Comparison of the number of pedestrian and cyclist injuries captured in police data compared with health service utilisation data in Toronto, Canada 2016-2021

INTRODUCTION

Pedestrian and cyclist injuries represent a preventable burden to Canadians. Police-reported collision data include information on where such collisions occur but under-report the number of collisions. The primary objective of this study was to compare the number of police-reported collisions with emergency department (ED) visits and hospitalisations in Toronto, Canada.

METHODS

Police-reported collisions were provided by Toronto Police Services (TPS). Data included the location of the collision, approximate victim age and whether the pedestrian or cyclist was killed or seriously injured. Health services data included ED visits in the National Ambulatory Care Reporting System and hospitalisations from the Discharge Abstract Database using ICD-10 codes for pedestrian and cycling injuries. Data were compared from 2016 to 2021.

RESULTS

Injuries reported in the health service data were higher than those reported in the TPS for cyclists and pedestrians. The discrepancy was the largest for cyclists treated in the ED, with TPS capturing 7.9% of all cycling injuries. Cyclist injuries not involving a motor vehicle have increased since the start of the pandemic (from 3629 in 2019 to 5459 in 2020 for ED visits and from 251 in 2019 to 430 for hospital admissions).

IMPLICATIONS

While police-reported data are important, it under-reports the burden. There have been increases in cyclist collisions not involving motor vehicles and decreases in pedestrian injuries since the start of the pandemic. The results suggest that using police data alone when planning for road safety is inadequate, and that linkage with other health service data is essential.

Respiratory Function and Racial Health Disparities With Residential Proximity to Coal Power Plants in Wisconsin

BACKGROUND

Burning fossil fuels, including coal, is the primary source of greenhouse gas emissions driving anthropogenic climate change and its associated health harms. Coal-fired power plants supply 23% of electricity nationally and 42% for Wisconsin, contributing to air pollution and associated respiratory diseases, cancers, and cardiovascular and neurologic disorders, especially for vulnerable populations. Authors seek to quantify residential distance from coal-fired power plants, pulmonary function of Wisconsin residents, and demographics.

METHODS

Data from 2,327 adults aged 21-74 years was obtained from the Survey of the Health of Wisconsin database from 2008 through 2013. Pulmonary function was measured by expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) as a ratio of FEV1/FVC. An average of at least 3 FEV1/FVC readings less than 80% was considered abnormal.

RESULTS

Adults living near 1 of 11 coal-fired power plants may have worse pulmonary function. The odds ratio of FEV1/FVC values below 80% for those living within 35 km of a coal-fired power plant was 1.24 (95% CI, 0.90-1.70) when compared to those living greater than 35 km from a plant. While Black individuals made up 4.8% of the total sample population, they accounted for 13.3% of individuals living within 35 km of coal-fired power plants. Similarly, Hispanic populations accounted for 4.8% of those living within 35 km of a plant, while making up 2.8% of the sample population.

INTERPRETATION

Significant disparities were found in residential proximity to Wisconsin coal-fired power plants for Black and Hispanic populations, with trends that support worse pulmonary function when living within 35 km of these plants. When linked with socioeconomic and racial/ethnic factors, closing down coal-fired power plants becomes a necessity to reduce disparities and address environmental injustices.

Persistence of mortgage lending bias in the United States: 80 years after the Home Owners' Loan Corporation security maps

Housing discrimination and racial segregation have a long history in the United States. The 1930's Home Owners' Loan Corporation (HOLC) "residential security maps," recently digitized, have become a popular visualization of Depression era mortgage lending risk patterns across American cities. Numerous housing policies have since been instituted, including the Home Mortgage Disclosure Act (HMDA), but mortgage lending bias persists. The degree to which detailed spatial patterns of bias have persisted or changed along with urban change is not well understood. We compare historic HOLC grades and contemporary levels of mortgage lending bias using spatially detailed HMDA data. We further examine the relationship between HOLC risk grades and contemporary racial and ethnic settlement patterns. Results suggest that historical mortgage lending risk categorizations and settlement patterns are associated with contemporary mortgage lending bias and racial and ethnic settlement patterns. Concerted and deliberate efforts will be needed to change these patterns.

Mortgage Lending Bias and Breast Cancer Survival Among Older Women in the United States

PURPOSE

The objective was to examine the relationship between contemporary redlining (mortgage lending bias on the basis of property location) and survival among older women with breast cancer in the United States.

METHODS

A redlining index using Home Mortgage Disclosure Act data (2007-2013) was linked by census tract with a SEER-Medicare cohort of 27,516 women age 66-90 years with an initial diagnosis of stage I-IV breast cancer in 2007-2009 and follow-up through 2015. Cox proportional hazards models were used to examine the relationship between redlining and both all-cause and breast cancer-specific mortality, accounting for covariates.

RESULTS

Overall, 34% of non-Hispanic White, 57% of Hispanic, and 79% of non-Hispanic Black individuals lived in redlined tracts. As the redlining index increased, women experienced poorer survival. This effect was strongest for women with no comorbid conditions, who comprised 54% of the sample. For redlining index values of 1 (low), 2 (moderate), and 3 (high), as compared with 0.5 (least), hazard ratios (HRs) (and 95% CIs) for all-cause mortality were HR = 1.10 (1.06 to 1.14), HR = 1.27 (1.17 to 1.38), and HR = 1.39 (1.25 to 1.55), respectively, among women with no comorbidities. A similar pattern was found for breast cancer-specific mortality.

CONCLUSION

Contemporary redlining is associated with poorer breast cancer survival. The impact of this bias is emphasized by the pronounced effect even among women with health insurance (Medicare) and no comorbid conditions. The magnitude of this neighborhood level effect demands an increased focus on upstream determinants of health to support comprehensive patient care. The housing sector actively reveals structural racism and economic disinvestment and is an actionable policy target to mitigate adverse upstream health determinants for the benefit of patients with cancer.

Resilience and Equity in a Time of Crises: Investing in Public Urban Greenspace Is Now More Essential Than Ever in the US and Beyond

The intersecting negative effects of structural racism, COVID-19, climate change, and chronic diseases disproportionately affect racial and ethnic minorities in the US and around the world. Urban populations of color are concentrated in historically redlined, segregated, disinvested, and marginalized neighborhoods with inadequate quality housing and limited access to resources, including quality greenspaces designed to support natural ecosystems and healthy outdoor activities while mitigating urban environmental challenges such as air pollution, heat island effects, combined sewer overflows and poor water quality. Disinvested urban environments thus contribute to health inequity via physical and social environmental exposures, resulting in disparities across numerous health outcomes, including COVID-19 and chronic diseases such as cancer and cardiovascular diseases (CVD). In this paper, we build off an existing conceptual framework and propose another conceptual framework for the role of greenspace in contributing to resilience and health equity in the US and beyond. We argue that strategic investments in public greenspaces in urban neighborhoods impacted by long term economic disinvestment are critically needed to adapt and build resilience in communities of color, with urgency due to immediate health threats of climate change, COVID-19, and endemic disparities in chronic diseases. We suggest that equity-focused investments in public urban greenspaces are needed to reduce social inequalities, expand economic opportunities with diversity in workforce initiatives, build resilient urban ecosystems, and improve health equity. We recommend key strategies and considerations to guide this investment, drawing upon a robust compilation of scientific literature along with decades of community-based work, using strategic partnerships from multiple efforts in Milwaukee Wisconsin as examples of success.

Neighborhood Characteristics and Cancer Survivorship: An Overview of the Current Literature on Neighborhood Landscapes and Cancer Care

There is a growing literature on the association between neighborhood contexts and cancer survivorship. To understand the current trends and the gaps in the literature, we aimed to answer the following questions: To what degree, and how, has cancer survivorship research accounted for neighborhood-level effects? What neighborhood metrics have been used to operationalize neighborhood factors? To what degree do the neighborhood level metrics considered in cancer research reflect neighborhood development as identified in the Leadership for Energy and Environmental Design for Neighborhood Development (LEED-ND) guidelines? We first conducted a review guided by PRISMA extension for scoping review of the extant literature on neighborhood effects and cancer survivorship outcomes from January 2000 to January 2021. Second, we categorized the studied neighborhood metrics under six main themes. Third, we assessed the findings based on the LEED-ND guidelines to identify the most relevant neighborhood metrics in association with areas of focus in cancer survivorship care and research. The search results were scoped to 291 relevant peer-reviewed journal articles. Results show that survivorship disparities, primary care, and weight management are the main themes in the literature. Additionally, most articles rely on neighborhood SES as the primary (or only) examined neighborhood level metric. We argue that the expansion of interdisciplinary research to include neighborhood metrics endorsed by current paradigms in salutogenic urban design can enhance the understanding of the role of socioecological context in survivorship care and outcomes.

Residential history in cancer research: Utility of the annual billing ZIP code in the SEER-Medicare database and mobility among older women with breast cancer in the United States

There is a rise in attention to residential history in cancer epidemiology aimed at more effective estimation of social and physical environmental exposures and the influence of place of residence on cancer outcomes. However, in the United States, as in many other countries, residential history data are not readily available. In this paper we explore the feasibility of using the annual Medicare billing ZIP code history available in the SEER-Medicare database to study residential mobility among older cancer survivors in the U.S. In a cohort of women diagnosed with breast cancer between 2007 and 2015, we examine the completeness of the data along with the overall characteristics of residential moves based on race and stage at diagnosis. Findings indicate that residential mobility among older women with breast cancer in the U.S. is limited, but differences by race/ethnicity, stage at diagnosis and before/after diagnosis are statistically significant. And breast cancer survivors from minority groups move more frequently than their non-Hispanic White counterparts. The results also show that move rate slightly, but statistically significantly, increases after diagnosis. We conclude that SEER-Medicare can be utilized to study residential mobility among older cancer survivors. We recommend the creation of sub-cohorts based on specific research questions to account for variability in residential mobility due to very short survival times or a diagnosis shortly after Medicare enrollment. Studying residential history provides the opportunity for assigning socioecological and exposure metrics for future survival studies.

The role of residential history in cancer research: A scoping review

The role of residential history in cancer prevention, diagnosis, treatment, and survivorship is garnering increasing attention in cancer research. To our knowledge, there is no comprehensive synthesis of the current state of knowledge in the field. We reviewed the extant literature on this topic and conducted a scoping analysis to examine two main research questions: (a) To what degree, and how, have researchers accounted for residential history/mobility in cancer research? and (b) What are the gaps in the literature based on a knowledge synthesis using scoping review and concept mapping? To answer these questions, this scoping analysis focuses on how researchers compile, analyze and discuss residential history/mobility in studies on cancer. The study is focused on peer-reviewed articles from 6 different datasets (PubMed, Cinahl, Scopus, Web of Science and JSTOR, ERIC) from 1990 to August 2020. The review captured 1951 results in total, which was scoped to 281 relevant peer-reviewed journal articles. First, we examined these articles based on cancer continuum, cancer type and the main theme. Second, we identified 21 main themes and an additional 16 sub-themes in the pool of the selected articles. We utilized concept mapping to provide a conceptual framework and to highlight the underlying socioecological assumptions and paradigms. Results show that cancer research incorporating residential histories is primarily focused on incidence and estimating cumulative exposure, with little consideration across the cancer continuum. Additionally, our review suggests that although the social environment plays an important role across the cancer continuum, a small number of articles were focused on such factors and this area remains relatively unexplored. Additionally, the expansion of interdisciplinary research on residential mobility before and after cancer diagnosis will enhance understanding of the role of environmental and socioeconomic characteristics and exposures on cancer continuum.

Abstract A061: The Breast Cancer, Race and Place study: Exploring the influence of race, racism, and residential segregation on cancer survivorship among Black women in Milwaukee, Wisconsin

Introduction: Racial breast cancer survival disparities persist, indicating that not all populations are benefitting equally from advances in cancer control. Individual and health care factors do not fully explain these disparities, and factors such as institutional racism and racial segregation may be contributors. Our study explores the ways in which Black women in a highly segregated metropolitan area navigate cancer survivorship. Methods: The study utilizes novel qualitative methods and is guided by a community advisory board. Participants were recruited from Milwaukee, Wisconsin, a hyper-segregated city. We use a stratified, purposive sampling approach to include survivors who vary by neighborhood racial and ethnic composition. Eligible participants have been diagnosed with breast cancer, identify as Black, and have completed their initial treatment regimen. The study population is diverse in age, tumor type and stage at diagnosis to ensure multiple perspectives. Instruments and processes were guided by a conceptual framework relating racism and racial segregation to breast cancer survival. We use narrative inquiry as a reflexive tool in which participants’ lived experiences are captured as textual representations. Semi-structured interviews include a demographic questionnaire, a life narrative account, and completion of a life history calendar detailing residential history since diagnosis. Interviews were transcribed and analyzed utilizing a hybrid approach of both a data-driven inductive process and a deductive, a priori coding template consistent with the conceptual framework. We present early findings from this ongoing study. Results: To date, 18 interviews have been completed with Black women. Participants lived in neighborhoods that were predominantly Black (50%), diverse (28%), and predominantly white (22%). Ages of women ranged from 41 to 79, with a median of 63. Most women had their cancer diagnosed in the early stage (83%). Narrative responses included: 1) determinants of health such as biology and family history; 2) social status, including socioeconomic status, race, and neighborhood of residence; 3) individual and family stressors such as discrimination, access to health information, and care quality; and 4) social support, resilience, and physiological responses to treatment. Participants discussed living in different geographic locations in the city, personal safety, and exposure to racism in their communities and workplaces. All were hopeful that sharing their experiences would benefit other cancer survivors. Conclusions: This study demonstrates the importance of examining race, racism, and residential segregation as contributors to breast cancer survivorship. Utilizing narrative analysis and a modified life history calendar, emphasizing residential histories, allows for a deeper examination of women’s experiences situated in place. Study findings can inform community-based conversations, advocacy and policy change to reduce disparities.

Citation Format: Staci Young, Natalie Jones, Charissa Fritzen-Pedicini, Sima Namin, Kirsten Beyer. The Breast Cancer, Race and Place study: Exploring the influence of race, racism, and residential segregation on cancer survivorship among Black women in Milwaukee, Wisconsin [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A061.

Association Between Environmental Factors and Toxigenic Clostridioides difficile Carriage at Hospital Admission

IMPORTANCE

Clostridioides difficile infection is the most frequent health care-associated infection in the United States. However, exposure to this organism might occur outside the health care setting.

OBJECTIVE

To examine whether exposure to environmental factors, such as livestock farms, is associated with a higher probability of being colonized with C difficile at hospital admission.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cohort study was conducted from May 1, 2017, to June 30, 2018, at a teaching-affiliated hospital in Milwaukee, Wisconsin. All consecutive patients underwent C difficile screening using a nucleic acid amplification test at hospital admission. Data analyses were performed from July 2018 to October 2019.

EXPOSURES

The distances from patient residence to the nearest livestock farms, meat processing plants, raw materials services, and sewage facilities were measured in addition to risk factors previously evaluated in other studies.

MAIN OUTCOMES AND MEASURES

The main outcome was a positive result on C difficile screening tests performed within 72 hours of hospital admission.

RESULTS

A total of 3043 patients admitted to the hospital were included in the final analysis. Of those, 1564 (51.4%) were women and 2074 (68.9%) were white, with a mean (SD) age of 62.0 (15.9) years; 978 patients (32.1%) were admitted to hematology-oncology units. At first admission, 318 patients (10.4%) were detected through testing as C difficile carriers. Multivariable logistic regression analyses were performed on a stratified sample of patients based on hematology-oncology admission status. These analyses indicated that although patients admitted to hematology-oncology units were 35% more likely to be colonized with C difficile, no significant association existed between their sociodemographic and economic characteristics or health care and environmental exposures and the likelihood of a positive C difficile test result. In contrast, among patients admitted to non-hematology-oncology units, comorbidities increased the likelihood for colonization by more than 4 times; women had 60% greater colonization than men, and a history of recent hospitalization (ie, within the preceding 6 months) increased the likelihood of colonization by 70%. Residential proximity to livestock farms were all significantly associated with a higher likelihood of a positive C difficile test result. Residential proximity to livestock farms more than doubled the probability of C difficile colonization in patients admitted to non-hematology-oncology units.

CONCLUSIONS AND RELEVANCE

A shorter distance between residence and livestock farms was associated with C difficile colonization. Knowledge of the epidemiology of C difficile in the community surrounding the hospital is important, as it has potential implications for the incidence of hospital-onset C difficile infection.

The legacy of the Home Owners' Loan Corporation and the political ecology of urban trees and air pollution in the United States

This study examines the persistent impacts of historical racebased discriminatory housing policies on contemporary urban environments in the United States. Specifically, we examine the relationships between Home Owners' Loan Corporation (HOLC) grades assigned to neighborhoods in the 1930s and the current distribution of tree canopy and level of exposure to air pollution hazards. Our results indicate a clear gradient in tree canopy by HOLC grade, with better neighborhood grades associated with significantly higher percentage of tree canopy coverage. The pattern also exists for airborne carcinogens and respiratory hazards, with worse neighborhood grades associated with significantly higher hazards exposure. Our findings indicate that early 20th century discriminatory housing policies exert a contemporary influence on patterns of green space exposure in American cities, with implications for health and health inequities. Our findings suggest that, in order to achieve equitable access to the benefits of urban greenspace, we must acknowledge these historical influences and consider policies and practices that directly counter these influences, for example, through targeted greenspace development in areas historically identified as unfit for investment.

Carbon nanotube reinforced polylactide-caprolactone copolymer: mechanical strengthening and interaction with human osteoblasts in vitro

This study proposes the use of carbon nanotubes (CNTs) as reinforcement to enhance the mechanical properties of a polylactide-caprolactone copolymer (PLC) matrix. Biological interaction of PLC-CNT composites with human osteoblast cells is also investigated. Addition of 2 wt % CNT shows very uniform dispersion in the copolymer matrix, whereas 5 wt % CNT shows severe agglomeration and high porosity. PLC-2 wt % CNT composite shows an improvement in the mechanical properties with an increase in the elastic modulus by 100% and tensile strength by 160%, without any adverse effect on the ductility up to 240% elongation. An in vitro biocompatibility study on the composites shows an increase in the viability of human osteoblast cells compared to the PLC matrix, which is attributed to the combined effect of CNT content and surface roughness of the composite films.