andes, Bogotá 111711, Colombia
| | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
| | - Olga L. Sarmiento
- School of Medicine, Universidad de los Andes, Bogotá 111711, Colombia
| | - Ana V. Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
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22
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Schnake-Mahl AS, O'Leary G, Mullachery PH, Skinner A, Kolker J, Diez Roux AV, Raifman JR, Bilal U. Higher COVID-19 Vaccination And Narrower Disparities In US Cities With Paid Sick Leave Compared To Those Without. Health Aff (Millwood) 2022; 41:1565-1574. [PMID: 36343316 PMCID: PMC9913883 DOI: 10.1377/hlthaff.2022.00779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Paid sick leave provides workers with paid time off to receive COVID-19 vaccines and to recover from potential vaccine adverse effects. We hypothesized that US cities with paid sick leave would have higher COVID-19 vaccination coverage and narrower coverage disparities than those without such policies. Using county-level vaccination data and paid sick leave data from thirty-seven large US cities in 2021, we estimated the association between city-level paid sick leave policies and vaccination coverage in the working-age population and repeated the analysis using coverage in the population ages sixty-five and older as a negative control. We also examined associations by neighborhood social vulnerability. Cities with a paid sick leave policy had 17 percent higher vaccination coverage than cities without such a policy. We found stronger associations between paid sick leave and vaccination in the most socially vulnerable neighborhoods compared with the least socially vulnerable ones, and no association in the population ages sixty-five and older. Paid sick leave policies are associated with higher COVID-19 vaccination coverage and narrower coverage disparities. Increasing access to these policies may help increase vaccination and reduce inequities in coverage.
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Affiliation(s)
| | | | - Pricila H Mullachery
- Pricila H. Mullachery, Drexel University and Temple University, Philadelphia, Pennsylvania
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23
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Abstract
BACKGROUND Life expectancy in the United States has declined since 2014 but characterization of disparities within and across metropolitan areas of the country is lacking. METHODS Using census tract-level life expectancy from the 2010 to 2015 US Small-area Life Expectancy Estimates Project, we calculate 10 measures of total and income-based disparities in life expectancy at birth, age 25, and age 65 within and across 377 metropolitan statistical areas (MSAs) of the United States. RESULTS We found wide heterogeneity in disparities in life expectancy at birth across MSAs and regions: MSAs in the West show the narrowest disparities (absolute disparity: 8.7 years, relative disparity: 1.1), while MSAs in the South (absolute disparity: 9.1 years, relative disparity: 1.1) and Midwest (absolute disparity: 9.8 years, relative disparity: 1.1) have the widest life expectancy disparities. We also observed greater variability in life expectancy across MSAs for lower income census tracts (coefficient of variation [CoV] 3.7 for first vs. tenth decile of income) than for higher income census tracts (CoV 2.3). Finally, we found that a series of MSA-level variables, including larger MSAs and greater proportion college graduates, predicted wider life expectancy disparities for all age groups. CONCLUSIONS Sociodemographic and policy factors likely help explain variation in life expectancy disparities within and across metro areas.
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Affiliation(s)
- Alina S Schnake-Mahl
- From the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
- Department of Health Management and Policy, Drexel University, Philadelphia, PA
| | - Pricila H Mullachery
- From the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Jonathan Purtle
- Department of Public Health Policy & Management, New York University School of Global Public Health, New York, NY
| | - Ran Li
- From the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Ana V Diez Roux
- From the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Usama Bilal
- From the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
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24
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Braverman-Bronstein A, Vidaña-Pérez D, Ortigoza AF, Baldovino-Chiquillo L, Diez-Canseco F, Maslowsky J, Sánchez BN, Barrientos-Gutiérrez T, Diez Roux AV. Adolescent birth rates and the urban social environment in 363 Latin American cities. BMJ Glob Health 2022; 7:bmjgh-2022-009737. [PMID: 36253017 PMCID: PMC9577896 DOI: 10.1136/bmjgh-2022-009737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/06/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Latin America has the second-highest adolescent birth rate (ABR) worldwide. Variation between urban and rural areas and evidence linking country development to ABR points towards upstream factors in the causal pathway. We investigated variation in ABR within and between cities, and whether different features of urban social environments are associated with ABR. Methods We included 363 cities in 9 Latin American countries. We collected data on social environment at country, city and subcity levels and birth rates among adolescents (ages 15–19). We investigated variation in ABR within and between countries and cities along with associations between social environment and ABR by fitting three-level negative binomial models (subcities nested within cities nested within countries). Results The median subcity ABR was 58.5 per 1000 women 15–19 (IQR 43.0–75.3). We found significant variability in subcity ABR between countries and cities (37% of variance between countries and 47% between cities within countries). Higher homicide rates and greater population growth in cities were associated with higher ABR (rate ratio (RR) 1.09; 95% CI 1.06 to 1.12 and RR 1.02; 95% CI 1.00 to 1.04, per SD, respectively), while better living conditions and educational attainment in subcities were associated with lower ABR after accounting for other social environment characteristics (RR 0.95; 95% CI 0.92 to 0.98 and 0.78; 95% CI 0.76 to 0.79, per SD, respectively). Conclusions The large heterogeneity of ABR found within countries and cities highlights the key role urban areas have in developing local policies. Holistic interventions targeting education inequalities and living conditions are likely important to reducing ABR in cities.
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Affiliation(s)
- Ariela Braverman-Bronstein
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Dèsirée Vidaña-Pérez
- Center for Survey Research and Evaluation, National Institute of Public Health, Cuernavaca, Mexico
| | - Ana F Ortigoza
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Julie Maslowsky
- Center of Excellence in Maternal and Child Health School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Brisa N. Sánchez
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Ana V. Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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25
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Mullachery PH, Li R, Melly S, Kolker J, Barber S, Diez Roux AV, Bilal U. Inequities in spatial accessibility to COVID-19 testing in 30 large US cities. Soc Sci Med 2022; 310:115307. [PMID: 36049353 PMCID: PMC9420026 DOI: 10.1016/j.socscimed.2022.115307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/16/2022] [Accepted: 08/17/2022] [Indexed: 12/24/2022]
Abstract
Testing for SARS-CoV-2 infection has been a key strategy to mitigate and control the COVID-19 pandemic. Wide spatial and racial/ethnic disparities in COVID-19 outcomes have emerged in US cities. Previous research has highlighted the role of unequal access to testing as a potential driver of these disparities. We described inequities in spatial accessibility to COVID-19 testing locations in 30 large US cities. We used location data from Castlight Health Inc corresponding to October 2021. We created an accessibility metric at the level of the census block group (CBG) based on the number of sites per population in a 15-minute walkshed around the centroid of each CBG. We also calculated spatial accessibility using only testing sites without restrictions, i.e., no requirement for an appointment or a physician order prior to testing. We measured the association between the social vulnerability index (SVI) and spatial accessibility using a multilevel negative binomial model with random city intercepts and random SVI slopes. Among the 27,195 CBG analyzed, 53% had at least one testing site within a 15-minute walkshed, and 36% had at least one site without restrictions. On average, a 1-decile increase in the SVI was associated with a 3% (95% Confidence Interval: 2% - 4%) lower accessibility. Spatial inequities were similar across various components of the SVI and for sites with no restrictions. Despite this general pattern, several cities had inverted inequity, i.e., better accessibility in more vulnerable areas, which indicates that some cities may be on the right track when it comes to promoting equity in COVID-19 testing. Testing is a key component of the strategy to mitigate transmission of SARS-CoV-2 and efforts should be made to improve accessibility to testing, particularly as new and more contagious variants become dominant.
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Affiliation(s)
- Pricila H. Mullachery
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA,Department of Health Services Administration and Policy, Temple University College of Public Health, 1301 Cecil B. Moore Ave, Philadelphia, PA, 19122, USA,Corresponding author. 1301 Cecil B. Moore Ave., 539, Philadelphia, PA, 19122, United States
| | - Ran Li
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA
| | - Steven Melly
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA
| | - Jennifer Kolker
- Department of Health Management and Policy, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Sharrelle Barber
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA,Ubuntu Center on Racism, Global Movements, and Population Health Equity, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA
| | - Ana V. Diez Roux
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA
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26
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Rodríguez López S, Tumas N, Bilal U, Moore KA, Acharya B, Quick H, Quistberg DA, Acevedo GE, Diez Roux AV. Intraurban socioeconomic inequalities in life expectancy: a population-based cross-sectional analysis in the city of Córdoba, Argentina (2015-2018). BMJ Open 2022; 12:e061277. [PMID: 36691155 PMCID: PMC9442478 DOI: 10.1136/bmjopen-2022-061277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 08/18/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To evaluate variability in life expectancy at birth in small areas, describe the spatial pattern of life expectancy, and examine associations between small-area socioeconomic characteristics and life expectancy in a mid-sized city of a middle-income country. DESIGN Cross-sectional, using data from death registries (2015-2018) and socioeconomic characteristics data from the 2010 national population census. PARTICIPANTS/SETTING 40 898 death records in 99 small areas of the city of Córdoba, Argentina. We summarised variability in life expectancy at birth by using the difference between the 90th and 10th percentile of the distribution of life expectancy across small areas (P90-P10 gap) and evaluated associations with small-area socioeconomic characteristics by calculating a Slope Index of Inequality in linear regression. PRIMARY OUTCOME Life expectancy at birth. RESULTS The median life expectancy at birth was 80.3 years in women (P90-P10 gap=3.2 years) and 75.1 years in men (P90-P10 gap=4.6 years). We found higher life expectancies in the core and northwest parts of the city, especially among women. We found positive associations between life expectancy and better small-area socioeconomic characteristics, especially among men. Mean differences in life expectancy between the highest versus the lowest decile of area characteristics in men (women) were 3.03 (2.58), 3.52 (2.56) and 2.97 (2.31) years for % adults with high school education or above, % persons aged 15-17 attending school, and % households with water inside the dwelling, respectively. Lower values of % overcrowded households and unemployment rate were associated with longer life expectancy: mean differences comparing the lowest versus the highest decile were 3.03 and 2.73 in men and 2.57 and 2.34 years in women, respectively. CONCLUSION Life expectancy is substantially heterogeneous and patterned by socioeconomic characteristics in a mid-sized city of a middle-income country, suggesting that small-area inequities in life expectancy are not limited to large cities or high-income countries.
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Affiliation(s)
- Santiago Rodríguez López
- Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas, Córdoba, Argentina
- Cátedra de Antropología, Departamento de Fisiología, Facultad de Ciencias Exactas Físicas y Naturales, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Natalia Tumas
- Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas, Córdoba, Argentina
- Research Group on Health Inequalities, Environment, and Employment Conditions Network (GREDS-EMCONET), Department of Social and Political Science, Universitat Pompeu Fabra, Barcelona, Spain
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Kari A Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Binod Acharya
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Harrison Quick
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - D Alex Quistberg
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Gabriel E Acevedo
- Cátedra de Medicina Preventiva y Social, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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27
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Bakhtsiyarava M, Ortigoza A, Sánchez BN, Braverman-Bronstein A, Kephart JL, Rodríguez López S, Rodríguez J, Diez Roux AV. Ambient temperature and term birthweight in Latin American cities. Environ Int 2022; 167:107412. [PMID: 35870377 PMCID: PMC9376808 DOI: 10.1016/j.envint.2022.107412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/30/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Extreme temperatures may lead to adverse pregnancy and birth outcomes, including low birthweight. Studies on the impact of temperature on birthweight have been inconclusive due to methodological challenges related to operationalizing temperature exposure, the definitions of exposure windows, accounting for gestational age, and a limited geographic scope. METHODS We combined data on individual-level term live births (N≈15 million births) from urban areas in Brazil, Chile, and Mexico from 2010 to 2015 from the SALURBAL study (Urban Health in Latin America) with high-resolution daily air temperature data and computed average ambient temperature for every month of gestation for each newborn. Associations between full-term birthweight and average temperature during gestation were analyzed using multi-level distributed lag non-linear models that adjusted for newborn's sex, season of conception, and calendar year of child's birth; controlled for maternal age, education, partnership status, presence of previous births, and climate zone; and included a random term for the sub-city of mother's residence. FINDINGS Higher temperatures during the entire gestation are associated with lower birthweight, particularly in Mexico and Brazil. The cumulative effect of temperature on birthweight is mostly driven by exposure to higher temperatures during months 7-9 of gestation. Higher maternal education can attenuate the temperature-birthweight associations. INTERPRETATION Our work shows that climate-health impacts are likely to be context- and place-specific and warrants research on temperature and birthweight in diverse climates to adequately anticipate global climate change. Given the high societal cost of suboptimal birthweight, public health efforts should be aimed at diminishing the detrimental effect of higher temperatures on birthweight. FUNDING The Wellcome Trust.
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Affiliation(s)
- Maryia Bakhtsiyarava
- Institute of Urban and Regional Development, University of California Berkeley, USA.
| | - Ana Ortigoza
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, USA
| | - Brisa N Sánchez
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, USA
| | | | - Josiah L Kephart
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, USA
| | - Santiago Rodríguez López
- Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas y Universidad Nacional de Córdoba, Córdoba, Argentina; Facultad de Ciencias Exactas, Físicas y Naturales, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Jordan Rodríguez
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, USA
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, USA
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Perner MS, Ortigoza A, Trotta A, Yamada G, Braverman Bronstein A, Friche AA, Alazraqui M, Diez Roux AV. Cesarean sections and social inequalities in 305 cities of Latin America. SSM Popul Health 2022; 19:101239. [PMID: 36203470 PMCID: PMC9529579 DOI: 10.1016/j.ssmph.2022.101239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/02/2022] Open
Abstract
Background Aim Methods Results Conclusion Overall cesarean section rate was 52%, ranging across large cities from 13% to 91%. Lower cesarean rate was found in mothers with lower education (39%) vs higher (61%). Better socioeconomic conditions were associated with higher caesarean section rate. Reduction of caesarean rates needs concerted action on healthcare working process.
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Mullachery PH, Vela E, Cleries M, Comin-Colet J, Nasir K, Diez Roux AV, Cainzos-Achirica M, Mauri J, Bilal U. Inequalities by Income in the Prevalence of Cardiovascular Disease and Its Risk Factors in the Adult Population of Catalonia. J Am Heart Assoc 2022; 11:e026587. [PMID: 36000437 PMCID: PMC9496415 DOI: 10.1161/jaha.122.026587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Understanding the magnitude of cardiovascular disease (CVD) inequalities is the first step toward addressing them. The linkage of socioeconomic and clinical data in universal health care settings provides critical information to characterize CVD inequalities. Methods and Results We employed a prospective cohort design using electronic health records data from all residents of Catalonia aged 18+ between January and December of 2019 (N=6 332 228). We calculated age‐adjusted sex‐specific prevalence of 5 CVD risk factors (diabetes, hypertension, hyperlipidemia, obesity, and smoking), and 4 CVDs (coronary heart disease, cerebrovascular disease, atrial fibrillation, and heart failure). We categorized income into high, moderate, low, and very low according to individual income (tied to prescription copayments) and receipt of welfare support. We found large inequalities in CVD and CVD risk factors among men and women. CVD risk factors with the largest inequalities were diabetes, smoking, and obesity, with prevalence rates 2‐ or 3‐fold higher for those with very low (versus high) income. CVDs with the largest inequalities were cerebrovascular disease and heart failure, with prevalence rates 2 to 4 times higher for men and women with very low (versus high) income. Inequalities varied by age, peaking at midlife (30–50 years) for most diseases, while decreasing gradually with age for smoking. Conclusions We found wide and heterogeneous inequalities by income in 5 CVD risk factors and 4 CVD. Our findings in a region with a high‐quality public health care system and universal coverage stress that strong equity‐promoting policies are necessary to reduce disparities in CVD.
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Affiliation(s)
- Pricila H Mullachery
- Urban Health Collaborative Drexel Dornsife School of Public Health Philadelphia PA.,Department of Health Services Administration and Policy Temple University College of Public Health Philadelphia PA
| | - Emili Vela
- Healthcare Information and Knowledge Unit Health Department of the Government of Catalonia Spain.,Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya Barcelona Spain
| | - Montse Cleries
- Healthcare Information and Knowledge Unit Health Department of the Government of Catalonia Spain.,Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya Barcelona Spain
| | - Josep Comin-Colet
- Pla Director de Malalties de l'Aparell Circulatori, Health Department of the Government of Catalonia Spain.,Community Heart Failure Program, Department of Cardiology Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL) L'Hospitalet de Llobregat, Barcelona Spain.,Department of Clinical Sciences Universitat de Barcelona Spain
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX
| | - Ana V Diez Roux
- Urban Health Collaborative Drexel Dornsife School of Public Health Philadelphia PA.,Department of Epidemiology and Biostatistics Drexel Dornsife School of Public Health Philadelphia PA
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX
| | - Josepa Mauri
- Pla Director de Malalties de l'Aparell Circulatori, Health Department of the Government of Catalonia Spain.,Department of Cardiology Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Usama Bilal
- Urban Health Collaborative Drexel Dornsife School of Public Health Philadelphia PA.,Department of Epidemiology and Biostatistics Drexel Dornsife School of Public Health Philadelphia PA
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30
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Bilal U, Mullachery PH, Schnake-Mahl A, Rollins H, McCulley E, Kolker J, Barber S, Diez Roux AV. Heterogeneity in Spatial Inequities in COVID-19 Vaccination Across 16 Large US Cities. Am J Epidemiol 2022; 191:1546-1556. [PMID: 35452081 PMCID: PMC9047229 DOI: 10.1093/aje/kwac076] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/02/2022] [Accepted: 04/14/2022] [Indexed: 01/29/2023] Open
Abstract
Differences in vaccination coverage can perpetuate coronavirus disease 2019 (COVID-19) disparities. We explored the association between neighborhood-level social vulnerability and COVID-19 vaccination coverage in 16 large US cities from the beginning of the vaccination campaign in December 2020 through September 2021. We calculated the proportion of fully vaccinated adults in 866 zip code tabulation areas (ZCTAs) of 16 large US cities: Long Beach, Los Angeles, Oakland, San Diego, San Francisco, and San Jose, all in California; Chicago, Illinois; Indianapolis, Indiana; Minneapolis, Minnesota; New York, New York; Philadelphia, Pennsylvania; and Austin, Dallas, Fort Worth, Houston, and San Antonio, all in Texas. We computed absolute and relative total and Social Vulnerability Index-related inequities by city. COVID-19 vaccination coverage was 0.75 times (95% confidence interval: 0.69, 0.81) or 16 percentage points (95% confidence interval: 12.1, 20.3) lower in neighborhoods with the highest social vulnerability as compared with those with the lowest. These inequities were heterogeneous, with cities in the West generally displaying narrower inequities in both the absolute and relative scales. The Social Vulnerability Index domains of socioeconomic status and of household composition and disability showed the strongest associations with vaccination coverage. Inequities in COVID-19 vaccinations hamper efforts to achieve health equity, as they mirror and could lead to even wider inequities in other COVID-19 outcomes.
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Affiliation(s)
- Usama Bilal
- Correspondence to Dr. Usama Bilal, 3600 Market Street, Suite 730, Philadelphia, PA, 19104 (e-mail: )
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31
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Castillo-Riquelme M, Yamada G, Diez Roux AV, Alfaro T, Flores-Alvarado S, Barrientos T, Teixeira Vaz C, Trotta A, Sarmiento OL, Lazo M. Aging and self-reported health in 114 Latin American cities: gender and socio-economic inequalities. BMC Public Health 2022; 22:1499. [PMID: 35932016 PMCID: PMC9356475 DOI: 10.1186/s12889-022-13752-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Understanding how urban environments influence people’s health, especially as individuals age, can help identify ways to improve health in the rapidly urbanizing and rapidly aging populations. Objectives To investigate the association between age and self-reported health (SRH) in adults living in Latin-American cities and whether gender and city-level socioeconomic characteristics modify this association. Methods Cross-sectional analyses of 71,541 adults aged 25–97 years, from 114 cities in 6 countries (Argentina, Brazil, Colombia, Chile, El Salvador, and Guatemala), as part of the Salud Urbana en America Latina (SALURBAL) Project. We used individual-level age, gender, education, and self-reported health (SRH) data from harmonized health surveys. As proxies for socioeconomic environment we used a city-level socioeconomic index (SEI) calculated from census data, and gross domestic product (GDP) per-capita. Multilevel Poisson models with a robust variance were used to estimate relative risks (RR), with individuals nested in cities and binary SRH (poor SHR vs. good SRH) as the outcome. We examined effect modification by gender and city-level socioeconomic indicators. Results Overall, 31.4% of the sample reported poor SRH. After adjusting for individual-level education, men had a lower risk of poor SRH (RR = 0.76; CI 0.73–0.78) compared to women, and gender modified the association between age and poor SRH (p-value of interaction < 0.001). In gender stratified models, the association between older age and poor SRH was more pronounced in men than in women, and in those aged 25–65 than among those 65+ (RR/10 years = 1.38 vs. 1.10 for men, and RR/10 years = 1.29 vs. 1.02 for women). Living in cities with higher SEI or higher GDP per-capita was associated with a lower risk of poor SRH. GDP per-capita modified the association between age (25–65) and SRH in men and women, with SEI the interaction was less clear. Conclusions Across cities in Latin America, aging impact on health is significant among middle-aged adults, and among men. In both genders, cities with lower SEI or lower GDP per-capita were associated with poor SRH. More research is needed to better understand gender inequalities and how city socioeconomic environments, represented by different indicators, modify exposures and vulnerabilities associated with aging. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13752-2.
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Affiliation(s)
- Marianela Castillo-Riquelme
- Doctoral Program in Public Health, School of Public Health, Faculty of Medicine, University of Chile, Avenida Independencia, 939, Santiago, Chile.
| | - Goro Yamada
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Tania Alfaro
- Doctoral Program in Public Health, School of Public Health, Faculty of Medicine, University of Chile, Avenida Independencia, 939, Santiago, Chile
| | - Sandra Flores-Alvarado
- Doctoral Program in Public Health, School of Public Health, Faculty of Medicine, University of Chile, Avenida Independencia, 939, Santiago, Chile
| | | | - Camila Teixeira Vaz
- Campus Centro-Oeste Dona Lindu, Federal University of São João del-Rei, Divinópolis, Brazil
| | - Andrés Trotta
- Institute of Collective Health, National University of Lanus, Buenos Aires, Argentina
| | | | - Mariana Lazo
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.,Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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De Ramos IP, Lazo M, Schnake-Mahl A, Li R, Martinez-Donate AP, Roux AVD, Bilal U. COVID-19 Outcomes Among the Hispanic Population of 27 Large US Cities, 2020-2021. Am J Public Health 2022; 112:1034-1044. [PMID: 35588187 PMCID: PMC9222469 DOI: 10.2105/ajph.2022.306809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To examine racial/ethnic disparities in COVID-19 outcomes between Hispanics and Whites across 27 US jurisdictions whose health departments are members of the Big Cities Health Coalition (BCHC). Methods. Using surveillance data from the BCHC COVID-19 dashboard as of mid-June 2021, we computed crude incidence, age-adjusted hospitalization and mortality, and full vaccination coverage rates for Hispanics and Whites by city. We estimated relative and absolute disparities cumulatively and for 2020 and 2021 and explored associations between city-level social vulnerability and the magnitude of disparities. Results. In most of the cities with available COVID-19 incidence data, rates among Hispanics were 2.2 to 6.7 times higher than those among Whites. In all cities, Hispanics had higher age-adjusted hospitalization (1.5-8.6 times as high) and mortality (1.4-6.2 times as high) rates. Hispanics had lower vaccination coverage in all but 1 city. Disparities in incidence and hospitalizations narrowed in 2021, whereas disparities in mortality remained similar. Disparities in incidence, hospitalization, mortality, and vaccination rates were wider in cities with lower social vulnerability. Conclusions. A deeper exploration of racial/ethnic disparities in COVID-19 outcomes is essential to understand and prevent disparities among marginalized communities. (Am J Public Health. 2022;112(7): 1034-1044. https://doi.org/10.2105/AJPH.2022.306809).
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Affiliation(s)
- Isabel P De Ramos
- Isabel P. De Ramos, Mariana Lazo, Alina Schnake-Mahl, Ran Li, Ana V. Diez Roux, and Usama Bilal are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Ana P. Martinez-Donate is with the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University
| | - Mariana Lazo
- Isabel P. De Ramos, Mariana Lazo, Alina Schnake-Mahl, Ran Li, Ana V. Diez Roux, and Usama Bilal are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Ana P. Martinez-Donate is with the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University
| | - Alina Schnake-Mahl
- Isabel P. De Ramos, Mariana Lazo, Alina Schnake-Mahl, Ran Li, Ana V. Diez Roux, and Usama Bilal are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Ana P. Martinez-Donate is with the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University
| | - Ran Li
- Isabel P. De Ramos, Mariana Lazo, Alina Schnake-Mahl, Ran Li, Ana V. Diez Roux, and Usama Bilal are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Ana P. Martinez-Donate is with the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University
| | - Ana P Martinez-Donate
- Isabel P. De Ramos, Mariana Lazo, Alina Schnake-Mahl, Ran Li, Ana V. Diez Roux, and Usama Bilal are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Ana P. Martinez-Donate is with the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University
| | - Ana V Diez Roux
- Isabel P. De Ramos, Mariana Lazo, Alina Schnake-Mahl, Ran Li, Ana V. Diez Roux, and Usama Bilal are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Ana P. Martinez-Donate is with the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University
| | - Usama Bilal
- Isabel P. De Ramos, Mariana Lazo, Alina Schnake-Mahl, Ran Li, Ana V. Diez Roux, and Usama Bilal are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Ana P. Martinez-Donate is with the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University
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Diez Roux AV. Health Implications of Racism, Sexism, and Social Class: Reflections From Nearly 30 Years Ago. Am J Prev Med 2022; 62:814-815. [PMID: 35597563 DOI: 10.1016/j.amepre.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/02/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Ana V Diez Roux
- Dean's Office, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania.
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Langellier BA, Stankov I, Hammond RA, Bilal U, Auchincloss AH, Barrientos-Gutierrez T, Cardoso LDO, Diez Roux AV. Potential impacts of policies to reduce purchasing of ultra-processed foods in Mexico at different stages of the social transition: an agent-based modelling approach. Public Health Nutr 2022; 25:1711-1719. [PMID: 34895382 PMCID: PMC7612742 DOI: 10.1017/s1368980021004833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/21/2021] [Accepted: 12/04/2021] [Indexed: 12/02/2022]
Abstract
OBJECTIVES To develop a simulation framework for assessing how combinations of taxes, nutrition warning labels and advertising levels could affect purchasing of ultra-processed foods (UPF) in Latin American countries and to understand whether policies reinforce or reduce pre-existing social disparities in UPF consumption. DESIGN We developed an agent-based simulation model using international evidence regarding the effect of price, nutrition warning labels and advertising on UPF purchasing. SETTING We estimated policy effects in scenarios representing two stages of the 'social transition' in UPF purchasing: (1) a pre-transition scenario, where UPF purchasing is higher among high-income households, similar to patterns in Mexico; and (2) a post-transition scenario where UPF purchasing is highest among low-income households, similar to patterns in Chile. PARTICIPANTS A population of 1000 individual agents with levels of age, income, educational attainment and UPF purchasing similar to adult women in Mexico. RESULTS A 20 % tax would decrease purchasing by 24 % relative to baseline in both the pre- and post-transition scenarios, an effect that is similar in magnitude to that of a nutrition warning label policy. A 50 % advertising increase or decrease had a comparatively small effect. Nutrition warning labels were most effective among those with higher levels of educational attainment. Labelling reduced inequities in the pre-transition scenario (i.e. highest UPF purchasing among the highest socio-economic group) but widened inequities in the post-transition scenario. CONCLUSIONS Effective policy levers are available to reduce UPF purchasing, but policymakers should anticipate that equity impacts will differ depending on existing social patterns in UPF purchasing.
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Affiliation(s)
- Brent A Langellier
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, 3215 Market St, Office 356, Philadelphia, PA19104, USA
| | - Ivana Stankov
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Ross A Hammond
- Center on Social Dynamics & Policy, Brookings Institution, Washington, DC, USA
- Public Health and Social Policy, Washington University in St. Louis, St. Louis, MO, USA
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Amy H Auchincloss
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | | | | | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Bilal U, McCulley E, Li R, Rollins H, Schnake-Mahl A, Mullachery PH, Vaidya V, Koh C, Dureja K, Sharaf A, Furukawa A, Juliano C, Barber S, Kolker J, Diez Roux AV. Tracking COVID-19 Inequities Across Jurisdictions Represented in the Big Cities Health Coalition (BCHC): The COVID-19 Health Inequities in BCHC Cities Dashboard. Am J Public Health 2022; 112:904-912. [PMID: 35420892 PMCID: PMC9137009 DOI: 10.2105/ajph.2021.306708] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To describe the creation of an interactive dashboard to advance the understanding of the COVID-19 pandemic from an equity and urban health perspective across 30 large US cities that are members of the Big Cities Health Coalition (BCHC). Methods. We leveraged the Drexel‒BCHC partnership to define the objectives and audience for the dashboard and developed an equity framework to conceptualize COVID-19 inequities across social groups, neighborhoods, and cities. We compiled data on COVID-19 trends and inequities by race/ethnicity, neighborhood, and city, along with neighborhood- and city-level demographic and socioeconomic characteristics, and built an interactive dashboard and Web platform to allow interactive comparisons of these inequities across cities. Results. We launched the dashboard on January 21, 2021, and conducted several dissemination activities. As of September 2021, the dashboard included data on COVID-19 trends for the 30 cities, on inequities by race/ethnicity in 21 cities, and on inequities by neighborhood in 15 cities. Conclusions. This dashboard allows public health practitioners to contextualize racial/ethnic and spatial inequities in COVID-19 across large US cities, providing valuable insights for policymakers. (Am J Public Health. 2022;112(6):904-912. https://doi.org/10.2105/AJPH.2021.306708).
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Affiliation(s)
- Usama Bilal
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Edwin McCulley
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Ran Li
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Heather Rollins
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Alina Schnake-Mahl
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Pricila H Mullachery
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Vaishnavi Vaidya
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Celina Koh
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Kristina Dureja
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Asma Sharaf
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Alyssa Furukawa
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Chrissie Juliano
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Sharrelle Barber
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Jennifer Kolker
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Ana V Diez Roux
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
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De Roos AJ, Kenyon CC, Yen YT, Moore K, Melly S, Hubbard RA, Maltenfort M, Forrest CB, Diez Roux AV, Schinasi LH. Does Living near Trees and Other Vegetation Affect the Contemporaneous Odds of Asthma Exacerbation among Pediatric Asthma Patients? J Urban Health 2022; 99:533-548. [PMID: 35467328 PMCID: PMC9187838 DOI: 10.1007/s11524-022-00633-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 02/02/2023]
Abstract
Vegetation may influence asthma exacerbation through effects on aeroallergens, localized climates, air pollution, or children's behaviors and stress levels. We investigated the association between residential vegetation and asthma exacerbation by conducting a matched case-control study based on electronic health records of asthma patients, from the Children's Hospital of Philadelphia (CHOP). Our study included 17,639 exacerbation case events and 34,681 controls selected from non-exacerbation clinical visits for asthma, matched to cases by age, sex, race/ethnicity, public payment source, and residential proximity to the CHOP main campus ED and hospital. Overall greenness, tree canopy, grass/shrub cover, and impervious surface were assessed near children's homes (250 m) using satellite imagery and high-resolution landcover data. We used generalized estimating equations to estimate odds ratios (OR) and 95% confidence intervals (CI) for associations between each vegetation/landcover measure and asthma exacerbation, with adjustment for seasonal and sociodemographic factors-for all cases, and for cases defined by diagnosis setting and exacerbation frequency. Lower odds of asthma exacerbation were observed in association with greater levels of tree canopy near the home, but only for children who experienced multiple exacerbations in a year (OR = 0.94 per 10.2% greater tree canopy coverage, 95% CI = 0.90-0.99). Our findings suggest possible protection for asthma patients from tree canopy, but differing results by case frequency suggest that potential benefits may be specific to certain subpopulations of asthmatic children.
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Affiliation(s)
- Anneclaire J De Roos
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA. .,Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
| | - Chén C Kenyon
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Yun-Ting Yen
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Steven Melly
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Mitchell Maltenfort
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christopher B Forrest
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.,Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Leah H Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.,Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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37
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Guimarães JMN, Yamada G, Barber S, Caiaffa WT, Friche AADL, de Menezes MC, Santos G, Santos I, Cardoso LDO, Diez Roux AV. Racial Inequities in Self-Rated Health Across Brazilian Cities: Does Residential Segregation Play a Role? Am J Epidemiol 2022; 191:1071-1080. [PMID: 35244147 PMCID: PMC9169054 DOI: 10.1093/aje/kwac001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 12/23/2021] [Accepted: 01/04/2022] [Indexed: 11/14/2022] Open
Abstract
Racial health inequities may be partially explained by area-level factors such as residential segregation. In this cross-sectional study, using a large, multiracial, representative sample of Brazilian adults (n = 37,009 individuals in the 27 state capitals; National Health Survey (Pesquisa Nacional de Saúde), 2013), we investigated 1) whether individual-level self-rated health (SRH) (fair or poor vs. good or better) varies by race (self-declared White, Brown, or Black) and 2) whether city-level economic or racial residential segregation (using dissimilarity index values in tertiles: low, medium, and high) interacts with race, increasing racial inequities in SRH. Prevalence of fair or poor SRH was 31.5% (Black, Brown, and White people: 36.4%, 34.0%, and 27.3%, respectively). Marginal standardization based on multilevel logistic regression models, adjusted for age, gender, and education, showed that Black and Brown people had, respectively, 20% and 10% higher prevalence of fair or poor SRH than did White people. Furthermore, residential segregation interacted with race such that the more segregated a city, the greater the racial gap among Black, Brown, and White people in fair or poor SRH for both income and race segregation. Policies to reduce racial inequities may need to address residential segregation and its consequences for health.
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Affiliation(s)
- Joanna M N Guimarães
- Correspondence to Dr. Joanna M.N. Guimarães, National School of Public Health, Oswaldo Cruz Foundation, R. Leopoldo Bulhões 1480, Manguinhos, Cep 21041-210, Rio de Janeiro, RJ, Brazil (e-mail: )
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38
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Wang YZ, Zhao W, Ammous F, Song Y, Du J, Shang L, Ratliff SM, Moore K, Kelly KM, Needham BL, Diez Roux AV, Liu Y, Butler KR, Kardia SLR, Mukherjee B, Zhou X, Smith JA. DNA Methylation Mediates the Association Between Individual and Neighborhood Social Disadvantage and Cardiovascular Risk Factors. Front Cardiovasc Med 2022; 9:848768. [PMID: 35665255 PMCID: PMC9162507 DOI: 10.3389/fcvm.2022.848768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/29/2022] [Indexed: 12/14/2022] Open
Abstract
Low socioeconomic status (SES) and living in a disadvantaged neighborhood are associated with poor cardiovascular health. Multiple lines of evidence have linked DNA methylation to both cardiovascular risk factors and social disadvantage indicators. However, limited research has investigated the role of DNA methylation in mediating the associations of individual- and neighborhood-level disadvantage with multiple cardiovascular risk factors in large, multi-ethnic, population-based cohorts. We examined whether disadvantage at the individual level (childhood and adult SES) and neighborhood level (summary neighborhood SES as assessed by Census data and social environment as assessed by perceptions of aesthetic quality, safety, and social cohesion) were associated with 11 cardiovascular risk factors including measures of obesity, diabetes, lipids, and hypertension in 1,154 participants from the Multi-Ethnic Study of Atherosclerosis (MESA). For significant associations, we conducted epigenome-wide mediation analysis to identify methylation sites mediating the relationship between individual/neighborhood disadvantage and cardiovascular risk factors using the JT-Comp method that assesses sparse mediation effects under a composite null hypothesis. In models adjusting for age, sex, race/ethnicity, smoking, medication use, and genetic principal components of ancestry, epigenetic mediation was detected for the associations of adult SES with body mass index (BMI), insulin, and high-density lipoprotein cholesterol (HDL-C), as well as for the association between neighborhood socioeconomic disadvantage and HDL-C at FDR q < 0.05. The 410 CpG mediators identified for the SES-BMI association were enriched for CpGs associated with gene expression (expression quantitative trait methylation loci, or eQTMs), and corresponding genes were enriched in antigen processing and presentation pathways. For cardiovascular risk factors other than BMI, most of the epigenetic mediators lost significance after controlling for BMI. However, 43 methylation sites showed evidence of mediating the neighborhood socioeconomic disadvantage and HDL-C association after BMI adjustment. The identified mediators were enriched for eQTMs, and corresponding genes were enriched in inflammatory and apoptotic pathways. Our findings support the hypothesis that DNA methylation acts as a mediator between individual- and neighborhood-level disadvantage and cardiovascular risk factors, and shed light on the potential underlying epigenetic pathways. Future studies are needed to fully elucidate the biological mechanisms that link social disadvantage to poor cardiovascular health.
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Affiliation(s)
- Yi Zhe Wang
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Wei Zhao
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Farah Ammous
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Yanyi Song
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Jiacong Du
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Lulu Shang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Scott M. Ratliff
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Kari Moore
- Urban Health Collaborative, Drexel University, Philadelphia, PA, United States
| | - Kristen M. Kelly
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Belinda L. Needham
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Ana V. Diez Roux
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Yongmei Liu
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Kenneth R. Butler
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, MS, United States
| | - Sharon L. R. Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Bhramar Mukherjee
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Xiang Zhou
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Jennifer A. Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
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Schinasi LH, Kenyon CC, Hubbard RA, Zhao Y, Maltenfort M, Melly SJ, Moore K, Forrest CB, Diez Roux AV, de Roos AJ. Associations between high ambient temperatures and asthma exacerbation among children in Philadelphia, PA: a time series analysis. Occup Environ Med 2022; 79:326-332. [PMID: 35246484 DOI: 10.1136/oemed-2021-107823] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 02/10/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES High ambient temperatures may contribute to acute asthma exacerbation, a leading cause of morbidity in children. We quantified associations between hot-season ambient temperatures and asthma exacerbation in children ages 0-18 years in Philadelphia, PA. METHODS We created a time series of daily counts of clinical encounters for asthma exacerbation at the Children's Hospital of Philadelphia linked with daily meteorological data, June-August of 2011-2016. We estimated associations between mean daily temperature (up to a 5-day lag) and asthma exacerbation using generalised quasi-Poisson distributed models, adjusted for seasonal and long-term trends, day of the week, mean relative humidity,and US holiday. In secondary analyses, we ran models with adjustment for aeroallergens, air pollutants and respiratory virus counts. We quantified overall associations, and estimates stratified by encounter location (outpatient, emergency department, inpatient), sociodemographics and comorbidities. RESULTS The analysis included 7637 asthma exacerbation events. High mean daily temperatures that occurred 5 days before the index date were associated with higher rates of exacerbation (rate ratio (RR) comparing 33°C-13.1°C days: 1.37, 95% CI 1.04 to 1.82). Associations were most substantial for children ages 2 to <5 years and for Hispanic and non-Hispanic black children. Adjustment for air pollutants, aeroallergens and respiratory virus counts did not substantially change RR estimates. CONCLUSIONS This research contributes to evidence that ambient heat is associated with higher rates of asthma exacerbation in children. Further work is needed to explore the mechanisms underlying these associations.
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Affiliation(s)
- Leah H Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health at Drexel University, Philadelphia, Pennsylvania, USA .,Urban Health Collaborative, Dornsife School of Public Health at Drexel University, Philadelphia, Pennsylvania, USA
| | - Chen C Kenyon
- PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Yuzhe Zhao
- Urban Health Collaborative, Dornsife School of Public Health at Drexel University, Philadelphia, Pennsylvania, USA
| | - Mitchell Maltenfort
- The Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Steven J Melly
- Urban Health Collaborative, Dornsife School of Public Health at Drexel University, Philadelphia, Pennsylvania, USA
| | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health at Drexel University, Philadelphia, Pennsylvania, USA
| | - Christopher B Forrest
- The Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health at Drexel University, Philadelphia, Pennsylvania, USA.,Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, Pennsylvania, USA
| | - Anneclaire J de Roos
- Department of Environmental and Occupational Health, Dornsife School of Public Health at Drexel University, Philadelphia, Pennsylvania, USA.,Urban Health Collaborative, Dornsife School of Public Health at Drexel University, Philadelphia, Pennsylvania, USA
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40
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Mullachery PH, Lankenau S, Diez Roux AV, Li R, Henson RM, Bilal U. Urban scaling of opioid overdose deaths in the USA: a cross-sectional study in three periods between 2005 and 2017. BMJ Open 2022; 12:e048831. [PMID: 35241464 PMCID: PMC8896002 DOI: 10.1136/bmjopen-2021-048831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe the association between population size, population growth and opioid overdose deaths-overall and by type of opioid-in US commuting zones (CZs) in three periods between 2005 and 2017. SETTINGS 741 CZs covering the entirety of the US CZs are aggregations of counties based on commuting patterns that reflect local economies. PARTICIPANTS We used mortality data at the county level from 2005 to 2017 from the National Center for Health Statistics. OUTCOME Opioid overdose deaths were defined using underlying and contributory causes of death codes from the International Classification of Diseases, 10th revision (ICD-10). We used the underlying cause of death to identify all drug poisoning deaths. Contributory cause of death was used to classify opioid overdose deaths according to the three major types of opioid, that is, prescription opioids, heroin and synthetic opioids other than methadone. RESULTS Opioid overdose deaths were disproportionally higher in largely populated CZs. A CZ with 1.0% larger population had 1.10%, 1.10%, and 1.16% higher opioid death count in 2005-2009, 2010-2014, and 2015-2017, respectively. This pattern was largely driven by a high number of deaths involving heroin and synthetic opioids, particularly in 2015-2017. Population growth over time was associated with lower age-adjusted opioid overdose mortality rate: a 1.0% increase in population over time was associated with 1.4% (95% CI: -2.8% to 0.1%), 4.5% (95% CI: -5.8% to -3.2%), and 1.2% (95% CI: -4.2% to 1.8%) lower opioid overdose mortality in 2005-2009, 2010-2014, and 2015-2017, respectively. The association between positive population growth and lower opioid mortality rates was stronger in larger CZs. CONCLUSIONS Opioid overdose mortality in the USA was disproportionately higher in mid-sized and large CZs, particularly those affected by declines in population over time, regardless of the region where they are located.
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Affiliation(s)
- Pricila H Mullachery
- Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA
| | - Stephen Lankenau
- Dornsife School of Public Health, Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, USA
| | - Ana V Diez Roux
- Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA
- Dornsife School of Public Health, Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Ran Li
- Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA
| | - Rosie Mae Henson
- Dornsife School of Public Health, Department of Health Management and Policy, Drexel University, Philadelphia, Pennsylvania, USA
| | - Usama Bilal
- Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA
- Dornsife School of Public Health, Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
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41
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Schnake-Mahl AS, O'Leary G, Mullachery PH, Vaidya V, Connor G, Rollins H, Kolker J, Diez Roux AV, Bilal U. The Impact of Keeping Indoor Dining Closed on COVID-19 Rates Among Large US Cities: A Quasi-Experimental Design. Epidemiology 2022; 33:200-208. [PMID: 34799474 PMCID: PMC8810740 DOI: 10.1097/ede.0000000000001444] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Indoor dining is one of the potential drivers of COVID-19 transmission. We used the heterogeneity among state government preemption of city indoor dining closures to estimate the impact of keeping indoor dining closed on COVID-19 incidence. METHODS We obtained case rates and city or state reopening dates from March to October 2020 in 11 US cities. We categorized cities as treatment cities that were allowed by the state to reopen but kept indoor dining closed or comparison cities that would have kept indoor dining closed but that were preempted by their state and had to reopen indoor dining. We modeled associations using a difference-in-difference approach and an event study specification. We ran negative binomial regression models, with city-day as the unit of analysis, city population as an offset, and controlling for time-varying nonpharmaceutical interventions, as well as city and time fixed effects in sensitivity analysis and the event study specification. RESULTS Keeping indoor dining closed was associated with a 55% (IRR = 0.45; 95% confidence intervals = 0.21, 0.99) decline in the new COVID-19 case rate over 6 weeks compared with cities that reopened indoor dining, and these results were consistent after testing alternative modeling strategies. CONCLUSIONS Keeping indoor dining closed may be directly or indirectly associated with reductions in COVID-19 spread. Evidence of the relationship between indoor dining and COVID-19 case rates can inform policies to restrict indoor dining as a tailored strategy to reduce COVID-19 incidence. See video abstract at, http://links.lww.com/EDE/B902.
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Affiliation(s)
- Alina S Schnake-Mahl
- From the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Gabriella O'Leary
- From the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Pricila H Mullachery
- From the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Vaishnavi Vaidya
- From the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Gabrielle Connor
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Heather Rollins
- From the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Jennifer Kolker
- From the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Ana V Diez Roux
- From the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Usama Bilal
- From the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
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42
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Quistberg DA, Hessel P, Rodriguez DA, Sarmiento OL, Bilal U, Caiaffa WT, Miranda JJ, de Pina MDF, Hernández-Vásquez A, Diez Roux AV. Urban landscape and street-design factors associated with road-traffic mortality in Latin America between 2010 and 2016 (SALURBAL): an ecological study. Lancet Planet Health 2022; 6:e122-e131. [PMID: 35150622 PMCID: PMC8850369 DOI: 10.1016/s2542-5196(21)00323-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 11/05/2021] [Accepted: 11/18/2021] [Indexed: 05/13/2023]
Abstract
BACKGROUND Road-traffic injuries are a key cause of death and disability in low-income and middle-income countries, but the effect of city characteristics on road-traffic mortality is unknown in these countries. The aim of this study was to determine associations between city-level built environment factors and road-traffic mortality in large Latin American cities. METHODS We selected cities from Argentina, Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Mexico, Panama, and Peru; cities included in the analysis had a population of at least 100 000 people. We extracted data for road-traffic deaths that occurred between 2010 and 2016 from country vital registries. Deaths were grouped by 5-year age groups and sex. Road-traffic deaths were identified using ICD-10 codes, with adjustments for ill-defined codes and incomplete registration. City-level measures included population, urban development, street design, public transportation, and social environment. Associations were estimated using multilevel negative binomial models with robust variances. FINDINGS 366 cities were included in the analysis. There were 328 408 road-traffic deaths in nearly 3·5 billion person-years across all countries, with an average crude rate of 17·1 deaths per 100 000 person-years. Nearly half of the people who died were younger than 35 years. In multivariable models, road-traffic mortality was higher in cities where urban development was more isolated (rate ratio [RR] 1·05 per 1 SD increase, 95% CI 1·02-1·09), but lower in cities with higher population density (0·94, 0·90-0·98), higher gross domestic product per capita (0·96, 0·94-0·98), and higher intersection density (0·92, 0·89-0·95). Cities with mass transit had lower road mortality rates than did those without (0·92, 0·86-0·99). INTERPRETATION Urban development policies that reduce isolated and disconnected urban development and that promote walkable street networks and public transport could be important strategies to reduce road-traffic deaths in Latin America and elsewhere. FUNDING Wellcome Trust.
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Affiliation(s)
- D Alex Quistberg
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
| | - Philipp Hessel
- Escuela de Gobierno Alberto Lleras Camargo, Universidad de Los Andes, Bogotá, Colombia
| | - Daniel A Rodriguez
- City + Regional Planning and Institute for Transportation Studies, University of California, Berkeley, CA, USA
| | | | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Waleska Teixeira Caiaffa
- Observatório de Saúde Urbana em Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria de Fatima de Pina
- Instituto de Comunicação e Investigação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil; i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Akram Hernández-Vásquez
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Avila-Palencia I, Rodríguez DA, Miranda JJ, Moore K, Gouveia N, Moran MR, Caiaffa WT, Diez Roux AV. Associations of Urban Environment Features with Hypertension and Blood Pressure across 230 Latin American Cities. Environ Health Perspect 2022. [PMID: 35167325 DOI: 10.1289/isee.2021.o-lt-031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Features of the urban physical environment may be linked to the development of high blood pressure, a leading risk factor for global burden of disease. OBJECTIVES We examined associations of urban physical environment features with hypertension and blood pressure measures in adults across 230 Latin American cities. METHODS In this cross-sectional study we used health, social, and built environment data from the SALud URBana en América Latina (SALURBAL) project. The individual-level outcomes were hypertension and levels of systolic and diastolic blood pressure. The exposures were city and subcity built environment features, mass transit infrastructure, and green space. Odds ratios (ORs) and mean differences and 95% confidence intervals (CIs) were estimated using multilevel logistic and linear regression models, with single- and multiple-exposure models adjusted for individual-level age, sex, education, and subcity educational attainment. RESULTS A total of 109,176 participants from 230 cities and eight countries were included in the hypertension analyses and 50,228 participants from 194 cities and seven countries were included in the blood pressure measures analyses. Participants were 18-97 years of age. In multiple-exposure models, higher city fragmentation was associated with higher odds of having hypertension (OR per standard deviation (SD) increase=1.11; 95% CI: 1.01, 1.21); presence (vs. no presence) of mass transit in the city was associated with higher odds of having hypertension (OR=1.30; 95% CI: 1.09, 1.54); higher subcity population density was associated with lower odds of having hypertension (OR per SD increase=0.90; 95% CI: 0.85, 0.94); and higher subcity intersection density was associated with higher odds of having hypertension [OR per SD increase=1.09; 95% CI: 1.04, 1.15). The presence of mass transit was also associated with slightly higher systolic and diastolic blood pressure in multiple-exposure models adjusted for treatment. Except for the association between intersection density and hypertension, associations were attenuated after adjustment for country. An inverse association of greenness with continuous blood pressure emerged after country adjustment. DISCUSSION Our results suggest that urban physical environment features-such as fragmentation, mass transit, population density, and intersection density-may be related to hypertension in Latin American cities. Reducing chronic disease risks in the growing urban areas of Latin America may require attention to integrated management of urban design and transport planning. https://doi.org/10.1289/EHP7870.
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Affiliation(s)
- Ione Avila-Palencia
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Daniel A Rodríguez
- Department of City and Regional Planning, University of California, Berkeley, Berkeley, California, USA
- Institute for Transportation Studies, University of California, Berkeley, Berkeley, California, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Nelson Gouveia
- Department of Preventive Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Mika R Moran
- Institute of Urban and Regional Development, University of California, Berkeley, Berkeley, California, USA
| | - Waleska T Caiaffa
- Observatory for Urban Health, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerals, Brazil
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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Avila-Palencia I, Rodríguez DA, Miranda JJ, Moore K, Gouveia N, Moran MR, Caiaffa WT, Diez Roux AV. Associations of Urban Environment Features with Hypertension and Blood Pressure across 230 Latin American Cities. Environ Health Perspect 2022; 130:27010. [PMID: 35167325 PMCID: PMC8846315 DOI: 10.1289/ehp7870] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Features of the urban physical environment may be linked to the development of high blood pressure, a leading risk factor for global burden of disease. OBJECTIVES We examined associations of urban physical environment features with hypertension and blood pressure measures in adults across 230 Latin American cities. METHODS In this cross-sectional study we used health, social, and built environment data from the SALud URBana en América Latina (SALURBAL) project. The individual-level outcomes were hypertension and levels of systolic and diastolic blood pressure. The exposures were city and subcity built environment features, mass transit infrastructure, and green space. Odds ratios (ORs) and mean differences and 95% confidence intervals (CIs) were estimated using multilevel logistic and linear regression models, with single- and multiple-exposure models adjusted for individual-level age, sex, education, and subcity educational attainment. RESULTS A total of 109,176 participants from 230 cities and eight countries were included in the hypertension analyses and 50,228 participants from 194 cities and seven countries were included in the blood pressure measures analyses. Participants were 18-97 years of age. In multiple-exposure models, higher city fragmentation was associated with higher odds of having hypertension (OR per standard deviation (SD) increase=1.11; 95% CI: 1.01, 1.21); presence (vs. no presence) of mass transit in the city was associated with higher odds of having hypertension (OR=1.30; 95% CI: 1.09, 1.54); higher subcity population density was associated with lower odds of having hypertension (OR per SD increase=0.90; 95% CI: 0.85, 0.94); and higher subcity intersection density was associated with higher odds of having hypertension [OR per SD increase=1.09; 95% CI: 1.04, 1.15). The presence of mass transit was also associated with slightly higher systolic and diastolic blood pressure in multiple-exposure models adjusted for treatment. Except for the association between intersection density and hypertension, associations were attenuated after adjustment for country. An inverse association of greenness with continuous blood pressure emerged after country adjustment. DISCUSSION Our results suggest that urban physical environment features-such as fragmentation, mass transit, population density, and intersection density-may be related to hypertension in Latin American cities. Reducing chronic disease risks in the growing urban areas of Latin America may require attention to integrated management of urban design and transport planning. https://doi.org/10.1289/EHP7870.
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Affiliation(s)
- Ione Avila-Palencia
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Daniel A. Rodríguez
- Department of City and Regional Planning, University of California, Berkeley, Berkeley, California, USA
- Institute for Transportation Studies, University of California, Berkeley, Berkeley, California, USA
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Nelson Gouveia
- Department of Preventive Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Mika R. Moran
- Institute of Urban and Regional Development, University of California, Berkeley, Berkeley, California, USA
| | - Waleska T. Caiaffa
- Observatory for Urban Health, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerals, Brazil
| | - Ana V. Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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Tabb LP, Diez Roux AV, Barber S, Judd S, Lovasi G, Lawson A, McClure LA. Spatially varying racial inequities in cardiovascular health and the contribution of individual- and neighborhood-level characteristics across the United States: The REasons for geographic and racial differences in stroke (REGARDS) study. Spat Spatiotemporal Epidemiol 2022; 40:100473. [PMID: 35120683 PMCID: PMC8867394 DOI: 10.1016/j.sste.2021.100473] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 11/15/2021] [Accepted: 11/29/2021] [Indexed: 02/03/2023]
Abstract
Black-White inequities in cardiovascular health (CVH) pose a significant public health challenge, with these disparities also varying geographically across the US. There remains limited evidence of the impact of social determinants of health on these inequities. Using a national population-based cohort from the REasons for Geographic and Racial Differences in Stroke study, we assessed the spatial heterogeneity in Black-White differences in CVH and determined the extent to which individual- and neighborhood-level characteristics explain these inequities. We utilized a Bayesian hierarchical statistical framework to fit spatially varying coefficient models. Results showed overall and spatially varying inequities, where Black participants had significantly poorer CVH. The maps of the state level random effects also highlighted how inequities vary. The evidence produced in this study further highlights the importance of multilevel approaches - at the individual- and neighborhood-levels - that need to be in place to address these geographic and racial differences in CVH.
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Affiliation(s)
- Loni Philip Tabb
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA,Corresponding Author:
| | - Ana V. Diez Roux
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA
| | - Sharrelle Barber
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA
| | - Suzanne Judd
- University of Alabama at Birmingham, School of Public Health, Department of Biostatistics
| | - Gina Lovasi
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA
| | - Andrew Lawson
- Medical University of South Carolina, College of Medicine
| | - Leslie A. McClure
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA
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Gao X, Kershaw KN, Barber S, Schreiner PJ, Do DP, Diez Roux AV, Mujahid MS. Associations Between Residential Segregation and Incident Hypertension: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2022; 11:e023084. [PMID: 35048712 PMCID: PMC9238487 DOI: 10.1161/jaha.121.023084] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Xing Gao
- Division of Epidemiology School of Public Health University of California Berkeley CA
| | - Kiarri N Kershaw
- Department of Preventive Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Sharrelle Barber
- Department of Epidemiology & Biostatistics Dornsife School of Public Health Drexel University Philadelphia PA
| | - Pamela J Schreiner
- Division of Epidemiology & Community Health School of Public Health University of Minnesota Minneapolis MN
| | - D Phuong Do
- Public Health Policy and Administration Zilber School of Public Health University of Wisconsin-Milwaukee Milwaukee WI
| | - Ana V Diez Roux
- Department of Epidemiology & Biostatistics Dornsife School of Public Health Drexel University Philadelphia PA
| | - Mahasin S Mujahid
- Division of Epidemiology School of Public Health University of California Berkeley CA
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Abstract
In a context where epidemiologic research has been heavily influenced by a biomedical and individualistic approach, the naming of “social epidemiology” allowed explicit emphasis on the social production of disease as a powerful explanatory paradigm and as critically important for interventions to improve population health. This review briefly highlights key substantive areas of focus in social epidemiology over the past 30 years, reflects on major advances and insights, and identifies challenges and possible future directions. Future opportunities for social epidemiology include grounding research in theoretically based and systemic conceptual models of the fundamental social drivers of health; implementing a scientifically rigorous yet realistic approach to drawing conclusions about social causes; using complementary methods to generate valid explanations and identify effective actions; leveraging the power of harmonization, replication, and big data; extending interdisciplinarity and diversity; advancing emerging critical approaches to understanding the health impacts of systemic racism and its policy implications; going global; and embracing a broad approach to generating socially useful research. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Ana V. Diez Roux
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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Bilal U, de Castro CP, Alfaro T, Barrientos-Gutierrez T, Barreto ML, Leveau CM, Martinez-Folgar K, Miranda JJ, Montes F, Mullachery P, Pina MF, Rodriguez DA, dos Santos GF, Andrade RFS, Diez Roux AV. Scaling of mortality in 742 metropolitan areas of the Americas. Sci Adv 2021; 7:eabl6325. [PMID: 34878846 PMCID: PMC8654292 DOI: 10.1126/sciadv.abl6325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/20/2021] [Indexed: 06/13/2023]
Abstract
We explored how mortality scales with city population size using vital registration and population data from 742 cities in 10 Latin American countries and the United States. We found that more populated cities had lower mortality (sublinear scaling), driven by a sublinear pattern in U.S. cities, while Latin American cities had similar mortality across city sizes. Sexually transmitted infections and homicides showed higher rates in larger cities (superlinear scaling). Tuberculosis mortality behaved sublinearly in U.S. and Mexican cities and superlinearly in other Latin American cities. Other communicable, maternal, neonatal, and nutritional deaths, and deaths due to noncommunicable diseases were generally sublinear in the United States and linear or superlinear in Latin America. Our findings reveal distinct patterns across the Americas, suggesting no universal relation between city size and mortality, pointing to the importance of understanding the processes that explain heterogeneity in scaling behavior or mortality to further advance urban health policies.
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Affiliation(s)
- Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Caio P. de Castro
- Center for Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Bahia, Brazil
- Institute of Physics, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Tania Alfaro
- Escuela de Salud Pública, Universidad de Chile, Santiago de Chile, Chile
| | | | - Mauricio L. Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Carlos M. Leveau
- Instituto de Producción, Economía y Trabajo, Universidad Nacional de Lanús, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Kevin Martinez-Folgar
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - J. Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Felipe Montes
- Department of Industrial Engineering, Universidad de los Andes, Bogotá, Colombia
| | - Pricila Mullachery
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Maria Fatima Pina
- Institute for Information and Communication on Health—ICICT/FIOCRUZ, Rio de Janeiro, Brazil
- i3S—Instituto de Investigação e Inovação em Saúde, Porto, Portugal
| | - Daniel A. Rodriguez
- Department of City and Regional Planning, University of California, Berkeley, Berkeley, CA, USA
| | - Gervasio F. dos Santos
- Center for Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Bahia, Brazil
- Economics Faculty, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Roberto F. S. Andrade
- Center for Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Bahia, Brazil
- Institute of Physics, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Ana V. Diez Roux
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
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Forde AT, Sims M, Wang X, Barber S, Diez Roux AV. The role of perceived discrimination in predicting changes in health behaviours among African Americans in the Jackson Heart Study. J Epidemiol Community Health 2021; 75:1222-1231. [PMID: 34117112 PMCID: PMC8588298 DOI: 10.1136/jech-2020-215998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 05/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study examined whether perceived discrimination was associated with health behaviours over time and whether associations of discrimination with behaviours varied by attribution of discrimination. METHODS Multinomial logistic regression was used to estimate ORs and CIs for the associations of discrimination (everyday, lifetime, stress from lifetime discrimination) with health behaviours (cigarette smoking, alcohol use) over time among 3050 African Americans in the Jackson Heart Study from visit 1 (2000-2004) to visit 3 (2009-2013). Smoking status was classified as persistent current, persistent former, persistent never, current to former and former/never to current smokers. Alcohol use status was classified as persistent heavy, persistent moderate/none, heavy to moderate/none and moderate/none to heavy alcohol users. RESULTS Higher everyday discrimination was associated with persistent current smoking (OR per SD higher discrimination 1.26, 95% CI 1.11,1.43) and with persistent former smoking (high vs low OR 1.32, 95% CI 1.02,1.70) relative to persistent never smoking. Similar findings were observed for lifetime discrimination and persistent current smoking (high vs low OR 1.85, 95% CI 1.15,2.95) and with persistent former smoking (high vs low OR 1.45, 95% CI 1.06,1.98). Participants reporting lifetime discrimination as very stressful compared with not stressful were more likely to be persistent former smokers (OR 1.44, 95% CI 1.04,1.99). Associations did not vary by discrimination attribution. CONCLUSION Discrimination did not predict changes in smoking status or alcohol use. Discrimination was associated with persistent current smoking status, which may provide a plausible mechanism through which discrimination impacts the health of African Americans.
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Affiliation(s)
- Allana T Forde
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
- The Urban Health Collaborative, and the Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Xu Wang
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Sharrelle Barber
- The Urban Health Collaborative, and the Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Ana V Diez Roux
- The Urban Health Collaborative, and the Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
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Daniels KM, Schinasi LH, Auchincloss AH, Forrest CB, Diez Roux AV. The built and social neighborhood environment and child obesity: A systematic review of longitudinal studies. Prev Med 2021; 153:106790. [PMID: 34506813 DOI: 10.1016/j.ypmed.2021.106790] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/17/2021] [Accepted: 09/05/2021] [Indexed: 11/25/2022]
Abstract
The built and social neighborhood environment where a child lives has been increasingly studied as an exposure that may affect child weight long term. We conducted a systematic review of primary research articles published in 2011 through 2019 that reported results from longitudinal analyses of associations between neighborhood environment characteristics and child obesity or weight. Neighborhood environment measures included proximity to food stores, parks, and recreational facilities, walkability, crime, perceived safety, and social cohesion. Information on study population, exposure and outcome measures, and main results were extracted from 39 studies and results were presented for full cohorts and stratified by sex. Most studies were prospective cohorts (90%) with a median follow-up time of six years. Studies analyzing changes in the neighborhood versus changes in weight were less common than approaches analyzing baseline measures of the neighborhood environment in relation to obesity incidence or weight trajectories. Associations varied by sex, race/ethnicity, and age group. Within the food environment domain, the strongest evidence of adverse impact was for fast food restaurants but the effect was only apparent among girls. Results suggested green space, parks, and recreational facilities may have a beneficial effect on weight. Increased crime and low perceived safety may be risk factors for increased weight although not all studies were consistent. Standardization of measures across studies, investigation of multiple social and physical environment measures simultaneously, effect modification by demographic characteristics, and change in the environment vs change in weight analyses are needed to strengthen conclusions.
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Affiliation(s)
- Kimberly M Daniels
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA.
| | - Leah H Schinasi
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA; Department of Environmental and Occupational Health, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Amy H Auchincloss
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Christopher B Forrest
- Applied Clinical Research Center, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ana V Diez Roux
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
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