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Mei Y, Christensen GM, Li Z, Waller LA, Ebelt S, Marcus M, Lah JJ, Wingo AP, Wingo TS, Hüls A. Joint effects of air pollution and neighborhood socioeconomic status on cognitive decline - Mediation by depression, high cholesterol levels, and high blood pressure. Sci Total Environ 2024; 923:171535. [PMID: 38453069 DOI: 10.1016/j.scitotenv.2024.171535] [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: 09/29/2023] [Revised: 12/21/2023] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
Air pollution and neighborhood socioeconomic status (N-SES) are associated with adverse cardiovascular health and neuropsychiatric functioning in older adults. This study examines the degree to which the joint effects of air pollution and N-SES on the cognitive decline are mediated by high cholesterol levels, high blood pressure (HBP), and depression. In the Emory Healthy Aging Study, 14,390 participants aged 50+ years from Metro Atlanta, GA, were assessed for subjective cognitive decline using the cognitive function instrument (CFI). Information on the prior diagnosis of high cholesterol, HBP, and depression was collected through the Health History Questionnaire. Participants' census tracts were assigned 3-year average concentrations of 12 air pollutants and 16 N-SES characteristics. We used the unsupervised clustering algorithm Self-Organizing Maps (SOM) to create 6 exposure clusters based on the joint distribution of air pollution and N-SES in each census tract. Linear regression analysis was used to estimate the effects of the SOM cluster indicator on CFI, adjusting for age, race/ethnicity, education, and neighborhood residential stability. The proportion of the association mediated by high cholesterol levels, HBP, and depression was calculated by comparing the total and direct effects of SOM clusters on CFI. Depression mediated up to 87 % of the association between SOM clusters and CFI. For example, participants living in the high N-SES and high air pollution cluster had CFI scores 0.05 (95 %-CI:0.01,0.09) points higher on average compared to those from the high N-SES and low air pollution cluster; after adjusting for depression, this association was attenuated to 0.01 (95 %-CI:-0.04,0.05). HBP mediated up to 8 % of the association between SOM clusters and CFI and high cholesterol up to 5 %. Air pollution and N-SES associated cognitive decline was partially mediated by depression. Only a small portion (<10 %) of the association was mediated by HBP and high cholesterol.
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Affiliation(s)
- Yiyang Mei
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Grace M Christensen
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Zhenjiang Li
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lance A Waller
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Stefanie Ebelt
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michele Marcus
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - James J Lah
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Aliza P Wingo
- Division of Mental Health, Atlanta VA Medical Center, Decatur, GA, USA; Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA
| | - Thomas S Wingo
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA; Department of Human Genetics, Emory University, Atlanta, GA, USA
| | - Anke Hüls
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Satapathy P, Khatib MN, Gaidhane S, Zahiruddin QS, Gaidhane AM, Rustagi S, Serhan HA, Padhi BK. Association of neighborhood deprivation and hypertension: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102438. [PMID: 38301916 DOI: 10.1016/j.cpcardiol.2024.102438] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Hypertension impacts nearly one billion individuals and is a primary health challenge. While traditional perspectives have focused on individual behavior and genetics as principal risk factors, recent research underscores the profound influence of socioeconomic factors within neighborhoods on the risk of hypertension. This systematic review and meta-analysis is aimed to elucidate the association between neighborhood deprivation and the risk of hypertension. METHODS A comprehensive literature search was conducted across PubMed, Embase, and Web of Science from inception until December 25, 2023. Observational studies defining neighborhood deprivation and reporting hypertension incidence were included. Nested Knowledge software was used for screening and data extraction, with study quality assessed using the Newcastle-Ottawa Scale. Statistical analysis was performed with R software (V 4.3), using a random-effects model to calculate the pooled relative risk (RR). RESULTS Twenty-six studies were included in the qualitative analysis and 22 in the meta-analysis, covering over 62 million participants. The pooled RR was 1.139 (95% CI: 1.006 - 1.290), p=0.04, indicating a higher hypertension risk in deprived neighborhoods. Subgroup analyses showed variability by country and deprivation assessment methods. RR varied from 1.00 in Japan (95% CI: 0.93-1.08) to 1.60 (95% CI: 1.07-2.39) in France and 1.57 (95% CI: 0.67-3.70) in Germany, with significant heterogeneity observed in measures of neighborhood deprivation. CONCLUSION Our analysis confirms a significant association between neighborhood deprivation and hypertension, underscoring the importance of socioeconomic factors in public health. It highlights the need for targeted local assessments and interventions. Future research should explore the causal mechanisms and effectiveness of interventions addressing neighborhood deprivation.
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Affiliation(s)
- Prakasini Satapathy
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India; School of Pharmacy, Graphic Era Hill University, Dehradun, India; Medical Laboratories Techniques Department, AL-Mustaqbal University, Hillah, Babil 51001, Iraq
| | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Shilpa Gaidhane
- One Health Centre (COHERD), Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education, Wardha, India
| | - Quazi Syed Zahiruddin
- South Asia Infant Feeding Research Network (SAIFRN), Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Abhay M Gaidhane
- Jawaharlal Nehru Medical College, and Global Health Academy, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education, Wardha, India
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun, Uttarakhand, India
| | - Hashem Abu Serhan
- Department of Ophthalmology, Hamad Medical Corporation, Doha, Qatar.
| | - Bijaya K Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
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Choi EY, Cho G, Chang VW. Neighborhood Social Environment and Dementia: The Mediating Role of Social Isolation. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbad199. [PMID: 38180790 DOI: 10.1093/geronb/gbad199] [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: 06/15/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVES Despite the potential importance of the neighborhood social environment for cognitive health, the connection between neighborhood characteristics and dementia remains unclear. This study investigated the association between the prospective risk of dementia and three distinct aspects of neighborhood social environment: socioeconomic deprivation, disorder, and social cohesion. We also examined whether objective and subjective aspects of individual-level social isolation may function as mediators. METHODS Leveraging data from the Health and Retirement Study (2006-2018; N = 9,251), we used Cox proportional hazards models to examine the association between time-to-dementia incidence and each neighborhood characteristic, adjusting for covariates and the propensity to self-select into disadvantaged neighborhoods. We used inverse odds weighting to decompose significant total effects of neighborhood characteristics into mediational effects of objective and subjective social isolation. RESULTS The risk of dementia was associated with deprivation and disorder but not low cohesion. In deprived neighborhoods, individuals had an 18% increased risk of developing dementia (cause-specific hazard ratio [CHR] = 1.18, 95% CI: 1.02 to 1.38), and those in disordered areas had a 27% higher risk (CHR = 1.27, 95% CI: 1.03 to 1.59). 20% of the disorder's effects were mediated by subjective social isolation, while the mediational effects of objective isolation were nonsignificant. Deprivation's total effects were not partitioned into mediational effects given its nonsignificant associations with the mediators. DISCUSSION Neighborhood deprivation and disorder may increase middle to older adults' risks of dementia. The disorder may adversely affect cognitive health through increasing loneliness. Our results suggest a clear need for dementia prevention targeting upstream neighborhood contexts, including the improvement of neighborhood conditions to foster social integration among residents.
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Affiliation(s)
- Eun Young Choi
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Gawon Cho
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Virginia W Chang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, New York, USA
- Department of Population Health, Grossman School of Medicine, New York University, New York, New York, USA
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Suresh T, LaPointe S, Lee JC, Nagy ZP, Shapiro DB, Kramer MR, Hipp HS, Gaskins AJ. Neighborhood deprivation in relation to ovarian reserve and outcomes of ovarian stimulation among oocyte donors. Fertil Steril 2024:S0015-0282(24)00172-9. [PMID: 38461907 DOI: 10.1016/j.fertnstert.2024.03.002] [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: 11/16/2023] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To study the relationship between neighborhood deprivation index (NDI) and markers of ovarian reserve and outcomes of controlled ovarian stimulation among young, healthy oocyte donors. DESIGN Retrospective cohort study. PATIENTS A total of 547 oocyte donors who underwent 905 oocyte retrieval cycles (2008-2020) at a private fertility center in Sandy Springs, Georgia, United States. INTERVENTIONS Neighborhood deprivation index was calculated using principal component analysis applied to census-level measures of poverty, employment, household composition, and public assistance, which was then standardized and linked to donor information on the basis of donor residence. MAIN OUTCOME MEASURES Markers of ovarian reserve, including antral follicle count (AFC) and antimüllerian hormone (AMH) levels, and outcomes of controlled ovarian stimulation including number of total and mature oocytes retrieved and ovarian sensitivity index (OSI) (defined as the number of oocytes retrieved/total gonadotropin dose × 1,000). Multivariable generalized estimating equations with Poisson and normal distribution were used to model the relationship between NDI and outcome measures adjusting for age, body mass index, and year of retrieval. RESULTS The mean (SD) age of donors was 25.0 (2.8) years and 29% of the donors were racial or ethnic minorities. There were no associations between donor NDI and ovarian reserve markers. For every interquartile range increase in NDI, there was a reduction of -1.5% (95% confidence interval: -5.3% to 2.4%) in total oocytes retrieved although the effect estimate was imprecise. Associations of NDI with a number of mature oocytes retrieved and OSI were in a similar direction. We observed evidence for effect modification of the NDI and OSI association by donor race. There was a suggestive positive association between NDI and OSI in Black donors but no association in White donors. CONCLUSION In this cohort of young, healthy, racially diverse oocyte donors, we found little evidence of associations between NDI and markers of ovarian reserve or outcomes of ovarian stimulation.
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Affiliation(s)
- Tanvi Suresh
- Department of Epidemiology, Emory University Rollins School of Public Heath, Atlanta, Georgia
| | - Sarah LaPointe
- Department of Epidemiology, Emory University Rollins School of Public Heath, Atlanta, Georgia
| | - Jaqueline C Lee
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Zsolt P Nagy
- Reproductive Biology Associates, Sandy Springs, Georgia
| | | | - Michael R Kramer
- Department of Epidemiology, Emory University Rollins School of Public Heath, Atlanta, Georgia
| | - Heather S Hipp
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Audrey J Gaskins
- Department of Epidemiology, Emory University Rollins School of Public Heath, Atlanta, Georgia.
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Barber LE, Maliniak ML, Nash R, Moubadder L, Haynes D, Ward KC, McCullough LE. A Comparison of Three Area-Level Indices of Neighborhood Deprivation and Socioeconomic Status and their Applicability to Breast Cancer Mortality. J Urban Health 2024; 101:75-79. [PMID: 38158547 PMCID: PMC10897108 DOI: 10.1007/s11524-023-00811-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 01/03/2024]
Abstract
Neighborhood deprivation indices are widely used in research, but the performance of these indices has rarely been directly compared in the same analysis. We examined the Area Deprivation Index, Neighborhood Deprivation Index, and Yost index, and compared their associations with breast cancer mortality. Indices were constructed for Georgia census block groups using 2011-2015 American Community Survey data. Pearson correlation coefficients and percent agreement were calculated. Associations between each index and breast cancer mortality were estimated among 36,795 women diagnosed with breast cancer using Cox proportional hazards regression. The indices were strongly correlated (absolute value of correlation coefficients > 0.77), exhibited moderate (41.4%) agreement, and were similarly associated with a 36% increase in breast cancer mortality. The similar associations with breast cancer mortality suggest the indices measure the same underlying construct, despite only moderate agreement. By understanding their correlations, agreement, and associations with health outcomes, researchers can choose the most appropriate index for analysis.
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Affiliation(s)
- Lauren E Barber
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA.
| | - Maret L Maliniak
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - Rebecca Nash
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - Leah Moubadder
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - David Haynes
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | - Kevin C Ward
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - Lauren E McCullough
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
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Ren W, Liang Z. Neighborhood deprivation and depressive symptoms in Chinese adolescents: Mediated by parenting styles and moderated by relative family status. J Affect Disord 2023; 341:17-25. [PMID: 37633523 DOI: 10.1016/j.jad.2023.08.109] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Previous research has shown that neighborhood and family have a crucial impact on adolescent mental health. However, limited research has been conducted on the intersection between neighborhood and family and the mechanisms behind its influence. This study investigates the direct and indirect associations between neighborhood deprivation and adolescent depressive symptoms through parental responsiveness and demandingness. The heterogeneity of neighborhood effects, varying across different relative family statuses, is also discussed. METHODS Using a sample (n = 6775) from the two waves of the China Education Panel Survey, this study used moderated mediation analysis to analyze simultaneously the mediation roles of parental responsiveness and demandingness and the moderating effect of relative family status. RESULTS Neighborhood deprivation (W1) was positively associated with adolescent depressive symptoms (W2). Parental responsiveness (W2) rather than demandingness (W2) partially mediated the relationship between neighborhood deprivation and adolescent depression. Additionally, relative family status moderated the direct relationship between neighborhood deprivation and depression and the indirect relationship through parental responsiveness. LIMITATIONS First, Neighborhood deprivation in this study was self-reported. Second, relative family status was a single-item measure. Third, only family and neighborhood environments were discussed in this study. Finally, long-term changes in the mental health of adolescents in poor neighborhoods could not be captured in this study. CONCLUSIONS The results highlight that neighborhood deprivation and relative family status can influence adolescent mental health individually and intersectively. This study also contributes to a more nuanced understanding of parenting styles in the Chinese context.
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Affiliation(s)
- Wanting Ren
- Department of Sociology, School of Humanities, Southeast University, Nanjing 211189, China; National Experiment Base for Intelligent Social Governance on Education, Southeast University, Nanjing 211189, China
| | - Zurong Liang
- Department of Sociology, Zhejiang University, Hangzhou 310058, China.
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Roy AM, George A, Attwood K, Alaklabi S, Patel A, Omilian AR, Yao S, Gandhi S. Effect of neighborhood deprivation index on breast cancer survival in the United States. Breast Cancer Res Treat 2023; 202:139-153. [PMID: 37542631 PMCID: PMC10504126 DOI: 10.1007/s10549-023-07053-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/14/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE To analyze the association between the Neighborhood Deprivation Index (NDI) and clinical outcomes of locoregional breast cancer (BC). METHODS Surveillance, Epidemiology and End Results (SEER) database is queried to evaluate overall survival (OS) and disease-specific survival (DSS) of early- stage BC patients diagnosed between 2010 and 2016. Cox multivariate regression was performed to measure the association between NDI (Quintiles corresponding to most deprivation (Q1), above average deprivation (Q2), average deprivation (Q3), below average deprivation (Q4), least deprivation (Q5)) and OS/DSS. RESULTS Of the 88,572 locoregional BC patients, 27.4% (n = 24,307) were in the Q1 quintile, 26.5% (n = 23,447) were in the Q3 quintile, 17% (n = 15,035) were in the Q2 quintile, 13.5% (n = 11,945) were in the Q4 quintile, and 15.6% (n = 13,838) were in the Q5 quintile. There was a predominance of racial minorities in the Q1 and Q2 quintiles with Black women being 13-15% and Hispanic women being 15% compared to only 8% Black women and 6% Hispanic women in the Q5 quintile (p < 0.001). In multivariate analysis, in the overall cohort, those who live in Q2 and Q1 quintile have inferior OS and DSS compared to those who live in Q5 quintile (OS:- Q2: Hazard Ratio (HR) 1.28, Q1: HR 1.2; DSS:- Q2: HR 1.33, Q1: HR 1.25, all p < 0.001). CONCLUSION Locoregional BC patients from areas with worse NDI have poor OS and DSS. Investments to improve the socioeconomic status of areas with high deprivation may help to reduce healthcare disparities and improve breast cancer outcomes.
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Affiliation(s)
- Arya Mariam Roy
- Division of Hematology and Oncology, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263 USA
| | - Anthony George
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14228 USA
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14228 USA
| | - Sabah Alaklabi
- Division of Oncology, Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Archit Patel
- Division of Hematology and Oncology, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263 USA
| | - Angela R. Omilian
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14228 USA
| | - Song Yao
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14228 USA
| | - Shipra Gandhi
- Division of Hematology and Oncology, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263 USA
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Boyle J, Ward MH, Cerhan JR, Rothman N, Wheeler DC. Modeling historic neighborhood deprivation and non-Hodgkin lymphoma risk. Environ Res 2023; 232:116361. [PMID: 37295583 PMCID: PMC10526976 DOI: 10.1016/j.envres.2023.116361] [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: 03/22/2023] [Revised: 05/22/2023] [Accepted: 06/07/2023] [Indexed: 06/12/2023]
Abstract
Many studies have identified associations between neighborhood deprivation and disease, emphasizing the importance of social determinants of health. However, when studying diseases with long latency periods such as cancers, considering the timing of exposures for deprivation becomes more important. In this study, we estimated the associations between neighborhood deprivation indices at several time points and risk of non-Hodgkin lymphoma (NHL) in a population-based case-control study at four study centers - Detroit, Iowa, Los Angeles County, and Seattle (1998-2000). We used the Bayesian index regression model and residential histories to estimate neighborhood deprivation index effects in crude models and adjusted for four chemical mixtures measured in house dust and individual-level covariates. We found that neighborhood deprivation in 1980, approximately twenty years before study entry, provided better model fit than did neighborhood deprivation at 1990 and 2000. We identified several statistically significant associations between neighborhood deprivation in 1980 and NHL risk in Iowa and among long-term (20+ years) residents of Detroit. The most important variables in these indices were median gross rent as a percentage of household income in Iowa and percent of single-parent households with at least one child and median household income in Detroit. Associations remained statistically significant after adjustment for individual-level covariates and chemical mixtures, providing evidence for historic neighborhood deprivation as a risk factor for NHL and motivating future research to uncover the specific carcinogens driving these associations in deprived areas.
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Affiliation(s)
- Joseph Boyle
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA.
| | - Mary H Ward
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - James R Cerhan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Nathaniel Rothman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - David C Wheeler
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
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Jackson P, Spector AL, Strath LJ, Antoine LH, Li P, Goodin BR, Hidalgo BA, Kempf MC, Gonzalez CE, Jones AC, Foster TC, Peterson JA, Quinn T, Huo Z, Fillingim R, Cruz-Almeida Y, Aroke EN. Epigenetic age acceleration mediates the relationship between neighborhood deprivation and pain severity in adults with or at risk for knee osteoarthritis pain. Soc Sci Med 2023; 331:116088. [PMID: 37473540 PMCID: PMC10407756 DOI: 10.1016/j.socscimed.2023.116088] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 04/06/2023] [Revised: 06/08/2023] [Accepted: 07/08/2023] [Indexed: 07/22/2023]
Abstract
An estimated 250 million people worldwide suffer from knee osteoarthritis (KOA), with older adults having greater risk. Like other age-related diseases, residents of high-deprivation neighborhoods experience worse KOA pain outcomes compared to their more affluent neighbors. The purpose of this study was to examine the relationship between neighborhood deprivation and pain severity in KOA and the influence of epigenetic age acceleration (EpAA) on that relationship. The sample of 128 participants was mostly female (60.9%), approximately half non-Hispanic Black (49.2%), and had a mean age of 58 years. Spearman bivariate correlations revealed that pain severity positively correlated with EpAA (ρ = 0.47, p ≤ 0.001) and neighborhood deprivation (ρ = 0.25, p = 0.004). We found a positive significant relationship between neighborhood deprivation and EpAA (ρ = 0.47, p ≤ 0.001). Results indicate a mediating relationship between neighborhood deprivation (predictor), EpAA (mediator), and pain severity (outcome variable). There was a significant indirect effect of neighborhood deprivation on pain severity through EpAA, as the mediator accounted for a moderate portion of the total effect, PM = 0.44. Epigenetic age acceleration may act as a mechanism through which neighborhood deprivation leads to worse KOA pain outcomes and may play a role in the well-documented relationship between the neighborhood of residence and age-related diseases.
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Affiliation(s)
- Pamela Jackson
- School of Public Health, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
| | - Antoinette L Spector
- School of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI, 53201, USA; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.
| | - Larissa J Strath
- Department of Community Dentistry and Behavioral Science, University of Florida, 1329 16th Street Southwest, Gainesville, FL, 32608, USA; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.
| | - Lisa H Antoine
- Department of Psychology, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
| | - Peng Li
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
| | - Burel R Goodin
- Washington University Pain Center, Department of Anesthesiology, Washington University School of Medicine in St. Louis, USA.
| | - Bertha A Hidalgo
- School of Public Health, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
| | - Mirjam-Colette Kempf
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
| | - Cesar E Gonzalez
- Department of Psychology, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
| | - Alana C Jones
- School of Public Health, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
| | - Thomas C Foster
- Department of Neuroscience, University of Florida, 1149 Newell Dr, Gainesville, FL, 32610, USA.
| | - Jessica A Peterson
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.
| | - Tammie Quinn
- Department of Psychology, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
| | - Zhiguang Huo
- Department of Biostatistics, University of Florida, 2004 Mowry Road, Gainesville, FL, 32603, USA.
| | - Roger Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, 1329 16th Street Southwest, Gainesville, FL, 32608, USA; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.
| | - Yenisel Cruz-Almeida
- Department of Community Dentistry and Behavioral Science, University of Florida, 1329 16th Street Southwest, Gainesville, FL, 32608, USA; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA; Department of Neuroscience, University of Florida, 1149 Newell Dr, Gainesville, FL, 32610, USA.
| | - Edwin N Aroke
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
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Lusk JB, Blass B, Mahoney H, Hoffman MN, Clark AG, Bae J, Ashana DC, Cox CE, Hammill BG. Neighborhood socioeconomic deprivation, healthcare access, and 30-day mortality and readmission after sepsis or critical illness: findings from a nationwide study. Crit Care 2023; 27:287. [PMID: 37454127 PMCID: PMC10349422 DOI: 10.1186/s13054-023-04565-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/05/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND To determine if neighborhood socioeconomic deprivation independently predicts 30-day mortality and readmission for patients with sepsis or critical illness after adjusting for individual poverty, demographics, comorbidity burden, access to healthcare, and characteristics of treating healthcare facilities. METHODS We performed a nationwide study of United States Medicare beneficiaries from 2017 to 2019. We identified hospitalized patients with severe sepsis and patients requiring prolonged mechanical ventilation, tracheostomy, or extracorporeal membrane oxygenation (ECMO) through Diagnosis Related Groups (DRGs). We estimated the association between neighborhood socioeconomic deprivation, measured by the Area Deprivation Index (ADI), and 30-day mortality and unplanned readmission using logistic regression models with restricted cubic splines. We sequentially adjusted for demographics, individual poverty, and medical comorbidities, access to healthcare services; and characteristics of treating healthcare facilities. RESULTS A total of 1,526,405 admissions were included in the mortality analysis and 1,354,548 were included in the readmission analysis. After full adjustment, 30-day mortality for patients was higher for those from most-deprived neighborhoods (ADI 100) compared to least deprived neighborhoods (ADI 1) for patients with severe sepsis (OR 1.35 95% [CI 1.29-1.42]) or with prolonged mechanical ventilation with or without sepsis (OR 1.42 [95% CI 1.31, 1.54]). This association was linear and dose dependent. However, neighborhood socioeconomic deprivation was not associated with 30-day unplanned readmission for patients with severe sepsis and was inversely associated with readmission for patients requiring prolonged mechanical ventilation with or without sepsis. CONCLUSIONS A strong association between neighborhood socioeconomic deprivation and 30-day mortality for critically ill patients is not explained by differences in individual poverty, demographics, measured baseline medical risk, access to healthcare resources, or characteristics of treating hospitals.
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Affiliation(s)
- Jay B Lusk
- Duke University School of Medicine, Durham, NC, USA
- Duke University Fuqua School of Business, Durham, NC, USA
| | - Beau Blass
- Duke University School of Medicine, Durham, NC, USA
| | - Hannah Mahoney
- Duke University Department of Population Health Sciences, 215 Morris St, Durham, NC, 27701, USA
| | - Molly N Hoffman
- Duke University Department of Population Health Sciences, 215 Morris St, Durham, NC, 27701, USA
| | - Amy G Clark
- Duke University Department of Population Health Sciences, 215 Morris St, Durham, NC, 27701, USA
| | - Jonathan Bae
- Duke University Health System, Durham, NC, USA
- Duke University Department of Medicine, Durham, NC, USA
| | | | | | - Bradley G Hammill
- Duke University School of Medicine, Durham, NC, USA.
- Duke University Department of Population Health Sciences, 215 Morris St, Durham, NC, 27701, USA.
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11
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Nyarko SH, Luo L, Schlundt DG, Xiao Q. Cross-sectional association between neighborhood socioeconomic status and sleep duration among Black and white men and women: The Southern Community Cohort Study. Sleep Health 2023; 9:277-282. [PMID: 37045662 PMCID: PMC10837766 DOI: 10.1016/j.sleh.2023.01.016] [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: 04/07/2022] [Revised: 12/19/2022] [Accepted: 01/30/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE To examine the association of neighborhood socioeconomic status (SES) with sleep duration among a large cohort of Black and white men and women in the United States. METHODS We used data from the Southern Community Cohort Study (SCCS, N = 75,248). Neighborhood SES was based on census data and sleep duration was measured by self-report. Multinomial logistic regression analysis was performed to assess the association between neighborhood SES and short (<7 hours) and long (≥9 hours) sleep in the overall sample and according to race-sex subgroups. RESULTS In the total sample, when compared with the highest quintile of neighborhood SES, the lowest quintile was associated with higher odds of both short (adjusted ORQ5 vs. Q1 [95% CI], 1.10 [1.03, 1.17]) and long sleep (1.37 [1.24, 1.52]). In race-sex specific analysis, the association between lower neighborhood SES and short sleep was only observed among white women (1.21 [1.05, 1.40]), but not in other subgroups. On the other hand, the association between lower neighborhood SES and long sleep duration was primarily observed among Black women (1.31 [1.06, 1.60]). CONCLUSIONS The association between neighborhood SES and sleep duration varied among race-and-sex subgroups. These findings provide new evidence on the importance of considering individual sociodemographic characteristics in understanding the potential effects of neighborhood socioeconomic context on sleep health.
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Affiliation(s)
- Samuel H Nyarko
- Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA.
| | - Liying Luo
- Department of Sociology and Criminology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - David G Schlundt
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Qian Xiao
- Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
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12
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Coutinho SR, Andersen OK, Lien N, Gebremariam MK. Neighborhood deprivation, built environment, and overweight in adolescents in the city of Oslo. BMC Public Health 2023; 23:812. [PMID: 37138266 PMCID: PMC10155174 DOI: 10.1186/s12889-023-15261-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/10/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Even though the social and built environment characteristics of neighborhoods have been studied as potential determinants of social inequalities in obesity among adults, fewer studies have focused on children. Our first aim was to investigate whether there were differences in the food and physical activity environments between different neighborhood deprivation levels in the city of Oslo. We also explored whether there was an association between the prevalence of overweight (including obesity) among adolescents and (i) neighborhood deprivation levels and (ii) food and physical activity environments of the neighborhoods they live in. METHODS We conducted a food and physical activity environment mapping (using ArcGIS Pro) in all neighborhoods of Oslo, which were defined by administrative boundaries (sub-districts). The neighborhood deprivation score was calculated based on the percentage of households living in poverty, unemployment in the neighborhood, and residents with low education. A cross-sectional study including 802 seventh graders from 28 primary schools in Oslo residing in 75 out of 97 sub-districts in Oslo was also performed. MANCOVA and partial correlations were ran to compare the built environment distribution between different neighborhood deprivation levels, and multilevel logistic regression analyses were used to explore the effect of neighborhood deprivation and the food and physical activity environments on childhood overweight. RESULTS We found that deprived neighborhoods had greater availability of fast food restaurants and fewer indoor recreational facilities compared to low-deprived neighborhoods. Additionally, we observed that the residential neighborhoods of the adolescents with overweight had greater availability of grocery and convenience stores when compared to the residential neighborhoods of the adolescents without overweight. Adolescents living in neighborhoods with high deprivation had a two-fold higher odds (95% CI = 1.1-3.8) to have overweight compared to adolescents living in neighborhoods with low deprivation, regardless of participants' ethnicity and parental education. However, the built environment did not determine the relationship between neighborhood deprivation and overweight in adolescents. CONCLUSION The neighborhoods in Oslo with higher deprivation levels had more obesogenic characteristics than the low-deprived neighborhoods. Adolescents living in high-deprived neighborhoods were more likely to have overweight than their counterparts from low-deprived neighborhoods. Thus, preventive measures targeting adolescents from high-deprived neighborhoods should be put in place in order to reduce incidence of overweight.
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Affiliation(s)
| | | | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
| | - Mekdes K Gebremariam
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
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13
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Tan CH, Tan JJX. Low neighborhood deprivation buffers against hippocampal neurodegeneration, white matter hyperintensities, and poorer cognition. GeroScience 2023:10.1007/s11357-023-00780-y. [PMID: 37004594 PMCID: PMC10400521 DOI: 10.1007/s11357-023-00780-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/20/2023] [Indexed: 04/04/2023] Open
Abstract
There is increasing recognition that socioeconomic inequalities contribute to disparities in brain and cognitive health in older adults. However, whether neighborhood socioeconomic status (SES) buffers individuals with low individual SES against neurodegeneration, cerebrovascular disease, and poorer cognitive function is not well understood. Here, we evaluated whether neighborhood deprivation (Townsend deprivation index) interacted with individual SES (composite household income and education levels) on hippocampus volume, regional cortical thickness, white matter hyperintensities, and cognition in 19,638 individuals (mean age = 54.8) from the UK Biobank. We found that individuals with low individual SES had the smallest hippocampal volumes, greatest white matter hyperintensity burden, and poorest cognition if they were living in high deprivation neighborhoods but that these deleterious effects on brain and cognitive function were attenuated if they were living in low deprivation neighborhoods (p for interactions < .05). While neighborhood deprivation did not interact with individual SES to influence regional cortical thickness, higher neighborhood deprivation was independently associated with lower cortical thickness in 16 regions (false discovery rate q < .05). Across multiple brain indices and cognitive function analyses, we found converging evidence suggesting that low neighborhood deprivation may have a neuroprotective effect against neurodegeneration, cerebrovascular pathology, and cognitive impairment, particularly in vulnerable individuals with low household income and education levels.
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Affiliation(s)
- Chin Hong Tan
- Department of Psychology, Nanyang Technological University, 48 Nanyang Avenue, Singapore, S639818, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, 48 Nanyang Avenue, Singapore, S639818, Singapore.
| | - Jacinth J X Tan
- School of Social Sciences, Singapore Management University, Singapore, Singapore
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14
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Zhang Y, Hu H, Fokaidis V, V CL, Xu J, Zang C, Xu Z, Wang F, Koropsak M, Bian J, Hall J, Rothman RL, Shenkman EA, Wei WQ, Weiner MG, Carton TW, Kaushal R. Identifying environmental risk factors for post-acute sequelae of SARS-CoV-2 infection: An EHR-based cohort study from the recover program. Environ Adv 2023; 11:100352. [PMID: 36785842 PMCID: PMC9907788 DOI: 10.1016/j.envadv.2023.100352] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/27/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
Post-acute sequelae of SARS-CoV-2 infection (PASC) affects a wide range of organ systems among a large proportion of patients with SARS-CoV-2 infection. Although studies have identified a broad set of patient-level risk factors for PASC, little is known about the association between "exposome"-the totality of environmental exposures and the risk of PASC. Using electronic health data of patients with COVID-19 from two large clinical research networks in New York City and Florida, we identified environmental risk factors for 23 PASC symptoms and conditions from nearly 200 exposome factors. The three domains of exposome include natural environment, built environment, and social environment. We conducted a two-phase environment-wide association study. In Phase 1, we ran a mixed effects logistic regression with 5-digit ZIP Code tabulation area (ZCTA5) random intercepts for each PASC outcome and each exposome factor, adjusting for a comprehensive set of patient-level confounders. In Phase 2, we ran a mixed effects logistic regression for each PASC outcome including all significant (false positive discovery adjusted p-value < 0.05) exposome characteristics identified from Phase I and adjusting for confounders. We identified air toxicants (e.g., methyl methacrylate), particulate matter (PM2.5) compositions (e.g., ammonium), neighborhood deprivation, and built environment (e.g., food access) that were associated with increased risk of PASC conditions related to nervous, blood, circulatory, endocrine, and other organ systems. Specific environmental risk factors for each PASC condition and symptom were different across the New York City area and Florida. Future research is warranted to extend the analyses to other regions and examine more granular exposome characteristics to inform public health efforts to help patients recover from SARS-CoV-2 infection.
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Affiliation(s)
- Yongkang Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Hui Hu
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Vasilios Fokaidis
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Colby Lewis V
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Jie Xu
- Department of Health Outcomes Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | - Chengxi Zang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Zhenxing Xu
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Fei Wang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Michael Koropsak
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Jiang Bian
- Department of Health Outcomes Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | - Jaclyn Hall
- Department of Health Outcomes Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | - Russell L Rothman
- Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Elizabeth A Shenkman
- Department of Health Outcomes Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Mark G Weiner
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Thomas W Carton
- Louisiana Public Health Institute, New Orleans, LA, United States
| | - Rainu Kaushal
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
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15
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Eom KY, Berg KA, Joseph NE, Runner K, Tarabichi Y, Khiyami A, Perzynski AT, Sossey-Alaoui K. Neighborhood and racial influences on triple negative breast cancer: evidence from Northeast Ohio. Breast Cancer Res Treat 2023; 198:369-381. [PMID: 36781520 PMCID: PMC10716786 DOI: 10.1007/s10549-023-06883-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/25/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE Triple negative breast cancer (TNBC) is an aggressive subtype of breast cancer (BC) with higher recurrence rates and poorer prognoses and most prevalent among non-Hispanic Black women. Studies of multiple health conditions and care processes suggest that neighborhood socioeconomic position is a key driver of health disparities. We examined roles of patients' neighborhood-level characteristics and race on prevalence, stage at diagnosis, and mortality among patients diagnosed with BC at a large safety-net healthcare system in Northeast Ohio. METHODS We used tumor registry to identify BC cases from 2007 to 2020 and electronic health records and American Community Survey for individual- and area-level factors. We performed multivariable regression analyses to estimate associations between neighborhood-level characteristics, measured by the Area Deprivation Index (ADI), race and comparative TNBC prevalence, stage at diagnosis, and total mortality. RESULTS TNBC was more common among non-Hispanic Black (53.7%) vs. non-Hispanic white patients (46.4%). Race and ADI were individually significant predictors of TNBC prevalence, stage at diagnosis, and total mortality. Race remained significantly associated with TNBC subtype, adjusting for covariates. Accounting for TNBC status, a more disadvantaged neighborhood was significantly associated with a worse stage at diagnosis and higher death rates. CONCLUSION Our findings suggest that both neighborhood socioeconomic position and race are strongly associated with TNBC vs. other BC subtypes. The burden of TNBC appears to be highest among Black women in the most socioeconomically disadvantaged neighborhoods. Our study suggests a complex interplay of social conditions and biological disease characteristics contributing to racial disparities in BC outcomes.
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Affiliation(s)
- Kirsten Y Eom
- Center for Health Care Research and Policy, The MetroHealth System and Case Western Reserve University, 2500 MetroHealth Dr. Rammelkamp Building R225, Cleveland, OH, 44109, USA.
| | - Kristen A Berg
- Center for Health Care Research and Policy, The MetroHealth System and Case Western Reserve University, 2500 MetroHealth Dr. Rammelkamp Building R225, Cleveland, OH, 44109, USA
| | - Natalie E Joseph
- Division of Surgical Oncology, MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | - Kristen Runner
- Division of Surgical Oncology, MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | - Yasir Tarabichi
- Division of Pulmonary, Critical Care, and Sleep Medicine, MetroHealth Medical Center of Case Western Reserve University, Cleveland, OH, USA
| | - Amer Khiyami
- Department of Pathology, MetroHealth Medical Center, Cleveland, OH, USA
| | - Adam T Perzynski
- Center for Health Care Research and Policy, The MetroHealth System and Case Western Reserve University, 2500 MetroHealth Dr. Rammelkamp Building R225, Cleveland, OH, 44109, USA
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16
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Trinidad S, Brokamp C, Sahay R, Moody S, Gardner D, Parsons AA, Riley C, Sofer N, Beck AF, Falcone RA, Kotagal M. Children from disadvantaged neighborhoods experience disproportionate injury from interpersonal violence. J Pediatr Surg 2023; 58:545-551. [PMID: 35787891 DOI: 10.1016/j.jpedsurg.2022.05.023] [Citation(s) in RCA: 2] [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] [Received: 03/18/2022] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Disparities in pediatric injury have been widely documented and are driven, in part, by differential exposures to social determinants of health (SDH). Here, we hypothesized that neighborhood socioeconomic deprivation and specific sociodemographic characteristics would be associated with interpersonal violence-related injury admission. METHODS We conducted a retrospective cohort study of all patients ≤16 years, residing in Hamilton County, admitted to our level 1 pediatric trauma center. Residential addresses were geocoded to link admissions with a census tract-level socioeconomic deprivation index. Admissions were categorized as resulting from interpersonal violence or not - based on a mechanism of injury (MOI) of abuse or assault. The percentage of interpersonal violence-related injury admissions was compared across patient demographics and neighborhood deprivation index tertiles. These factors were then evaluated with multivariable regression analysis. RESULTS Interpersonal violence accounted for 6.2% (394 of 6324) of all injury-related admissions. Interpersonal violence-related injury admission was associated with older age, male sex, Black race, public insurance, and living in tertiles of census tracts with higher socioeconomic deprivation. Those living in the most deprived tertile experienced 62.2% of all interpersonal violence-related injury admissions but only 36.9% of non-violence related injury admissions (p < 0.001). After adjustment, insurance and neighborhood deprivation accounted for much of the increase in interpersonal violence-related admissions for Black compared to White children. CONCLUSIONS Children from higher deprivation neighborhoods, who are also disproportionately Black and publicly insured, experience a higher burden of interpersonal violence-related injury admissions. Level of evidence Level III.
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Affiliation(s)
- Stephen Trinidad
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2023, Cincinnati, OH 45229, United States
| | - Cole Brokamp
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Division of Biostatistics and Epidemiology at Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Rashmi Sahay
- Division of Biostatistics and Epidemiology at Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Suzanne Moody
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2023, Cincinnati, OH 45229, United States
| | - Dawne Gardner
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2023, Cincinnati, OH 45229, United States
| | - Allison A Parsons
- Division of Critical Care, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Carley Riley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Division of Critical Care, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Nicole Sofer
- James M. Anderson Center for Health System Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Andrew F Beck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Division of General & Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Richard A Falcone
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2023, Cincinnati, OH 45229, United States; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Meera Kotagal
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2023, Cincinnati, OH 45229, United States; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
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17
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Nwana N, Taha MB, Javed Z, Gullapelli R, Nicolas JC, Jones SL, Acquah I, Khan S, Satish P, Mahajan S, Cainzos-Achirica M, Nasir K. Neighborhood deprivation and morbid obesity: Insights from the Houston Methodist Cardiovascular Disease Health System Learning Registry. Prev Med Rep 2022; 31:102100. [PMID: 36820380 PMCID: PMC9938328 DOI: 10.1016/j.pmedr.2022.102100] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022] Open
Abstract
This study examined the relationship between a validated measure of socioeconomic deprivation, such as the Area Deprivation Index (ADI), and morbid obesity. We used cross-sectional data on adult patients (≥18 years) in the Houston Methodist Cardiovascular Disease Health System Learning Registry (located in Houston, Texas, USA) between June 2016 and July 2021. Each patient was grouped by quintiles of ADI, with higher quintiles signaling greater deprivation. BMI was calculated using measured height and weight with morbid obesity defined as ≥ 40 kg/m2. Multivariable logistic regression models were used to examine the association between ADI and morbid obesity adjusting for demographic (age, sex, and race/ethnicity) factors. Out of the 751,174 adults with an ADI ranking included in the analysis, 6.9 % had morbid obesity (n = 51,609). Patients in the highest ADI quintile had a higher age-adjusted prevalence (10.9 % vs 3.3 %), and about 4-fold odds (aOR, 3.8; 95 % CI = 3.6, 3.9) of morbid obesity compared to the lowest ADI quintile. We tested for and found interaction effects between ADI and each demographic factor, with stronger ADI-morbid obesity association observed for patients that were female, Hispanic, non-Hispanic White and 40-65 years old. The highest ADI quintile also had a high prevalence (44 %) of any obesity (aOR, 2.2; 95 % CI = 2.1, 2.2). In geospatial mapping, areas with higher ADI were more likely to have higher proportion of patients with morbid obesity. Census-based measures, like the ADI, may be informative for area-level obesity reduction strategies as it can help identify neighborhoods at high odds of having patients with morbid obesity.
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Key Words
- ADI, Area Deprivation Index
- BMI, Body Mass Index
- CA, Catchment Area
- CI, Confidence Interval
- CVD, Cardiovascular Diseases
- Data-driven
- ED, Emergency Department
- FIPS, Federal Information Processing Standards
- HM, Houston Methodist
- Health equity
- IRB, Internal Review Board
- Morbid obesity
- Neighborhood deprivation
- OR, Odds Ratio
- SD, Standard Deviation
- SDOH, Social Determinants of Health
- SES, Socio-Economic Status
- US, United States
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Affiliation(s)
- Nwabunie Nwana
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
| | - Mohamad B. Taha
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Zulqarnain Javed
- Division of Health Disparities and Equity Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Rakesh Gullapelli
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
| | - Juan C. Nicolas
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
| | - Stephen L. Jones
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
| | - Isaac Acquah
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
| | - Safi Khan
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Priyanka Satish
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA,Division of Health Disparities and Equity Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Shivani Mahajan
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA,Division of Health Disparities and Equity Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Miguel Cainzos-Achirica
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Khurram Nasir
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA,Corresponding author at: Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, Houston, TX 77030, USA.
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18
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Phillips AR, Andraska EA, Reitz KM, Habib S, Martinez-Meehan D, Dai Y, Johnson AE, Liang NL. Association between neighborhood deprivation and presenting with a ruptured abdominal aortic aneurysm before screening age. J Vasc Surg 2022; 76:932-941.e2. [PMID: 35314299 PMCID: PMC9482667 DOI: 10.1016/j.jvs.2022.03.009] [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: 11/01/2021] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Recent data indicate social determinants of health (SDOH) have a great impact on prevention and treatment outcomes across a broad variety of disease states, especially cardiovascular diseases. The area deprivation index (ADI) is a validated measure of neighborhood level disadvantage capturing key social determinate factors. Abdominal aortic aneurysm rupture (rAAA) is highly morbid, but also preventable through evidence-based screening. However, the association between rAAA and SDOH is poorly characterized. Our objective is to study the association of SDOH with rAAA and screening age. METHODS This retrospective study included patients who underwent operative repair of a rAAA at a multihospital healthcare system (2003-2019). Deprivation was measured by the ADI (scale 1-100), grouped into quintiles for simplicity, with higher quintiles indicating greater deprivation. Patients with the highest quintile ADI (89-100) were categorized as the most deprived. We investigated the association between neighborhood deprivation with the odds of (i) undergoing repair for rAAA before screening age 65 and (ii) undergoing endovascular aortic repair (EVAR) using logistic regression, sequentially modeling nonmodifiable then both nonmodifiable and modifiable confounding variables. RESULTS There were 632 patients who met the inclusion criteria (aged 74.2 ± 9.4 years; 174 women [27.6%]; 564 White [89.2%]; ADI 66.8 ± 22.3). Those from the most deprived neighborhoods (n = 118) were younger (71.7 ± 10.0 years vs 74.8 ± 9.2 years; P = .002), more likely to be female (36% vs 26%; P = .031), more likely to be Black (5.9% vs 0.4%; P = .007), and fewer underwent EVAR (28% vs 39.5%; P = .020) compared with those from other neighborhoods. On sequential modeling, residing in the most deprived neighborhoods was associated with undergoing rAAA repair before age 65 after adjusting for nonmodifiable factors (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.39-2.95; P < .001), and nonmodifiable as well as modifiable factors (OR, 2.22; 95% CI, 1.56-3.16; P < .001). Those in the most deprived neighborhoods had a lower odds of undergoing EVAR compared with open repair after adjusting for nonmodifiable factors (OR, 0.64; 95% CI, 0.41-0.98; P = .042), and nonmodifiable as well as modifiable factors (OR, 0.61; 95% CI, 0.37-0.99; P = .047). CONCLUSIONS Among patients who underwent rAAA, residing in the most deprived neighborhoods was associated with greater adjusted odds of presenting under age 65 and undergoing an open repair. These neighborhoods represent tangible geographic targets that may benefit from a younger screening age, enhanced education, and access to care. These findings stress the importance of developing strategies for early prevention and diagnosis of cardiovascular diseases among patients with disadvantageous SDOH.
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Affiliation(s)
- Amanda R Phillips
- Department of Surgery, Division of Vascular Surgery, UPMC, Pittsburgh, PA.
| | | | - Katherine M Reitz
- Department of Surgery, Division of Vascular Surgery, UPMC, Pittsburgh, PA
| | - Salim Habib
- Department of Surgery, Division of Vascular Surgery, UPMC, Pittsburgh, PA
| | | | - Yancheng Dai
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Amber E Johnson
- Department of Medicine, Division of Cardiology, UPMC, Pittsburgh, PA
| | - Nathan L Liang
- Department of Surgery, Division of Vascular Surgery, UPMC, Pittsburgh, PA; University of Pittsburgh School of Medicine, Pittsburgh, PA
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Li Z, Christensen GM, Lah JJ, Marcus M, Russell AG, Ebelt S, Waller LA, Hüls A. Neighborhood characteristics as confounders and effect modifiers for the association between air pollution exposure and subjective cognitive functioning. Environ Res 2022; 212:113221. [PMID: 35378125 PMCID: PMC9233127 DOI: 10.1016/j.envres.2022.113221] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 05/25/2023]
Abstract
BACKGROUND Air pollution has been associated with cognitive function in the elderly. Previous studies have not evaluated the simultaneous effect of neighborhood-level socioeconomic status (N-SES), which can be an essential source of bias. OBJECTIVES We explored N-SES as a confounder and effect modifier in a cross-sectional study of air pollution and subjective cognitive function. METHODS We included 12,058 participants age 50+ years from the Emory Healthy Aging Study in Metro Atlanta using the Cognitive Function Instrument (CFI) score as our outcome, with higher scores representing worse subjective cognitive function. We estimated 9-year average ambient carbon monoxide (CO), nitrogen oxides (NOx), and fine particulate matter (PM2.5) concentrations at residential addresses using a fusion of dispersion and chemical transport models. We collected census-tract level N-SES indicators and created two composite measures via principal component analysis and k-means clustering. Associations between pollutants and CFI and effect modification by N-SES were estimated via linear regression models adjusted for age, education, race and N-SES. RESULTS N-SES confounded the association between air pollution and CFI, independent of individual characteristics. We found significant effect modifications by N-SES for the association between air pollution and CFI (p-values<0.001) suggesting that effects of air pollution differ depending on N-SES. Participants living in areas with low N-SES were most vulnerable to air pollution. In the lowest N-SES urban areas, interquartile range (IQR) increases in CO, NOx, and PM2.5 were associated with 5.4% (95%-confidence interval, -0.2,11.3), 4.9% (-0.4,10.4), and 9.8% (2.2,18.0) changes in CFI, respectively. In lowest N-SES suburban areas, IQR increases in CO, NOx, and PM2.5 were associated with higher changes in CFI, namely 13.0% (0.9,26.5), 13.0% (-0.1,27.8), and 17.3% (2.5,34.2), respectively. DISCUSSION N-SES is an important confounder and effect modifier in our study. This finding could have implications for studying health effects of air pollution and identifying susceptible populations.
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Affiliation(s)
- Zhenjiang Li
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Grace M Christensen
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - James J Lah
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Michele Marcus
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Armistead G Russell
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Stefanie Ebelt
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lance A Waller
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anke Hüls
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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20
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Herb J, Dunham L, Stitzenberg K. A Comparison of Area-Level Socioeconomic Status Indices in Colorectal Cancer Care. J Surg Res 2022; 280:304-311. [PMID: 36030606 DOI: 10.1016/j.jss.2022.07.036] [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] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/10/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There are multiple measures of area socioeconomic status (SES) and there is little evidence on the comparative performance of these measures. We hypothesized adding area SES measures improves model ability to predict guideline concordant care and overall survival compared to models with standard clinical and demographic data alone. MATERIALS AND METHODS We included patients with colorectal cancer from 2006 to 2015 from the North Carolina Cancer Registry merged with insurance claims data. The primary area SES study variables were the Social Deprivation Index, Distressed Communities Index, Area Deprivation Index, and Social Vulnerability Index. We used multivariable logistic modeling and Cox proportional hazards modeling to assess the adjusted association of each indicator, with guideline concordant care and overall survival, respectively. Model performance of the SES measures was compared to a base model using likelihood ratio testing and area under the curve (AUC) assessments to compare SES indicator models with each other. RESULTS We found that the Area Deprivation Index, Social Vulnerability Index and Social Deprivation Index, but not Distressed Communities Index, were significantly associated with receiving guideline concordant care and significantly improved model fit over the base model on likelihood ratio testing. All models had similar AUCs. With respect to overall survival, we found that all indices were independently and significantly associated with survival and had significantly improved model fit over the base model on likelihood ratio testing. AUC analysis again showed all area SES measures had comparable performance for overall survival at 5 y. CONCLUSIONS This analysis demonstrates the importance of including these measures in risk adjustment models. However, of the commonly available measures, no one measure stood out as superior to others.
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Affiliation(s)
- Joshua Herb
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Lisette Dunham
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Karyn Stitzenberg
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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21
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Bonner SN, Kunnath N, Dimick JB, Ibrahim AM. Neighborhood deprivation and Medicare expenditures for common surgical procedures. Am J Surg 2022; 224:1274-1279. [PMID: 35750504 DOI: 10.1016/j.amjsurg.2022.06.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The Center of Medicare and Medicaid Services valued based payments for inpatient surgical hospitalizations are adjusted for clinical but not social risk factors. While research has shown that social risk is associated with worse surgical patient outcomes, it is unknown if inpatient surgical episode Medicare payments are affected by social risk factors. METHODS Retrospective review of Medicare beneficiaries, age 65-99, undergoing appendectomy, colectomy, hernia repair, or cholecystectomy between 2014 and 2018. Neighborhood deprivation measured by Area Deprivation Index for beneficiary census tract. We evaluated Medicare payments for a total episode of surgical care comprised of index hospitalization, physician fees, post-acute care, and readmission by beneficiary neighborhood deprivation. RESULTS A total of 809,059 patients (Women, 56.0%) and mean (SD) age of 75.7 (7.4 years were included. A total of 145,351 beneficiaries lived in the least deprived neighborhoods and 134,188 who lived in the most deprived neighborhoods. Total surgical episode spending was $2654 higher among beneficiaries from the most deprived neighborhoods compared to those from the least after risk adjustment for clinical and hospital factors. These differences were driven in part by higher rates of readmissions (12.9% vs 10.8%, P < 0.001) and post-acute care (67.8% vs. 61.2%, P < 0.001) among beneficiaries living in the most deprived neighborhoods. CONCLUSION These findings suggest that value-based payment models with inclusion of social risk adjustment may be needed for surgical cohorts. Moreover, efforts focused on investing in deprived communities may be aligned with surgical quality improvement.
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Affiliation(s)
- Sidra N Bonner
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA; National Clinician Scholars Program, University of Michigan, Ann Arbor, MI, USA.
| | - Nicholas Kunnath
- Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Justin B Dimick
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Andrew M Ibrahim
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
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22
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Rassu FS, McFadden M, Aaron RV, Wegener ST, Ephraim PL, Lane E, Brennan G, Minick KI, Fritz JM, Skolasky RL. The Relationship between Neighborhood Deprivation and Perceived Changes for Pain-Related Experiences among U.S. Patients with Chronic Low Back Pain during the COVID-19 Pandemic. Pain Med 2021; 22:2550-2565. [PMID: 34181008 DOI: 10.1093/pm/pnab179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Disruptions caused by the COVID-19 pandemic could disproportionately affect the health of vulnerable populations, including patients experiencing persistent health conditions (i.e., chronic pain), along with populations living within deprived, lower socioeconomic areas. The current cross-sectional study characterized relationships between neighborhood deprivation and perceived changes in pain-related experiences during the COVID-19 pandemic (early-September to mid-October 2020) for adult patients (N = 97) with nonspecific chronic low back pain. METHODS We collected self-report perceived experiences from participants enrolled in an ongoing pragmatic randomized trial across medical centers within the Salt Lake City, Utah and Baltimore, Maryland metropolitans. The Area Deprivation Index (composite of 17 U.S. Census deprivation metrics) reflected neighborhood deprivation based on participants' zip codes. RESULTS Although those living in the neighborhoods with greater deprivation endorsed significantly poorer physical (pain severity, pain interference, physical functioning), mental (depression, anxiety), and social health during the pandemic, there were no significant differences for perceived changes in pain-related experiences (pain severity, pain interference, sleep quality) between levels of neighborhood deprivation since the onset of the pandemic. However, those in neighborhoods with greater deprivation endorsed disproportionately worse perceived changes in pain coping, social support, and mood since the pandemic. CONCLUSIONS The current findings offer evidence that changes in pain coping during the pandemic may be disproportionately worse for those living in deprived areas. Considering poorer pain coping may contribute to long-term consequences, the current findings suggest the need for further attention and intervention to reduce the negative affect of the pandemic for such vulnerable populations.
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Affiliation(s)
- Fenan S Rassu
- Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Molly McFadden
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Rachel V Aaron
- Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Patti L Ephraim
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth Lane
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Gerard Brennan
- Rehabilitation Services, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Kate I Minick
- Rehabilitation Services, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Julie M Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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23
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Wheeler DC, Boyle J, Raman S, Nelson EJ. Modeling elevated blood lead level risk across the United States. Sci Total Environ 2021; 769:145237. [PMID: 33493912 DOI: 10.1016/j.scitotenv.2021.145237] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/17/2020] [Accepted: 01/13/2021] [Indexed: 06/12/2023]
Abstract
Lead exposure adversely affects child health and continues to be a major public health concern in the United States (US). Lead exposure risk has been linked with older housing and households in poverty, but more studies of neighborhood socioeconomic status (SES) and lead exposure risk over large and diverse geographic areas are needed. In this paper, we combined lead test result data over many states for a majority of the US ZIP Codes in order to estimate its association with many SES variables and predict lead exposure risk in all populated ZIP Codes in the US. The methods used for estimation and prediction of lead risk included the Vox lead exposure risk score, random forest, weighted quantile sum (WQS) regression, and a Bayesian SES index model. The results showed that the Bayesian index model had the best overall performance for modeling elevated blood lead level (EBLL) risk and therefore was used to create a lead exposure risk score for US ZIP Codes. There was a statistically significant association between EBLL risk and the SES index and the most important SES variables for explaining EBLL risk were percentage of houses built before 1940 and median home value. When mapping the lead exposure risk scores, there was a clear pattern of elevated risk in the Northeast and Midwest, but areas in the South and Southwest regions of the US also had high risk. In summary, the Bayesian index model was an effective method for modeling EBLL risk associated with neighborhood deprivation while accounting for additional heterogeneity in risk using lead test result data covering a majority of the US. The resulting lead exposure risk score can be used for targeting public health intervention efforts.
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Affiliation(s)
- David C Wheeler
- Virginia Commonwealth University, Department of Biostatistics, One Capitol Square, Seventh Floor, 830 East Main Street, Richmond, VA 23219, USA.
| | - Joseph Boyle
- Virginia Commonwealth University, Department of Biostatistics, One Capitol Square, Seventh Floor, 830 East Main Street, Richmond, VA 23219, USA
| | - Shyam Raman
- Cornell University, Department of Policy Analysis & Management, Martha Van Rensselaer Hall, Ithaca, NY 14850, USA
| | - Erik J Nelson
- Indiana University, Department of Epidemiology and Biostatistics, 1025 East 7th Street, Bloomington, IN 47405, USA
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Oluyomi A, Aldrich KD, Foster KL, Badr H, Kamdar KY, Scheurer ME, Lupo PJ, Brown AL. Neighborhood deprivation index is associated with weight status among long-term survivors of childhood acute lymphoblastic leukemia. J Cancer Surviv 2020; 15:767-775. [PMID: 33226568 DOI: 10.1007/s11764-020-00968-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/21/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Area deprivation index (ADI), a measure of neighborhood socioeconomic disadvantage, has been linked to metabolic outcomes in the general population but has received limited attention in survivors of childhood acute lymphoblastic leukemia (ALL), a population with high rates of overweight and obesity. METHODS We retrospectively reviewed heights and weights of ≥ 5 year survivors of pediatric ALL (diagnosed 1990-2013). Residential addresses were geocoded using ArcGIS to assign quartiles of ADI, a composite of 17 measures of poverty, housing, employment, and education, with higher quartiles reflecting greater deprivation. Odds ratios (OR) and 95% confidence intervals (CI) for the association between ADI quartiles and overweight/obesity or obesity alone were calculated with logistic regression. RESULTS On average, participants (n = 454, 50.4% male, 45.2% Hispanic) were age 5.5 years at diagnosis and 17.4 years at follow-up. At follow-up, 26.4% were overweight and 24.4% obese. Compared to the lowest ADI quartile, survivors in the highest quartile were more likely to be overweight/obese at follow-up (OR = 2.33, 95% CI: 1.23-4.44) after adjusting for race/ethnicity, sex, age at diagnosis, and age at follow-up. The highest ADI quartile remained significantly associated with obesity (OR = 5.28, 95% CI: 1.79-15.54) after accounting for weight status at diagnosis. CONCLUSIONS This study provides novel insights into possible social determinants of health inequalities among survivors of childhood ALL by reporting a significant association between neighborhood deprivation and overweight/obesity. IMPLICATIONS FOR CANCER SURVIVORS Survivors of childhood ALL residing in neighborhood with greater socioeconomic disadvantage may be at increased risk of overweight and obesity and candidates for targeted interventions.
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Affiliation(s)
- Abiodun Oluyomi
- Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, MS BCM307, Houston, TX, 77030, USA.
| | - K Danielle Aldrich
- Section of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, MS BCM622, Houston, TX, 77030, USA
| | - Kayla L Foster
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Hoda Badr
- Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, MS BCM307, Houston, TX, 77030, USA
| | - Kala Y Kamdar
- Section of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, MS BCM622, Houston, TX, 77030, USA
| | - Michael E Scheurer
- Section of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, MS BCM622, Houston, TX, 77030, USA
| | - Philip J Lupo
- Section of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, MS BCM622, Houston, TX, 77030, USA
| | - Austin L Brown
- Section of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, MS BCM622, Houston, TX, 77030, USA.
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Vargas T, Damme KSF, Mittal VA. Neighborhood deprivation, prefrontal morphology and neurocognition in late childhood to early adolescence. Neuroimage 2020; 220:117086. [PMID: 32593800 PMCID: PMC7572635 DOI: 10.1016/j.neuroimage.2020.117086] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [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: 04/21/2020] [Revised: 06/14/2020] [Accepted: 06/21/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Neighborhood deprivation adversely effects neurodevelopment and cognitive function; however, mechanisms remain unexplored. Neighborhood deprivation could be particularly impactful in late childhood/early adolescence, in neural regions with protracted developmental trajectories, e.g., prefrontal cortex (PFC). Methods: The Adolescent Brain Cognitive Development (ABCD) study recruited 10,205 youth. Geocoded residential history was used to extract individual neighborhood characteristics. A general cognitive ability index and MRI scans were completed. Associations with neurocognition were examined. The relation of PFC surface area and cortical thickness to neighborhood deprivation was tested. PFC subregions and asymmetry, with putative differential environmental susceptibility during key developmental periods, were explored. Analyses tested PFC area as a possible mediating mechanism. Results: Neighborhood deprivation predicted neurocognitive performance (β = −0.11), even after accounting for parental education and household income (β = −0.07). Higher neighborhood deprivation related to greater overall PFC surface area (η2p = 0.003), and differences in leftward asymmetry were observed for area (η2p = 0.001), and thickness (η2p = 0.003). Subregion analyses highlighted differences among critical areas that are actively developing in late childhood/early adolescence and are essential to modulating high order cognitive function. These included orbitofrontal, superior frontal, rostral middle frontal, and frontal pole regions (Cohen’s d = 0.03–0.09). PFC surface area partially mediated the relation between neighborhood deprivation and neurocognition. Discussion: Neighborhood deprivation related to cognitive function (a foundational skill tied to a range of lifetime outcomes) and PFC morphology, with evidence found for partial mediation of PFC on neurocognitive function. Results inform public health conceptualizations of development and environmental vulnerability.
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Affiliation(s)
- Teresa Vargas
- Northwestern University Department of Psychology, United States.
| | | | - Vijay A Mittal
- Northwestern University Department of Psychology, Northwestern University Department of Psychiatry, Northwestern University Department of Medical Social Sciences, Northwestern University Institute for Innovations in Developmental Sciences, Northwestern University Institute for Policy Research, United States
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Temam S, Chanoine S, Bédard A, Dumas O, Sanchez M, Boutron-Ruault MC, Siroux V, Rican S, Varraso R, Le Moual N. Low socioeconomic position and neighborhood deprivation are associated with uncontrolled asthma in elderly. Respir Med 2019; 158:70-7. [PMID: 31610380 DOI: 10.1016/j.rmed.2019.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 09/12/2019] [Accepted: 09/15/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND While uncontrolled asthma in adults is frequent in Europe, the impact of socioeconomic position (SEP) was little investigated. We aimed to investigate the respective association of individual- and area-level SEP with uncontrolled asthma among French elderly women. METHODS Analyses were conducted in the Asthma-E3N study, among participants with current asthma (i.e., asthma attacks, treatment, or symptoms in previous year). Asthma control was evaluated using Asthma Control Test (uncontrolled: score ≤19); SEP was defined at both individual- and area-level, using educational level (low, medium, high), the French Deprivation index (tertiles defined at national level), and by merging them in a combined-SEP index. Associations between SEP and asthma control were estimated for 2258 women by logistic regression adjusted for age. Analyses were stratified by asthma controller medication use estimated through a drug reimbursement database. RESULTS Women were 70 years on average and 24% had uncontrolled asthma. A low educational level (11%) was associated with an increased risk of uncontrolled asthma [odds ratio (95% confidence interval) = 1.9 (1.4,2.6)], especially among women not using controller medication [3.1 (1.9,5.1)]. Using the combined-SEP index, the highest risk of uncontrolled asthma was observed among women with the most disadvantaged socioeconomic profile (low educational level and low-SEP neighborhood) [2.5 (1.5,4.2)]. CONCLUSIONS Women with low SEP had more often uncontrolled asthma, which might be partly explained by inadequate asthma treatment. To achieve the best management of asthma for elderly patients, a specific attention should be given not only to disadvantaged population and neighborhoods, but also to disadvantaged populations in affluent neighborhoods.
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Wheeler DC, Raman S, Jones RM, Schootman M, Nelson EJ. Bayesian deprivation index models for explaining variation in elevated blood lead levels among children in Maryland. Spat Spatiotemporal Epidemiol 2019; 30:100286. [PMID: 31421801 DOI: 10.1016/j.sste.2019.100286] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 11/15/2018] [Revised: 05/21/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
Lead exposure adversely affects children's health. Exposure in the United States is highest among socioeconomically disadvantaged individuals who disproportionately live in substandard housing. We used Bayesian binomial regression models to estimate a neighborhood deprivation index and its association with elevated blood lead level (EBLL) risk using blood lead level testing data in Maryland census tracts. Our results show the probability of EBLL was spatially structured with high values in Baltimore city and low values in the District of Columbia suburbs and Baltimore suburbs. The association between the neighborhood deprivation index and EBLL risk was statistically significant after accounting for spatial dependence in probability of EBLL. The percent of houses built before 1940, African Americans, and renter occupied housing were the most important variables in the index. Bayesian models provide a flexible one-step approach to modeling risk associated with neighborhood deprivation while accounting for spatially structured and unstructured heterogeneity in risk.
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Affiliation(s)
- David C Wheeler
- Department of Biostatistics, Virginia Commonwealth University, United States.
| | - Shyam Raman
- Department of Epidemiology and Biostatistics, Indiana University-Bloomington, United States
| | - Resa M Jones
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University and Fox Chase Cancer Center, Temple University Health, United States
| | | | - Erik J Nelson
- Department of Epidemiology and Biostatistics, Indiana University-Bloomington, United States
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Karriker-Jaffe KJ, Lönn SL, Cook WK, Kendler KS, Sundquist K. Chains of risk for alcohol use disorder: Mediators of exposure to neighborhood deprivation in early and middle childhood. Health Place 2018; 50:16-26. [PMID: 29334617 DOI: 10.1016/j.healthplace.2017.12.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 08/04/2017] [Revised: 12/18/2017] [Accepted: 12/22/2017] [Indexed: 12/23/2022]
Abstract
Our goal was to test a cascade model to identify developmental pathways, or chains of risk, from neighborhood deprivation in childhood to alcohol use disorder (AUD) in young adulthood. Using Swedish general population data, we examined whether exposure to neighborhood deprivation during early and middle childhood was associated with indicators of social functioning in adolescence and emerging adulthood, and whether these were predictive of AUD. Structural equation models showed exposure to neighborhood deprivation was associated with lower school achievement during adolescence, poor social functioning during emerging adulthood, and the development of AUD for both males and females. Understanding longitudinal pathways from early exposure to adverse environments to later AUD can inform prevention and intervention efforts.
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Affiliation(s)
| | - Sara L Lönn
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Won K Cook
- Alcohol Research Group, Public Health Institute, Emeryville, CA, United States
| | - Kenneth S Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Department of Psychiatry, Richmond, VA, United States
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden; Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, United States
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Forsberg PO, Ohlsson H, Sundquist K. Causal nature of neighborhood deprivation on individual risk of coronary heart disease or ischemic stroke: A prospective national Swedish co-relative control study in men and women. Health Place 2018; 50:1-5. [PMID: 29331785 DOI: 10.1016/j.healthplace.2017.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/18/2017] [Accepted: 12/22/2017] [Indexed: 11/19/2022]
Abstract
We studied the association between neighborhood socioeconomic status (SES) and incidence of coronary heart disease (CHD) or ischemic stroke in the total population and in full- and half-siblings to determine whether these associations are causal or a result from familial confounding. Data were retrieved from nationwide Swedish registers containing individual clinical data linked to neighborhood of residence. After adjustment for individual SES, the association between neighborhood SES and CHD showed no decrease with increasing genetic resemblance, particularly in women. This indicates that the association between neighborhood SES and CHD incidence is partially causal among women, which represents a novel finding.
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Affiliation(s)
- Per-Ola Forsberg
- Center for Primary Health Care Research, Lund University, Sweden.
| | - Henrik Ohlsson
- Center for Primary Health Care Research, Lund University, Sweden
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Beck A, Davidson AJ, Xu S, Josh Durfee M, Oronce CIA, Steiner JF, Havranek E. A Multilevel Analysis of Individual, Health System, and Neighborhood Factors Associated with Depression within a Large Metropolitan Area. J Urban Health 2017; 94:780-790. [PMID: 28842803 PMCID: PMC5722727 DOI: 10.1007/s11524-017-0190-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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] [Indexed: 11/30/2022]
Abstract
Depression prevalence is known to vary by individual factors (gender, age, race, medical comorbidities) and by neighborhood factors (neighborhood deprivation). However, the combination of individual- and neighborhood-level data is rarely available to assess their relative contribution to variation in depression across neighborhoods. We geocoded depression diagnosis and demographic data from electronic health records for 165,600 patients seen in two large health systems serving the Denver population (Kaiser Permanente and Denver Health) to Denver's 144 census tracts, and combined these data with indices of neighborhood deprivation obtained from the American Community Survey. Non-linear mixed models examined the relationships between depression rates and individual and census tract variables, stratified by health system. We found higher depression rates associated with greater age, female gender, white race, medical comorbidities, and with lower rates of home owner occupancy, residential stability, and higher educational attainment, but not with economic disadvantage. Among the Denver Health cohort, higher depression rates were associated with higher crime rates and a lower percent of foreign born residents and single mother households. Our findings suggest that individual factors had the strongest associations with depression. Neighborhood risk factors associated with depression point to low community cohesion, while the role of education is more complex. Among the Denver Health cohort, language and cultural barriers and competing priorities may attenuate the recognition and treatment of depression.
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Affiliation(s)
- Arne Beck
- Institute for Health Research Kaiser Permanente Colorado, Denver, CO, USA.
| | | | - Stanley Xu
- Institute for Health Research Kaiser Permanente Colorado, Denver, CO, USA
| | - M Josh Durfee
- Denver Health and Hospital Authority, Denver, CO, USA
| | | | - John F Steiner
- Institute for Health Research Kaiser Permanente Colorado, Denver, CO, USA
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31
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Algren MH, Ekholm O, van Lenthe F, Mackenbach J, Bak CK, Andersen PT. Health-risk behaviour among residents in deprived neighbourhoods compared with those of the general population in Denmark: A cross-sectional study. Health Place 2017; 45:189-198. [PMID: 28412595 DOI: 10.1016/j.healthplace.2017.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 11/28/2016] [Revised: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
This study compares health-risk behaviours (including the co-occurrence of health-risk behaviours) of residents in the deprived neighbourhoods with those of the general population of Denmark. It also examines associations between sociodemographic and socioeconomic characteristics and health-risk behaviours in deprived neighbourhoods in Denmark. Even after adjustment for socioeconomic characteristics there were large differences in health-risk behaviours between residents in deprived neighbourhoods and the general population. In the deprived neighbourhoods large sociodemographic and socioeconomic differences in health-risk behaviours were found among the residents. Our findings highlight the need for health promotion programmes targeting residents in deprived neighbourhoods.
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Affiliation(s)
- Maria Holst Algren
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700 Esbjerg, Denmark.
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Oester Farimagsgade 5A, 1353 Copenhagen, Denmark
| | - Frank van Lenthe
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Johan Mackenbach
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Carsten Kronborg Bak
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220 Aalborg, Denmark
| | - Pernille Tanggaard Andersen
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700 Esbjerg, Denmark
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Carlsson AC, Li X, Holzmann MJ, Ärnlöv J, Wändell P, Gasevic D, Sundquist J, Sundquist K. Neighborhood socioeconomic status at the age of 40 years and ischemic stroke before the age of 50 years: A nationwide cohort study from Sweden. Int J Stroke 2017; 12:815-826. [PMID: 28387158 DOI: 10.1177/1747493017702663] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective We aimed to study the association between neighborhood socioeconomic status at the age of 40 years and risk of ischemic stroke before the age of 50 years. Methods All individuals in Sweden were included if their 40th birthday occurred between 1998 and 2010. National registers were used to categorize neighborhood socioeconomic status into high, middle, and low and to retrieve information on incident ischemic strokes. Hazard ratios and their 95% confidence intervals were estimated. Results A total of 1,153,451 adults (women 48.9%) were followed for a mean of 5.5 years (SD 3.5 years), during which 1777 (0.30%) strokes among men and 1374 (0.24%) strokes among women were recorded. After adjustment for sex, marital status, education level, immigrant status, region of residence, and neighborhood services, there was a lower risk of stroke in residents from high-socioeconomic status neighborhoods (hazard ratio 0.87, 95% confidence interval 0.78-0.96), and an increased risk of stroke in adults from low-socioeconomic status neighborhoods (hazard ratio 1.16, 95% confidence interval 1.06-1.27), compared to their counterparts living in middle-socioeconomic status neighborhoods. After further adjustment for hospital diagnoses of hypertension, diabetes, heart failure, and atrial fibrillation prior to the age of 40, the higher risk in neighborhoods with low socioeconomic status was attenuated, but remained significant (hazard ratio 1.12, 95% confidence interval 1.02-1.23). Conclusions In a nationwide study of individuals between 40 and 50 years, we found that the risk of ischemic stroke differed depending on neighborhood socioeconomic status, which calls for increased efforts to prevent cardiovascular diseases in low socioeconomic status neighborhoods.
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Affiliation(s)
- Axel C Carlsson
- 1 Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden.,2 Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Xinjun Li
- 3 Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Martin J Holzmann
- 4 Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden.,5 Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Johan Ärnlöv
- 1 Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden.,6 School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Per Wändell
- 1 Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden
| | - Danijela Gasevic
- 7 Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Jan Sundquist
- 3 Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Kristina Sundquist
- 3 Center for Primary Health Care Research, Lund University, Malmö, Sweden
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Galán CA, Shaw DS, Dishion TJ, Wilson MN. Neighborhood Deprivation during Early Childhood and Conduct Problems in Middle Childhood: Mediation by Aggressive Response Generation. J Abnorm Child Psychol 2016; 45:935-946. [PMID: 27696324 DOI: 10.1007/s10802-016-0209-x] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The tremendous negative impact of conduct problems to the individual and society has provided the impetus for identifying risk factors, particularly in early childhood. Exposure to neighborhood deprivation in early childhood is a robust predictor of conduct problems in middle childhood. Efforts to identify and test mediating mechanisms by which neighborhood deprivation confers increased risk for behavioral problems have predominantly focused on peer relationships and community-level social processes. Less attention has been dedicated to potential cognitive mediators of this relationship, such as aggressive response generation, which refers to the tendency to generate aggressive solutions to ambiguous social stimuli with negative outcomes. In this study, we examined aggressive response generation, a salient component of social information processing, as a mediating process linking neighborhood deprivation to later conduct problems at age 10.5. Participants (N = 731; 50.5 % male) were drawn from a multisite randomized prevention trial that includes an ethnically diverse and low-income sample of male and female children and their primary caregivers followed prospectively from toddlerhood to middle childhood. Results indicated that aggressive response generation partially mediated the relationship between neighborhood deprivation and parent- and teacher-report of conduct problems, but not youth-report. Results suggest that the detrimental effects of neighborhood deprivation on youth adjustment may occur by altering the manner in which children process social information.
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Affiliation(s)
- Chardée A Galán
- Department of Psychology, University of Pittsburgh, 210 S. Bouquet St., 4425 Sennott Square, Pittsburgh, PA, 15260-0001, USA.
| | - Daniel S Shaw
- Department of Psychology, University of Pittsburgh, 210 S. Bouquet St., 4425 Sennott Square, Pittsburgh, PA, 15260-0001, USA
| | - Thomas J Dishion
- Department of Special Education, Arizona State University, Tempe, AZ, USA
| | - Melvin N Wilson
- Department of Psychology, University of Virginia, Charlottesville, VA, USA
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Forsberg PO, Li X, Sundquist K. Neighborhood socioeconomic characteristics and statin medication in patients with myocardial infarction: a Swedish nationwide follow-up study. BMC Cardiovasc Disord 2016; 16:146. [PMID: 27391128 PMCID: PMC4938992 DOI: 10.1186/s12872-016-0319-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 03/24/2016] [Accepted: 06/08/2016] [Indexed: 11/12/2022] Open
Abstract
Background Coronary heart disease (CHD) and myocardial infarction (MI) are associated with neighborhood-level socioeconomic status (SES). Statins are important drugs for secondary prevention of MI. However, no study has determined whether neighborhood-level SES is associated with statin medication in MI patients. We aimed to determine whether there is a difference in statin medication rate in MI patients across different levels of neighborhood SES. Methods All patients in Sweden, diagnosed with incident MI from January 1st, 2000 until December 31st 2010, were followed (n = 116,840). Of these, 89.7 % received statin medication. Data were analyzed by multilevel logistic regression, with individual-level characteristics (age, marital status, family income, educational attainment, country of origin, urban/rural status and comorbidities/chronic conditions related to MI) as covariates. Results Low neighborhood-level SES was significantly associated with low statin medication rate (Odds Ratio 0.80). In the full model, which took into account individual-level socioeconomic characteristics and MI comorbidities, the odds no longer remained significant. Conclusions Individual-level approaches may be most important in health care policies regarding statin medication in MI patients. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0319-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Per-Ola Forsberg
- Center for Primary Health Care Research, Clinical Research Centre (CRC), Lund University, building 28, floor 11, Jan Waldenströms gata 35, SE-205 02, Malmö, Sweden
| | - Xinjun Li
- Center for Primary Health Care Research, Clinical Research Centre (CRC), Lund University, building 28, floor 11, Jan Waldenströms gata 35, SE-205 02, Malmö, Sweden.
| | - Kristina Sundquist
- Center for Primary Health Care Research, Clinical Research Centre (CRC), Lund University, building 28, floor 11, Jan Waldenströms gata 35, SE-205 02, Malmö, Sweden
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Davis HT, Aelion CM, Liu J, Burch JB, Cai B, Lawson AB, McDermott S. Potential sources and racial disparities in the residential distribution of soil arsenic and lead among pregnant women. Sci Total Environ 2016; 551-552:622-30. [PMID: 26897405 PMCID: PMC4808624 DOI: 10.1016/j.scitotenv.2016.02.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 10/25/2015] [Revised: 02/02/2016] [Accepted: 02/02/2016] [Indexed: 05/20/2023]
Abstract
Exposure to arsenic (As) or lead (Pb) has been associated with adverse health outcomes, and high-risk populations can be disproportionately exposed to these metals in soils. The objectives of this study were: to examine if predicted soil As and Pb concentrations at maternal residences of South Carolina (SC) low-income mothers differed based on maternal race (non-Hispanic black versus white), to examine whether differences in predicted residential soil As and Pb concentrations among black and white mothers differed by socioeconomic status (SES), and to examine whether such disparities persisted after controlling for anthropogenic sources of these metals, including direction from, and distance to industrial facilities. Kriged soil As and Pb concentrations were estimated at maternal residences in 11 locations in SC, and models with maternal race and individual and US Census block group level SES measures were examined. US Environmental Protection Agency Toxics Release Inventory (TRI) facility As and Pb releases categorized by distance and direction to block groups in which mothers resided were also identified, as were proxy measures for historic use of leaded gasoline (road density) and Pb-based paint (categories of median year home built by US Census block group). Consistent racial disparities were observed for predicted residential soil As and Pb concentrations, and the disparity was stronger for Pb than As (betas from adjusted models for black mothers were 0.12 and 2.2 for As and Pb, respectively, all p<0.006). Higher road density and older homes in block groups were more closely associated with higher predicted soil As and Pb concentrations than on-site releases of As and Pb categorized by facility location. These findings suggest that non-Hispanic black mothers in this study population had elevated residential As and Pb soil concentrations, after adjusting for SES, and that soil As and Pb concentrations were not associated with recent industrial releases.
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Affiliation(s)
- Harley T Davis
- Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - C Marjorie Aelion
- School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 No. Pleasant Street, Amherst, MA 01003, USA.
| | - Jihong Liu
- Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - James B Burch
- Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Bo Cai
- Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Andrew B Lawson
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street Suite 303, Charleston, SC 29401, USA
| | - Suzanne McDermott
- Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
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Cho KH, Nam CM, Lee EJ, Choi Y, Yoo KB, Lee SH, Park EC. Effects of individual and neighborhood socioeconomic status on the risk of all-cause mortality in chronic obstructive pulmonary disease: A nationwide population-based cohort study, 2002-2013. Respir Med 2016; 114:9-17. [PMID: 27109806 DOI: 10.1016/j.rmed.2016.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 02/05/2016] [Accepted: 03/08/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Numerous previous studies have shown that individual socioeconomic status (SES) is associated with mortality in patients with chronic obstructive pulmonary disease (COPD), but few empirical studies have evaluated the effects of individual SES and neighborhood deprivation on mortality in COPD patients. METHODS We performed a prospective cohort study to examine the effect of socioeconomic disparity on all-cause mortality in newly diagnosed COPD patients in a setting with universal health care coverage. We used representative population-based nationwide cohort data from the Korean National Health Insurance claims database (2002-2013). We included patients who were at least 40 years old and newly diagnosed with COPD (N = 9275). To analyze the data, we utilized a frailty model and Cox's proportional hazard regression. RESULTS A total of 1849 (19.9%) of the 9275 eligible participants died during the study period. Compared to high-income patients from advantaged neighborhoods, the adjusted hazard ratio (HR) for middle-income COPD patients who lived in advantaged and disadvantaged neighborhoods was 1.22 (95% CI, 1.03-1.43) and 1.36 (95% CI, 1.15-1.60), respectively. For low-income patients, the adjusted HR for patients who lived in disadvantaged neighborhoods was higher than for patients who lived in advantaged neighborhoods (HR, 1.43; 95% CI, 1.17-1.74 vs. HR, 1.36; 95% CI, 1.11-1.66). There was no difference in the adjusted HRs for high-income patients who lived in advantaged and disadvantaged neighborhoods (HR, 1.01; 95% CI, 0.84-1.22). CONCLUSIONS Socioeconomic disparity contributes to all-cause mortality in COPD patients and neighborhood deprivation exacerbates the effect of individual SES on all-cause mortality in COPD patients.
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Rummo PE, Meyer KA, Green Howard A, Shikany JM, Guilkey DK, Gordon-Larsen P. Fast food price, diet behavior, and cardiometabolic health: Differential associations by neighborhood SES and neighborhood fast food restaurant availability in the CARDIA study. Health Place 2015; 35:128-35. [PMID: 26319447 PMCID: PMC4637179 DOI: 10.1016/j.healthplace.2015.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 06/19/2015] [Accepted: 06/29/2015] [Indexed: 10/23/2022]
Abstract
Little research has addressed whether neighborhood context influences associations between fast food price, diet, and cardiometabolic health. We investigated these associations using 25 years of Coronary Artery Risk Development in Young Adults (CARDIA) study data (n=4,469, observations=21,134). We found a negative association between fast food price and consumption, with stronger inverse associations in more (vs. less) deprived neighborhoods [3rd tertile: β=-0.68 (95% CI: (-0.85, -0.51); 1st tertile: β=-0.22 (95% CI: -0.42, -0.02); p-interaction-0.002], and a similar association for BMI [3rd tertile: β=-1.34 (95% CI: -1.54, -1.14); 1st tertile: β=-0.45 (95% CI: -0.66, -0.25); p-interaction<0.001], but not insulin resistance [3rd tertile: β=-0.07 (95% CI: -0.24, 0.09); 1st tertile: β=0.09 (95% CI: -0.08, 0.26); p-interaction=0.40]. We observed no modification of fast food price by fast food availability. Future research on obesity disparities should consider potential differences in the association between fast food prices and health outcomes across neighborhood socioeconomic levels.
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Affiliation(s)
- Pasquale E Rummo
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina at Chapel Hill, NC, USA.
| | - Katie A Meyer
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina at Chapel Hill, NC, USA.
| | - Annie Green Howard
- Carolina Population Center, University of North Carolina at Chapel Hill, NC, USA; Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA.
| | - James M Shikany
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - David K Guilkey
- Carolina Population Center, University of North Carolina at Chapel Hill, NC, USA; Department of Economics, University of North Carolina at Chapel Hill Carolina Population Center, Chapel Hill, NC, USA.
| | - Penny Gordon-Larsen
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina at Chapel Hill, NC, USA
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Richards JL, Chapple-McGruder T, Williams BL, Kramer MR. Does neighborhood deprivation modify the effect of preterm birth on children's first grade academic performance? Soc Sci Med 2015; 132:122-31. [PMID: 25797101 DOI: 10.1016/j.socscimed.2015.03.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Children's cognitive development and academic performance are linked to both fetal and early childhood factors, including preterm birth and family socioeconomic status. We evaluated whether the relationship between preterm birth (PTB) and first grade standardized test performance among Georgia public school students was modified by neighborhood deprivation in early childhood. The Georgia Birth to School cohort followed 327,698 children born in Georgia from 1998 to 2002 through to end-of-year first grade standardized tests. Binomial and log-binomial generalized estimating equations were used to estimate risk differences and risk ratios for the associations of both PTB and the Neighborhood Deprivation Index for the census tract in which each child's mother resided at the time of birth with test failure (versus passing). The presence of additive and multiplicative interaction was assessed. PTB was strongly associated with test failure, with increasing risk for earlier gestational ages. There was positive additive interaction between PTB and neighborhood deprivation. The main effect of PTB versus term birth increased risk of mathematics failure: 15.9% (95%CI: 13.3-18.5%) for early, 5.0% (95% CI: 4.1-5.9%) for moderate, and 1.3% (95%CI: 0.9-1.7%) for late preterm. Each 1 standard deviation increase in neighborhood deprivation was associated with 0.6% increased risk of mathematics failure. For children exposed to both PTB and higher neighborhood deprivation, test failure was 4.8%, 1.5%, and 0.8% greater than the sum of two main effects for early, moderate, and late PTB, respectively. Results were similar, but slightly attenuated, for reading and English/language arts. Our results suggest that PTB and neighborhood deprivation additively interact to produce greater risk among doubly exposed children than would be predicted from the sum of the effects of the two exposures. Understanding socioeconomic disparities in the effect of PTB on academic outcomes at school entry is important for targeting of early childhood interventions.
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Affiliation(s)
- Jennifer L Richards
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Theresa Chapple-McGruder
- Office of Epidemiology, Maternal and Child Health Program, Georgia State Department of Health, 2 Peachtree Street NW, Atlanta, GA 30303, USA.
| | - Bryan L Williams
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA; Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA 30322-4027, USA.
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
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Sundquist K, Eriksson U, Mezuk B, Ohlsson H. Neighborhood walkability, deprivation and incidence of type 2 diabetes: a population-based study on 512,061 Swedish adults. Health Place 2014; 31:24-30. [PMID: 25463914 DOI: 10.1016/j.healthplace.2014.10.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [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: 06/24/2013] [Revised: 09/29/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
Abstract
Neighborhood walkability has been associated with increased physical activity, but only a few studies have explored the association between walkability and health outcomes related to physical activity, such as type 2 diabetes. The aim of this study was to investigate the association between objectively assessed neighborhood walkability and the 4-year incidence of type 2 diabetes in a sample of 512,061 Swedish adults aged 18 years and older. Neighborhoods were defined by 408 administratively defined geographical areas in the city of Stockholm. We found a negative association between walkability and type 2 diabetes (OR=1.33, 95% CI=1.13-1.55) that remained significant after adjusting for neighborhood deprivation. This association, however, no longer remained statistically significant after adjusting for individual socio-demographic factors. These results were also confirmed using a co-sibling design. Future studies are encouraged to further explore the potential effect of a broader array of the neighborhood built environment on health outcomes related to physical activity.
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Affiliation(s)
- Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Jan Waldenströms Gata 35, SE-205 02 Malmö, Sweden.
| | - Ulf Eriksson
- Center for Primary Health Care Research, Lund University, Jan Waldenströms Gata 35, SE-205 02 Malmö, Sweden.
| | - Briana Mezuk
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, PO Box 980212, Richmond, 23238 VA, USA.
| | - Henrik Ohlsson
- Center for Primary Health Care Research, Lund University, Jan Waldenströms Gata 35, SE-205 02 Malmö, Sweden.
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Barrington WE, Stafford M, Hamer M, Beresford SAA, Koepsell T, Steptoe A. Neighborhood socioeconomic deprivation, perceived neighborhood factors, and cortisol responses to induced stress among healthy adults. Health Place 2014; 27:120-6. [PMID: 24603009 PMCID: PMC4212220 DOI: 10.1016/j.healthplace.2014.02.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 11/13/2013] [Accepted: 02/03/2014] [Indexed: 11/24/2022]
Abstract
Associations between measures of neighborhood socioeconomic deprivation and health have been identified, yet work is needed to uncover explanatory mechanisms. One hypothesized pathway is through stress, yet the few studies that have evaluated associations between characteristics of deprived neighborhoods and biomarkers of stress are mixed. This study evaluated whether objectively measured neighborhood socioeconomic deprivation and individual perceived neighborhood characteristics (i.e. social control and fear of crime) impacted cortisol responses to an induced stressor among older healthy adults. Data from Heart Scan, a sub-study of the Whitehall II cohort, were used to generate multilevel piecewise growth-curve models of cortisol trajectories after a laboratory stressor accounting for neighborhood and demographic characteristics. Neighborhood socioeconomic deprivation was significantly associated with individual perceptions of social control and fear of crime in the neighborhood while an association with blunted cortisol reactivity was only evidence among women. Social control was significantly associated with greater cortisol reactivity and mediation between neighborhood socioeconomic deprivation and cortisol reactivity was suggested among women. These findings support a gender-dependent role of neighborhood in stress process models of health.
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Affiliation(s)
- Wendy E Barrington
- University of Washington, School of Public Health, Department of Epidemiology, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA, USA.
| | - Mai Stafford
- Medical Research Council, Unit for Lifelong Health and Ageing, London, England, UK
| | - Mark Hamer
- University College London, Department of Epidemiology and Public Health, London, England, UK
| | - Shirley A A Beresford
- University of Washington, School of Public Health, Department of Epidemiology, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA, USA
| | - Thomas Koepsell
- University of Washington, School of Public Health, Department of Epidemiology, Seattle, WA, USA
| | - Andrew Steptoe
- University College London, Department of Epidemiology and Public Health, London, England, UK
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