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Mullachery PH, Bilal U, Li R, McClure LA. Area-Level Social Vulnerability and Severe COVID-19: A Case-Control Study Using Electronic Health Records from Multiple Health Systems in the Southeastern Pennsylvania Region. J Urban Health 2024:10.1007/s11524-024-00876-6. [PMID: 38740710 DOI: 10.1007/s11524-024-00876-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/16/2024]
Abstract
Knowledge about neighborhood characteristics that predict disease burden can be used to guide equity-based public health interventions or targeted social services. We used a case-control design to examine the association between area-level social vulnerability and severe COVID-19 using electronic health records (EHR) from a regional health information hub in the greater Philadelphia region. Severe COVID-19 cases (n = 15,464 unique patients) were defined as those with an inpatient admission and a diagnosis of COVID-19 in 2020. Controls (n = 78,600; 5:1 control-case ratio) were a random sample of individuals who did not have a COVID-19 diagnosis from the same geographic area. Retrospective data on comorbidities and demographic variables were extracted from EHR and linked to area-level social vulnerability index (SVI) data using ZIP codes. Models adjusted for different sets of covariates showed incidence rate ratios (IRR) ranging from 1.15 (95% CI, 1.13-1.17) in the model adjusted for individual-level age, sex, and marital status to 1.09 (95% CI, 1.08-1.11) in the fully adjusted model, which included individual-level comorbidities and race/ethnicity. The fully adjusted model indicates that a 10% higher area-level SVI was associated with a 9% higher risk of severe COVID-19. Individuals in neighborhoods with high social vulnerability were more likely to have severe COVID-19 after accounting for comorbidities and demographic characteristics. Our findings support initiatives incorporating neighborhood-level social determinants of health when planning interventions and allocating resources to mitigate epidemic respiratory diseases, including other coronavirus or influenza viruses.
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Affiliation(s)
- Pricila H Mullachery
- Department of Health Services Administration and Policy, College of Public Health, Temple University, 1301 Cecil B. Moore Ave., Philadelphia, PA, 19122, USA.
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St, Philadelphia, PA, 19104, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Ran Li
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St, Philadelphia, PA, 19104, USA
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA, 19104, USA
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Henson RM, Mullachery PH, Sánchez-Pájaro A, Cruz-Cruz C, Bilal U, Langellier B, Barrientos-Gutiérrez T. Spatial Heterogeneity in Fatal Overdose Rate Trends in Mexican Cities: 2005-2021. Am J Public Health 2024:e1-e9. [PMID: 38723222 DOI: 10.2105/ajph.2024.307650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Objectives. To describe national and city-level fatal drug overdose trends between 2005 and 2021 in Mexico. Methods. We calculated fatal overdose rates at the city level in 3-year periods from 2005 to 2021 and annually at the national level for people aged 15 to 64 years in Mexico. We calculated rate differences and rate ratios for each city between periods. Results. The national fatal overdose rate was 0.53 overdose deaths per 100 000 population and was almost twice as high in urban than in nonurban areas. The national fatal overdose rate was stable over the period 2005 to 2014 and increased monotonically to a peak in 2021. Fatal overdose rates varied across cities. Cities with the 8 highest fatal overdose rates in the period were all in states along the US-Mexico border. Conclusions. Fatal overdoses have doubled over the past 15 years in Mexico. Overdose rates are particularly high and increasing in cities close to the US-Mexico border. Public Health Implications. There is a need for enhanced overdose surveillance data and coordinated harm reduction strategies, particularly in the northern border region of Mexico. (Am J Public Health. Published online ahead of print May 9, 2024:e1-e9. https://doi.org/10.2105/AJPH.2024.307650).
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Affiliation(s)
- Rosie Mae Henson
- Rosie Mae Henson and Brent Langellier are with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Pricila H. Mullachery is with the Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, PA. Andrés Sánchez-Pájaro and Tonatiuh Barrientos-Gutiérrez are with the Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Mexico City, Mexico. Copytzy Cruz-Cruz is with the Servicios de Atención Psiquiátrica, Secretaría de Salud, Mexico City, Mexico. Usama Bilal is with the Urban Health Collaborative, Dornsife School of Public Health
| | - Pricila H Mullachery
- Rosie Mae Henson and Brent Langellier are with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Pricila H. Mullachery is with the Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, PA. Andrés Sánchez-Pájaro and Tonatiuh Barrientos-Gutiérrez are with the Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Mexico City, Mexico. Copytzy Cruz-Cruz is with the Servicios de Atención Psiquiátrica, Secretaría de Salud, Mexico City, Mexico. Usama Bilal is with the Urban Health Collaborative, Dornsife School of Public Health
| | - Andrés Sánchez-Pájaro
- Rosie Mae Henson and Brent Langellier are with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Pricila H. Mullachery is with the Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, PA. Andrés Sánchez-Pájaro and Tonatiuh Barrientos-Gutiérrez are with the Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Mexico City, Mexico. Copytzy Cruz-Cruz is with the Servicios de Atención Psiquiátrica, Secretaría de Salud, Mexico City, Mexico. Usama Bilal is with the Urban Health Collaborative, Dornsife School of Public Health
| | - Copytzy Cruz-Cruz
- Rosie Mae Henson and Brent Langellier are with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Pricila H. Mullachery is with the Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, PA. Andrés Sánchez-Pájaro and Tonatiuh Barrientos-Gutiérrez are with the Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Mexico City, Mexico. Copytzy Cruz-Cruz is with the Servicios de Atención Psiquiátrica, Secretaría de Salud, Mexico City, Mexico. Usama Bilal is with the Urban Health Collaborative, Dornsife School of Public Health
| | - Usama Bilal
- Rosie Mae Henson and Brent Langellier are with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Pricila H. Mullachery is with the Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, PA. Andrés Sánchez-Pájaro and Tonatiuh Barrientos-Gutiérrez are with the Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Mexico City, Mexico. Copytzy Cruz-Cruz is with the Servicios de Atención Psiquiátrica, Secretaría de Salud, Mexico City, Mexico. Usama Bilal is with the Urban Health Collaborative, Dornsife School of Public Health
| | - Brent Langellier
- Rosie Mae Henson and Brent Langellier are with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Pricila H. Mullachery is with the Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, PA. Andrés Sánchez-Pájaro and Tonatiuh Barrientos-Gutiérrez are with the Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Mexico City, Mexico. Copytzy Cruz-Cruz is with the Servicios de Atención Psiquiátrica, Secretaría de Salud, Mexico City, Mexico. Usama Bilal is with the Urban Health Collaborative, Dornsife School of Public Health
| | - Tonatiuh Barrientos-Gutiérrez
- Rosie Mae Henson and Brent Langellier are with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Pricila H. Mullachery is with the Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, PA. Andrés Sánchez-Pájaro and Tonatiuh Barrientos-Gutiérrez are with the Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Mexico City, Mexico. Copytzy Cruz-Cruz is with the Servicios de Atención Psiquiátrica, Secretaría de Salud, Mexico City, Mexico. Usama Bilal is with the Urban Health Collaborative, Dornsife School of Public Health
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Plans-Beriso E, Gullon P, Fontan-Vela M, Franco M, Perez-Gomez B, Pollan M, Cura-Gonzalez I, Bilal U. Modifying effect of urban parks on socioeconomic inequalities in diabetes prevalence: a cross-sectional population study of Madrid City, Spain. J Epidemiol Community Health 2024; 78:360-366. [PMID: 38453450 DOI: 10.1136/jech-2023-221198] [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: 07/24/2023] [Accepted: 02/25/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Evidence has shown contradicting results on how the density of urban green spaces may reduce socioeconomic inequalities in type 2 diabetes (equigenic hypothesis). The aim of this study is to test whether socioeconomic inequalities in diabetes prevalence are modified by park density. METHODS We designed a population-wide cross-sectional study of all adults registered in the primary healthcare centres in the city of Madrid, Spain (n=1 305 050). We obtained georeferenced individual-level data from the Primary Care Electronic Health Records, and census-tract level data on socioeconomic status (SES) and park density. We modelled diabetes prevalence using robust Poisson regression models adjusted by age, country of origin, population density and including an interaction term with park density, stratified by gender. We used this model to estimate the Relative Index of Inequality (RII) at different park density levels. FINDINGS We found an overall RII of 2.90 (95% CI 2.78 to 3.02) and 4.50 (95% CI 4.28 to 4.74) in men and women, respectively, meaning that the prevalence of diabetes was three to four and a half times higher in low SES compared with high SES areas. These inequalities were wider in areas with higher park density for both men and women, with a significant interaction only for women (p=0.008). INTERPRETATION We found an inverse association between SES and diabetes prevalence in both men and women, with wider inequalities in areas with more parks. Future works should study the mechanisms of these findings, to facilitate the understanding of contextual factors that may mitigate diabetes inequalities.
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Affiliation(s)
- Elena Plans-Beriso
- Department of Epidemiology of Chronic Diseases, National Center For Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- Public Health and Epidemiology Research Group, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcala de Henares, Alcala de Henares, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Pedro Gullon
- Public Health and Epidemiology Research Group, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcala de Henares, Alcala de Henares, Spain
| | - Mario Fontan-Vela
- Public Health and Epidemiology Research Group, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcala de Henares, Alcala de Henares, Spain
| | - Manuel Franco
- Social and Cardiovascular Research Group, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcala de Henares, Alcala de Henares, Spain
| | - Beatriz Perez-Gomez
- Department of Epidemiology of Chronic Diseases, National Center For Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Marina Pollan
- Department of Epidemiology of Chronic Diseases, National Center For Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Isabel Cura-Gonzalez
- Primary Care Research Unit, Madrid Health Service, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Usama Bilal
- Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA
- Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
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Alpaugh V, Ortigoza A, Braverman Bronstein A, Pérez-Ferrer C, Wagner-Gutierrez N, Pacifico N, Ezeh A, Caiaffa WT, Lovasi G, Bilal U. Association Between Household Deprivation and Living in Informal Settlements and Incidence of Diarrhea in Children Under 5 in Eleven Latin American Cities. J Urban Health 2024:10.1007/s11524-024-00854-y. [PMID: 38652338 DOI: 10.1007/s11524-024-00854-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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/25/2024]
Abstract
Diarrhea is a leading cause of death in children globally, mostly due to inadequate sanitary conditions and overcrowding. Poor housing quality and lack of tenure security that characterize informal settlements are key underlying contributors to these risk factors for childhood diarrhea deaths. The objective of this study is to better understand the physical attributes of informal settlement households in Latin American cities that are associated with childhood diarrhea. We used data from a household survey (Encuesta CAF) conducted by the Corporación Andina de Fomento (CAF), using responses from sampled individuals in eleven cities. We created a household deprivation score based on household water and sewage infrastructure, overcrowding, flooring and wall material, and security of tenure. We fitted a multivariable logistic regression model to estimate odds ratios (OR) and 95% confidence intervals (95% CI) to test the association between the deprivation score and its individual components and childhood diarrhea during the prior 2 weeks. We included a total of 4732 households with children, out of which 12.2% had diarrhea in the 2-week period prior to completing the survey. After adjusting for respondent age, gender, and city, we found a higher risk of diarrhea associated with higher household deprivation scores. Specifically, we found that the odds of diarrhea for children living in a mild and severe deprived household were 1.04 (95% CI 0.84-1.28) and 3.19 times (95% CI 1.80-5.63) higher, respectively, in comparison to households with no deprivation. These results highlight the connections between childhood health and deprived living conditions common in informal settlements.
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Affiliation(s)
- Victoria Alpaugh
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St. Suite 730, Philadelphia, PA, 19104, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3600 Market St. Suite 730, Philadelphia, PA, 19104, USA
| | - Ana Ortigoza
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St. Suite 730, Philadelphia, PA, 19104, USA
- Department of Social and Environmental Determinants of Health Equity, Pan American Health Organization, Washington, D.C., USA
| | - Ariela Braverman Bronstein
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St. Suite 730, Philadelphia, PA, 19104, USA
- Institute for Community Health, Cambridge Health Alliance, Malden, MA, USA
| | - Carolina Pérez-Ferrer
- Center for Research in Population Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | - Natalia Pacifico
- Institute of Collective Health, National University of Lanús, Remedios de Escalada, Argentina
- FJ Muñiz Infectious Hospital, Buenos Aires, Argentina
| | - Alex Ezeh
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St. Suite 730, Philadelphia, PA, 19104, USA
- Department of Community Health and Prevention, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Waleska Teixeira Caiaffa
- Observatory for Urban Health in Belo Horizonte, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Gina Lovasi
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St. Suite 730, Philadelphia, PA, 19104, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3600 Market St. Suite 730, Philadelphia, PA, 19104, USA
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St. Suite 730, Philadelphia, PA, 19104, USA.
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3600 Market St. Suite 730, Philadelphia, PA, 19104, USA.
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Schnake-Mahl A, Anfuso G, Goldstein ND, Purtle J, Eberth JM, Ortigoza A, Bilal U. Measuring Variation in Infant Mortality and Deaths of Despair by U.S. Congressional Districts in Pennsylvania: A Methodological Case Study. Am J Epidemiol 2024:kwae016. [PMID: 38412272 DOI: 10.1093/aje/kwae016] [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: 11/16/2022] [Revised: 01/26/2024] [Indexed: 02/29/2024] Open
Abstract
Many ecological studies examine health outcomes and disparities using administrative boundaries such as census tracts, counties, or states. These boundaries help us to understand the patterning of health by place along with impacts of policies implemented at these levels. However, additional geo-political units, or units with both geographic and political meaning, such as congressional districts, present further opportunities to connect research with public policy. We provide a step-by-step guide in how to conduct disparities-focused analysis at the congressional district level, and as an applied case study we use geocoded vital statistics data from 2010-2015 to examine levels and disparities of infant mortality (IM) and deaths of despair (DoD) in the 19 U.S. congressional districts of Pennsylvania for the 111th-112th (2009-2012) Congresses, and 18 districts for the 113th-114th (2013-2016) Congresses. We also provide recommendations for extending congressional district level analysis to other outcomes, states, and geopolitical boundaries such as state legislative districts. Increased surveillance of health outcomes at the congressional district level can help prompt policy action, advocacy, and hopefully, reduce rates and disparities in health.
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Affiliation(s)
- Alina Schnake-Mahl
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA
- Department of Health Management and Policy, Drexel Dornsife School of Public Health, Philadelphia, PA
| | - Giancarlo Anfuso
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA
| | - Neal D Goldstein
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA
| | - Jonathan Purtle
- Department of Public Health Policy & Management, New York University School of Global Public Health, New York, NY
| | - Jan M Eberth
- Department of Health Management and Policy, Drexel Dornsife School of Public Health, Philadelphia, PA
| | - Ana Ortigoza
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA
- Department of Social and Environmental Determinants of Health Equity, Pan American Health Organization, Washington, D.C
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA
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Paiva ASS, Santos GF, Castro CP, Rodriguez DA, Bilal U, de Sousa Filho JF, Freitas A, Montes F, Dronova I, Barreto ML, Andrade RFS. A scaling investigation of urban form features in Latin America cities. PLoS One 2023; 18:e0293518. [PMID: 38109440 PMCID: PMC10727436 DOI: 10.1371/journal.pone.0293518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/15/2023] [Indexed: 12/20/2023] Open
Abstract
This paper examines scaling behaviors of urban landscape and street design metrics with respect to city population in Latin America. We used data from the SALURBAL project, which has compiled and harmonized data on health, social, and built environment for 371 Latin American cities above 100,000 inhabitants. These metrics included total urbanized area, effective mesh size, area in km2 and number of streets. We obtained scaling relations by regressing log(metric) on log (city population). The results show an overall sub-linear scaling behavior of most variables, indicating a relatively lower value of each variable in larger cities. We also explored the potential influence of colonization on the current built environment, by analyzing cities colonized by Portuguese (Brazilian cities) or Spaniards (Other cities in Latin America) separately. We found that the scaling behaviors are similar for both sets of cities.
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Affiliation(s)
- Aureliano S. S. Paiva
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Gervásio F. Santos
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Economics Faculty, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Caio P. Castro
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Institute of Physics, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Daniel A. Rodriguez
- Department of City and Regional Planning and Institute of Transportation Studies, University of California Berkeley, Berkeley, California, United States of America
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania, United States of America
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania, United States of America
| | - J. Firmino de Sousa Filho
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Economics Faculty, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Anderson Freitas
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Felipe Montes
- Department of Industrial Engineering, Universidad de los Andes, Social and Health Complexity Center, Bogotá, Colombia
| | - Iryna Dronova
- Department of Landscape Architecture & Environmental Planning, University of California Berkeley, Berkeley, California, United States of America
| | - Maurício L. Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Roberto F. S. Andrade
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Institute of Physics, Federal University of Bahia, Salvador, Bahia, Brazil
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Kephart JL, Gouveia N, Rodríguez DA, Indvik K, Alfaro T, Texcalac-Sangrador JL, Miranda JJ, Bilal U, Diez Roux AV. Ambient nitrogen dioxide in 47 187 neighbourhoods across 326 cities in eight Latin American countries: population exposures and associations with urban features. Lancet Planet Health 2023; 7:e976-e984. [PMID: 38056968 PMCID: PMC10716820 DOI: 10.1016/s2542-5196(23)00237-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Health research on ambient nitrogen dioxide (NO2) is sparse in Latin America, despite the high prevalence of NO2-associated respiratory diseases in the region. This study describes within-city distributions of ambient NO2 concentrations at high spatial resolution and urban characteristics associated with neighbourhood ambient NO2 in 326 Latin American cities. METHODS We aggregated estimates of annual surface NO2 at 1 km2 spatial resolution for 2019, population counts, and urban characteristics compiled by the SALURBAL project to the neighbourhood level (ie, census tracts). We described the percentage of the urban population living with ambient NO2 concentrations exceeding WHO air quality guidelines. We used multilevel models to describe associations of neighbourhood ambient NO2 concentrations with population and urban characteristics at the neighbourhood and city levels. FINDINGS We examined 47 187 neighbourhoods in 326 cities from eight Latin American countries. Of the roughly 236 million urban residents observed, 85% lived in neighbourhoods with ambient annual NO2 above WHO guidelines. In adjusted models, higher neighbourhood-level educational attainment, closer proximity to the city centre, and lower neighbourhood-level greenness were associated with higher ambient NO2. At the city level, higher vehicle congestion, population size, and population density were associated with higher ambient NO2. INTERPRETATION Almost nine out of every ten residents of Latin American cities live with ambient NO2 concentrations above WHO guidelines. Increasing neighbourhood greenness and reducing reliance on fossil fuel-powered vehicles warrant further attention as potential actionable urban environmental interventions to reduce population exposure to ambient NO2. FUNDING Wellcome Trust, National Institutes of Health, Cotswold Foundation.
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Affiliation(s)
- Josiah L Kephart
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
| | - Nelson Gouveia
- Department of Preventive Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Daniel A Rodríguez
- Department of City and Regional Planning and Institute for Transportation Studies, University of California, Berkeley, CA, USA
| | - Katherine Indvik
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Tania Alfaro
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - José Luis Texcalac-Sangrador
- Department of Environmental Health, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Latasa P, Gil-Borrelli C, Reques L, Bilal U. [Challenges for public health policies in the era of illiberalism]. Gac Sanit 2023; 37:102340. [PMID: 38007957 DOI: 10.1016/j.gaceta.2023.102340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/28/2023]
Affiliation(s)
- Pello Latasa
- Departamento de Salud del Gobierno Vasco, Vitoria-Gasteiz, España.
| | | | - Laura Reques
- Agence Regionale Sante Ile de France, París, Francia
| | - Usama Bilal
- Drexel University Dornsife School of Public Health, Filadelfia, Estados Unidos
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Correa-Salazar C, Amon J, Page K, Groves A, Bilal U, Vera A, Martínez-Donate A. Barriers and facilitators to HIV prevention and care for Venezuelan migrant/refugee women and girls in Colombia. J Migr Health 2023; 8:100206. [PMID: 38047140 PMCID: PMC10690627 DOI: 10.1016/j.jmh.2023.100206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/30/2023] [Accepted: 11/04/2023] [Indexed: 12/05/2023] Open
Abstract
Venezuelan migrant and refugee women and girls (VMRWG) face risks of exposure to and infection from HIV and threats of multiple forms of violence (including GBV) during and after migration. Yet, there is a lack of evidence on barriers and facilitators to VMRWGs' access to HIV prevention and care services this population at all stages of their migration. We addressed this evidence gap by conducting a qualitative study composed of fifty-four semi-structured interviews with practitioners (n = 24) and VMRWG (n = 30) in the two largest receiving cities of migrants in Colombia. We sought to identify perceived barriers and facilitators to HIV prevention and care to inform policies and programmatic efforts. Analysis followed a theory-informed approach using the Socioecological Model. Findings describe multi-level barriers to access to HIV prevention and care related to discrimination, gender-based violence, rigid gender norms, lack of information and system fragmentation. Policies that integrate community-based networks and support intersectoral work are pivotal to breach the gaps between services and communities and develop a gender-sensitive approach that tackles the relationship between gender-based violence and HIV risk.
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Affiliation(s)
- C. Correa-Salazar
- Community health and prevention Department, Drexel University, United States
| | - J.J. Amon
- Community health and prevention Department, Drexel University, United States
| | - K. Page
- John Hopkins Medicine, United States
| | - A.K. Groves
- Community health and prevention Department, Drexel University, United States
| | - U. Bilal
- Department of Epidemiology and Biostatistics, United States
| | | | - A. Martínez-Donate
- Community health and prevention Department, Drexel University, United States
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Perner MS, Trotta A, Bilal U, Acharya B, Quick H, Pacífico N, Berazategui R, Alazraqui M, Diez Roux AV. Social inequalities and COVID-19 mortality between neighborhoods of Bariloche city, Argentina. Int J Equity Health 2023; 22:198. [PMID: 37770868 PMCID: PMC10537962 DOI: 10.1186/s12939-023-02019-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has shown how intraurban inequalities are likely to reinforce health and social inequalities. Studies at small area level help to visualize social inequialities hidden in large areas as cities or regions. AIM To describe the spatial patterning of COVID-19 death rates in neighborhoods of the medium-sized city of Bariloche, Argentina, and to explore its relationship with the socioeconomic characteristics of neighborhoods. METHODS We conducted an ecological study in Bariloche, Argentina. The outcome was counts of COVID-19 deaths between June 2020 and May 2022 obtained from the surveillance system and georeferenced to neighborhoods. We estimated crude- and age-adjusted death rates by neighborhood using a Bayesian approach through a Poisson regression that accounts for spatial-autocorrelation via Conditional Autoregressive (CAR) structure. We also analyzed associations of age-adjusted death rates with area-level socioeconomic indicators. RESULTS Median COVID-19 death rate across neighborhoods was 17.9 (10th/90th percentile of 6.3/35.2) per 10,000 inhabitants. We found lower age-adjusted rates in the city core and western part of the city. The age-adjusted death rate in the most deprived areas was almost double than in the least deprived areas, with an education-related relative index of inequality (RII) of 2.14 (95% CI 1.55 to 2.96). CONCLUSION We found spatial heterogeneity and intraurban variability in age-adjusted COVID-19 death rates, with a clear social gradient, and a higher burden in already deprived areas. This highlights the importance of studying inequalities in health outcomes across small areas to inform placed-based interventions.
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Affiliation(s)
- Mónica Serena Perner
- Institute of Collective Health, National University of Lanus, Buenos Aires, Argentina.
- CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina.
| | - Andrés Trotta
- Institute of Collective Health, National University of Lanus, Buenos Aires, Argentina
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Binod Acharya
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Harrison Quick
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Natalia Pacífico
- Institute of Collective Health, National University of Lanus, Buenos Aires, Argentina
| | | | - Marcio Alazraqui
- Institute of Collective Health, National University of Lanus, Buenos Aires, Argentina
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
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Schinasi LH, Kondo MC, Edwards J, Clougherty JE, De Roos AJ, Bilal U. Does Urban Greenspace Reduce Mortality Inequalities Based on Poverty, Race, or Both in Philadelphia, PA? J Urban Health 2023; 100:686-695. [PMID: 37563520 PMCID: PMC10447860 DOI: 10.1007/s11524-023-00748-5] [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: 06/06/2023] [Indexed: 08/12/2023]
Abstract
While past research suggests that urban greenspace is associated with weaker income-based mortality inequities, little is known about associations with racial inequities, which may be distinct owing to historical and contemporary forms of racism. We quantified the extent to which different measures of greenspace modified socioeconomic and racial/ethnic inequities in all-cause and cardiovascular disease mortality. For every residential census tract in Philadelphia, PA (N = 376), we linked counts of all-cause and cardiovascular mortality (years 2008-2015) with measures of greenspace (proportion tree canopy or grass/shrub cover, proportion residents reporting park access, and the normalized difference vegetation index measure of overall greenness) and American Community Survey-based measures of sociodemographic composition (proportion of residents living in poverty, proportion identifying as non-Hispanic Black, and the index of concentration at the extremes (ICE) representing racialized economic deprivation). We used age- and sex-adjusted negative binomial models, with the natural logarithm of age-specific population counts as an offset, to quantify the magnitude of inequities by each composition variable, overall and stratified by categories of each greenspace measure. Inequities in mortality were weaker among neighborhoods with higher proportion grass/shrub cover or overall greenness. The most substantially narrowed inequities were those by the ICE. Mortality inequities did not differ substantially by perceived park access, and tree canopy was associated with weaker ICE-based inequities only. In this ecologic analysis, neighborhood greenspace was associated with weaker mortality inequities. However, associations varied across greenspace type and sociodemographic composition metrics, with generally stronger associations with overall greenness and grass/shrub coverage, and for ICE-basedinequities.
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Affiliation(s)
- Leah H Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
- Urban Health Collaborative, Dornsife School of Public Health, Drexel Univeristy, Philadelphia, PA, USA.
| | - Michelle C Kondo
- USDA Forest Service, Northern Research Station, Philadelphia Field Station, 100 North 20th Street, Suite 205, Philadelphia, PA, 19103, USA
| | - Janelle Edwards
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Urban Health Collaborative, Dornsife School of Public Health, Drexel Univeristy, Philadelphia, PA, USA
| | - Jane E Clougherty
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Urban Health Collaborative, Dornsife School of Public Health, Drexel Univeristy, Philadelphia, PA, USA
| | - Anneclaire J De Roos
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Urban Health Collaborative, Dornsife School of Public Health, Drexel Univeristy, Philadelphia, PA, USA
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel Univeristy, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel Univeristy, Philadelphia, PA, USA
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Santa-Ramírez HA, Otálvaro-Castro GJ, Joost S, Melgar-Quiñonez H, Bilal U, Stringhini S. Small area vulnerability, household food insecurity and child malnutrition in Medellin, Colombia: results from a repeated cross-sectional study. Lancet Reg Health Am 2023; 23:100521. [PMID: 37275622 PMCID: PMC10238747 DOI: 10.1016/j.lana.2023.100521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/27/2023] [Accepted: 05/11/2023] [Indexed: 06/07/2023]
Abstract
Background Malnutrition and food insecurity might be driven not only by individual factors but also by contextual conditions, such as area-level deprivation or vulnerability. This study aimed to analyze the association between area-level vulnerability and i) household food insecurity and ii) malnutrition in children in Medellin, Colombia, during the years 2017 and 2018. Methods We obtained data from two different sources: the Living Standards Measurement Survey (LSMS) and the nutrition surveillance system of Medellin. The main outcomes were food insecurity in households with children and anthropometric indicators for children under five. The main predictor was area-level vulnerability. Mixed effects Poisson regression with robust standard errors models were conducted to test the association of quintiles of deprivation with each outcome. Findings Households with children living in areas with the highest deprivation had 1.9 times the prevalence of food insecurity as compared to those living in areas with the lowest deprivation (PR 1.91, 95% CI 1.42-2.57). Similar results were observed for underweight/risk of underweight (PR 1.26, 95% CI 1.11-1.42), stunting/risk of stunting (PR 1.36, 95% CI 1.22-1.53) and stunting (PR 1.93 95% CI 1.55-2.39) among children under five. We found no consistent associations with wasting/risk of wasting or excess weight/risk of overweight across quintiles of deprivation. Interpretation This study sheds light on the role of area-level vulnerability on malnutrition in children in Medellin, Colombia, showing a pattern of increasing prevalence of food insecurity, underweight and stunting by quintile of deprivation. Funding Swiss School of Public Health (SSPH+) and Centre for Global Health Inequalities Research (CHAIN).
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Affiliation(s)
- Hugo-Alejandro Santa-Ramírez
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- Health Policy and Management Research Group, National Faculty of Public Health, University of Antioquia, Medellin, Colombia
| | - Gabriel-Jaime Otálvaro-Castro
- Health Policy and Management Research Group, National Faculty of Public Health, University of Antioquia, Medellin, Colombia
| | - Stéphane Joost
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- Group of Geographic Information Research and Analysis in Population Health (GIRAPH), Geneva, Switzerland
- Laboratory of Geographic Information Systems (LASIG), School of Architecture, Civil and Environmental Engineering (ENAC), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Hugo Melgar-Quiñonez
- McGill Institute for Global Food Security, School of Human Nutrition, McGill University, Montreal, Canada
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- University Centre for General Medicine and Public Health (UNISANTE), University of Lausanne, Lausanne, Switzerland
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Martín-Turrero I, Sureda X, Escobar F, Bilal U, Berasaluce M, Valiente R. How Can We Measure Alcohol Outlet Density Around Schools? A Comparison Between Two Buffer-Based Methods. J Urban Health 2023:10.1007/s11524-023-00740-z. [PMID: 37351726 DOI: 10.1007/s11524-023-00740-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/24/2023]
Abstract
Measuring the density of alcohol outlets around schools is a critical step towards understanding the drivers of drinking among adolescents. Different methodologies have been used in the literature for this purpose, but the implications of using one methodology or another have not been clearly assessed. Our aim was to compare different methods to measure alcohol outlet density and highlight under which characteristics of the environment might be best using each approach. We used Geographic Information Systems to geolocate schools (n = 576) and alcohol outlets (n = 21,732) in Madrid. We defined the density of alcohol outlets as the number of establishments within an area of 400 m around schools measured using two buffering methods: crow flies' and street network distances. We evaluated the agreement between both methods visually and through regression models, including street connectivity, population density, and density of recreational venues as predictors of disagreement. The density of alcohol outlets around schools was higher using crow flies' distances compared to street network distances. The differences between methodologies were wider in areas of higher density of outlets, especially in the downtown areas, where there are higher population density and street connectivity. Our results suggest that the spatial characteristics and morphology of the study area (e.g., street connectivity and population density) should be considered when deciding the methodology to be used to measure alcohol outlet density. Future studies should explore the implications of different exposure measures in their association with drinking prevalence and consumption patterns among different geographical contexts.
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Affiliation(s)
- Irene Martín-Turrero
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Campus Universitario - Crta. de Madrid-Barcelona, Km. 33,600. Alcalá de Henares, 28871, Madrid, Spain
| | - Xisca Sureda
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Campus Universitario - Crta. de Madrid-Barcelona, Km. 33,600. Alcalá de Henares, 28871, Madrid, Spain.
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, 10027, USA.
- Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - Francisco Escobar
- Department of Geology, Geography and Environmental Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, 19104, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, 19104, USA
| | - Maitane Berasaluce
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Campus Universitario - Crta. de Madrid-Barcelona, Km. 33,600. Alcalá de Henares, 28871, Madrid, Spain
| | - Roberto Valiente
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Campus Universitario - Crta. de Madrid-Barcelona, Km. 33,600. Alcalá de Henares, 28871, Madrid, Spain
- Center for Research on Environment, Society and Health (CRESH), School of GeoSciences, University of Edinburgh, Edinburgh, UK
- SPECTRUM Consortium, London, UK
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Schnake-Mahl AS, Bilal U. Invited Commentary: Some Social Epidemiologic Lessons From the COVID-19 Pandemic. Am J Epidemiol 2023; 192:861-865. [PMID: 36617304 PMCID: PMC10505416 DOI: 10.1093/aje/kwad001] [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: 07/22/2022] [Revised: 10/13/2022] [Accepted: 12/19/2022] [Indexed: 01/09/2023] Open
Abstract
In their recent article, Dimitris et al. (Am J Epidemiol. 2022;191(6):980-986) presented a series of challenges modern epidemiology has faced during the coronavirus disease 2019 (COVID-19) pandemic, including challenges around the scientific progress, epidemiologic methods, interventions, equity, team science, and training needed to address these issues. Here, 2 social epidemiologists who have been working on COVID-19 inequities reflect on further lessons with an added year of perspective. We focus on 2 key challenges: 1) dominant biomedical individualistic narratives around the production of population health, and 2) the role of profit in policy-making. We articulate a need to consider social epidemiologic approaches, including acknowledging the importance of considering how societal systems lead to health inequities. To address these challenges, future (and current) epidemiologists should be trained in theories of population health distribution and political structures of governance. Last, we close with the need for better investment in public health infrastructure as a crucial step toward achieving population health equity.
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Affiliation(s)
- Alina S Schnake-Mahl
- Correspondence to Dr. Alina Schnake-Mahl, Urban Health Collaborative, Drexel Dornsife School of Public Health, Drexel University, 3600 Market Street, 7th floor, Philadelphia, PA 19104 (e-mail: )
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15
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Trotta A, Bilal U, Acharya B, Quick H, Moore K, Perner SM, Alazraqui M, Diez Roux A. Spatial Inequities in Life Expectancy in Small Areas of Buenos Aires, Argentina 2015-2017. J Urban Health 2023; 100:577-590. [PMID: 37225944 PMCID: PMC10323071 DOI: 10.1007/s11524-023-00730-1] [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: 04/14/2023] [Indexed: 05/26/2023]
Abstract
Studies of life expectancy (LE) in small areas of cities are relatively common in high-income countries but rare in Latin American countries. Small-area estimation methods can help to describe and quantify inequities in LE between neighborhoods and their predictors. Our objective was to analyze the distribution and spatial patterning of LE across small areas of Ciudad Autónoma de Buenos Aires (CABA), Argentina, and its association with socioeconomic characteristics. As part of the SALURBAL project, we used georeferenced death certificates in 2015-2017 for CABA, Argentina. We used a spatial Bayesian Poisson model using the TOPALS method to estimate age- and sex-specific mortality rates. We used life tables to estimate LE at birth. We obtained data on neighborhood socioeconomic characteristics from the 2010 census and analyzed their associations. LE at birth was higher for women (median of across neighborhoods = 81.1 years) compared to men (76.7 years). We found a gap in LE of 9.3 (women) and 14.9 years (men) between areas with the highest and the lowest LE. Better socioeconomic characteristics were associated with higher LE. For example, mean differences in LE at birth in areas with highest versus lowest values of composite SES index were 2.79 years (95% CI: 2.30 to 3.28) in women and 5.61 years (95% CI: 4.98 to 6.24) in men. We found large spatial inequities in LE across neighborhoods of a large city in Latin America, highlighting the importance of place-based policies to address this gap.
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Affiliation(s)
- Andrés Trotta
- Institute of Collective Health, National University of Lanus, Buenos Aires, Argentina.
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Binod Acharya
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Harrison Quick
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Serena Mónica Perner
- Institute of Collective Health, National University of Lanus, Buenos Aires, Argentina
| | - Marcio Alazraqui
- Institute of Collective Health, National University of Lanus, Buenos Aires, Argentina
| | - Ana Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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16
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Dsouza N, Carroll-Scott A, Bilal U, Headen IE, Reis R, Martinez-Donate AP. Investigating the measurement properties of livability: a scoping review. Cities Health 2023; 7:839-853. [PMID: 38046106 PMCID: PMC10691868 DOI: 10.1080/23748834.2023.2202894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/11/2023] [Indexed: 12/05/2023]
Abstract
Connecting evidence-based public health recommendations to livability, a popular and relatable construct, can increase the policy relevance of research to improve community design. However, there are many different definitions and conceptualizations of livability and little consensus about its measurement. Improved measurement, including standardization, is needed to increase understanding of livability's influence on health and to facilitate comparisons across contexts. This study sought to review existing livability measures, how they were created, and evidence regarding their reliability and validity. A scoping review of three databases (PubMed, Google Scholar, and Web of Science) identified 744 eligible studies. After screening, 24 studies, 15 from the original search and 9 through backward citation searches, were included in the review. Most studies were carried out in an urban context. There was minimal consensus across studies on the conceptualization of livability. However, measure domains and indicators overlapped significantly. While the process used to validate the measures varied, most studies reported high levels of reliability and found that livability was correlated with similar measures (e.g. place satisfaction, neighborhood safety, and sense of place) and self-reported health and wellbeing. Further research is needed to develop parsimonious, standardized measures of livability in order to create and sustain livable communities worldwide.
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Affiliation(s)
- Nishita Dsouza
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Amy Carroll-Scott
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Usama Bilal
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Irene E. Headen
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Rodrigo Reis
- Brown School, Washington University in St Louis, St. Louis, MO, USA
| | - Ana P. Martinez-Donate
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Kephart JL, Gouveia N, Rodriguez DA, Indvik K, Alfaro T, Texcalac JL, Miranda JJ, Bilal U, Roux AVD. Ambient nitrogen dioxide in 47,187 neighborhoods across 326 cities in eight Latin American countries: population exposures and associations with urban features. medRxiv 2023:2023.05.02.23289390. [PMID: 37205591 PMCID: PMC10187449 DOI: 10.1101/2023.05.02.23289390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Background Health research on ambient nitrogen dioxide (NO2) is sparse in Latin America, despite the high prevalence of NO2-associated respiratory diseases in the region. This study describes within-city distributions of ambient NO2 concentrations at high spatial resolution and urban characteristics associated with neighborhood ambient NO2 in 326 Latin American cities. Methods We aggregated estimates of annual surface NO2 at 1 km2 spatial resolution for 2019, population counts, and urban characteristics compiled by the SALURBAL project to the neighborhood level (i.e., census tracts). We described the percent of the urban population living with ambient NO2 levels exceeding WHO Air Quality Guidelines. We used multilevel models to describe associations of neighborhood ambient NO2 concentrations with population and urban characteristics at the neighborhood and city levels. Findings We examined 47,187 neighborhoods in 326 cities from eight Latin American countries. Of the ≈236 million urban residents observed, 85% lived in neighborhoods with ambient annual NO2 above WHO guidelines. In adjusted models, higher neighborhood-level educational attainment, closer proximity to the city center, and lower neighborhood-level greenness were associated with higher ambient NO2. At the city level, higher vehicle congestion, population size, and population density were associated with higher ambient NO2. Interpretation Almost nine out of every 10 residents of Latin American cities live with ambient NO2 concentrations above WHO guidelines. Increasing neighborhood greenness and reducing reliance on fossil fuel-powered vehicles warrant further attention as potential actionable urban environmental interventions to reduce population exposure to ambient NO2. Funding Wellcome Trust, National Institutes of Health, Cotswold Foundation.
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Affiliation(s)
- Josiah L. Kephart
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Nelson Gouveia
- Department of Preventive Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Daniel A. Rodriguez
- Department of City and Regional Planning and Institute for Transportation Studies, University of California, Berkeley, California, USA
| | - Katy Indvik
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Tania Alfaro
- Escuela de Salud Pública, Universidad de Chile, Santiago de Chile, Chile
| | - José Luis Texcalac
- Department of Environmental Health, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - J. Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Ana V. Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
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Cereijo L, Gullón P, Del Cura I, Valadés D, Bilal U, Franco M, Badland H. Exercise facility availability and incidence of type 2 diabetes and complications in Spain: A population-based retrospective cohort 2015-2018. Health Place 2023; 81:103027. [PMID: 37087897 DOI: 10.1016/j.healthplace.2023.103027] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND To study the association between exercise facility availability and type 2 diabetes incidence and its complications, and to explore effect modification by socioeconomic status (SES) and sex in the Madrid adult population. METHODS A multilevel longitudinal design, based on a population-based retrospective cohort including 1,214,281 residents of Madrid (Spain) aged 40-75 years from 2015 to 2018. Outcomes were type 2 diabetes incidence and macrovascular (cardiac ischemia and/or stroke) and microvascular (chronic kidney disease, retinopathy, and/or peripheral vascular disease) complications in those with diabetes at baseline. Exercise facility availability was defined as the count of exercise facilities in a 1000 m street network buffer around each participant's residence. Poisson regression models with robust standard errors were used to estimate the risk ratios (RR). Interactions were explored with SES tertiles and by sex. RESULTS Residents living in areas with lower exercise facility availability showed higher risk of type 2 diabetes (RRtertile3vs1 = 1.25, CI95% 1.21-1.30) as well as macrovascular (RRTertile3vs1 = 1.09 CI95% 1.00-1.19), and microvascular (RRTertile3vs1 = 1.10 CI95% 1.01-1.19) complications. Associations were strongest in low SES areas for type 2 diabetes (RRtertile3vs1-LOW-SES = 1.22, CI95% 1.12-1.32; RRtertile3vs1-HIGH-SES = 0.91, CI95% 0.85-0.98) and microvascular complications (RRtertile3vs1-LOW-SES = 1.12, CI95% 0,94-1,33; RRtertile3vs1-HIGH-SES = 0.88, CI95% 0.73-1.05). CONCLUSIONS Living in areas with lower availability of exercise facilities was associated with a greater risk of type 2 diabetes and its complications. Increasing exercise opportunities, particularly in low SES areas, could help reduce the social gradient of diabetes and its complications.
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Affiliation(s)
- Luis Cereijo
- Universidad de Alcalá, Facultad de Medicina y Ciencias de la Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de investigación en epidemiología y salud pública, Alcalá de Henares, Madrid, Spain; Universidad de Alcalá, Facultad de Medicina y Ciencias de la Salud, Departamento de Ciencias Biomédicas, Grupo de investigación en gestión y entrenamiento deportivo, Alcalá de Henares, Madrid, Spain; Centre for Urban Research, RMIT University, Melbourne, Australia.
| | - Pedro Gullón
- Universidad de Alcalá, Facultad de Medicina y Ciencias de la Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de investigación en epidemiología y salud pública, Alcalá de Henares, Madrid, Spain; Centre for Urban Research, RMIT University, Melbourne, Australia.
| | - Isabel Del Cura
- Unidad de investigación de atención primaria, Gerencia de Atención Primaria, Madrid, Spain; Departamento de especialidades médicas y salud pública, University Rey Juan Carlos, Madrid, Spain; Red de Investigación en Servicios de Salud y Enfermedades Crónicas (REDISSEC) & Red de la Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPs) ISCIII, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañon. IiSGM, Madrid, Spain.
| | - David Valadés
- Universidad de Alcalá, Facultad de Medicina y Ciencias de la Salud, Departamento de Ciencias Biomédicas, Grupo de investigación en gestión y entrenamiento deportivo, Alcalá de Henares, Madrid, Spain.
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA.
| | - Manuel Franco
- Universidad de Alcalá, Facultad de Medicina y Ciencias de la Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de investigación en epidemiología y salud pública, Alcalá de Henares, Madrid, Spain; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Hannah Badland
- Centre for Urban Research, RMIT University, Melbourne, Australia.
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19
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Fontán-Vela M, Gullón P, Bilal U, Franco M. Social and ideological determinants of COVID-19 vaccination status in Spain. Public Health 2023; 219:139-145. [PMID: 37178560 PMCID: PMC10080268 DOI: 10.1016/j.puhe.2023.04.007] [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] [Revised: 03/27/2023] [Accepted: 04/02/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVES This study analysed the association between social and ideological determinants with COVID-19 vaccine accessibility and hesitancy in the Spanish adult population. STUDY DESIGN This was a repeated cross-sectional study. METHODS The data analysed are based on monthly surveys conducted by the Centre for Sociological Research between May 2021 and February 2022. Individuals were classified according to their COVID-19 vaccination status into (1) vaccinated (reference group); (2) willing to vaccinate but not vaccinated, proxy of lack of vaccine accessibility; and (3) hesitant, proxy of vaccine hesitancy. Independent variables included social (educational attainment, gender) and ideological determinants (voting in the last elections, importance attached to the health vs the economic impact of the pandemic, and political self-placement). We estimated odds ratio (OR) and 95% confidence interval (CI) conducting one age-adjusted multinomial logistic regression model for each determinant and then stratified them by gender. RESULTS Both social and ideological determinants had a weak association with the lack of vaccine accessibility. Individuals with medium educational attainment had higher odds of vaccine hesitancy (OR = 1.44, CI 1.08-1.93) compared with those with high educational attainment. People self-identified as conservative (OR = 2.90; CI 2.02-4.15) and those who prioritised the economic impact (OR = 3.80; CI 2.62-5.49) and voted for parties opposed to the Government (OR = 2.00; CI 1.54-2.60) showed higher vaccine hesitancy. The stratified analysis showed a similar pattern for both men and women. CONCLUSIONS Considering the determinants of vaccine uptake and hesitancy could help to design strategies that increase immunisation at the population level and minimise health inequities.
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Affiliation(s)
- M Fontán-Vela
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain; Instituto de Lengua, Literatura y Antropología, Centro Superior de Investigaciones Sociológicas, Ministerio de Ciencia e Innovación, Spain
| | - P Gullón
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain; Centre for Urban Research, RMIT University, Melbourne, Australia.
| | - U Bilal
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain; Urban Health Collaborative, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - M Franco
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2217, USA
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20
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de Lima Friche AA, Silva UM, Bilal U, Sarmiento OL, de Salles Dias MA, Prado-Galbarro FJ, Briceño-León R, Alazraqui M, Diez-Roux AV, Caiaffa WT. Variation in youth and young adult homicide rates and their association with city characteristics in Latin America: the SALURBAL study. Lancet Reg Health Am 2023; 20:100476. [PMID: 36970493 PMCID: PMC10033737 DOI: 10.1016/j.lana.2023.100476] [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] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 02/25/2023] [Accepted: 03/07/2023] [Indexed: 03/28/2023]
Abstract
BACKGROUND Latin America and the Caribbean (LAC) is one of the most urbanized and violent regions worldwide. Homicides in youth (15-24 years old, yo) and young adults (25-39yo) are an especially pressing public health problem. Yet there is little research on how city characteristics relate to homicide rates in youth and young adults. We aimed to describe homicide rates among youth and young adults, as well as their association with socioeconomic and built environment factors across 315 cities in eight LAC countries. METHODS This is an ecological study. We estimated homicide rates in youth and young adults for the period 2010-2016. We investigated associations of homicide rates with sub-city education and GDP, Gini, density, landscape isolation, population and population growth using sex-stratified negative binomial models with city and sub-city level random intercepts, and country-level fixed effects. FINDINGS The mean sub-city homicide rate per 100,000 in persons aged 15-24 was 76.9 (SD = 95.9) in male and 6.7 (SD = 8.5) in female, and in persons aged 25-39 was 69.4 (SD = 68.9) in male and 6.0 (SD = 6.7) in female. Rates were higher in Brazil, Colombia, Mexico and El Salvador than in Argentina, Chile, Panama and Peru. There was significant variation in rates across cities and sub-cities, even after accounting for the country. In fully adjusted models, higher sub-city education scores and higher city GDP were associated with a lower homicide rate among male and female (rate ratios (RR) per SD higher value in male and female, respectively, 0.87 (CI 0.84-0.90) and 0.90 (CI 0.86-0.93) for education and 0.87 (CI 0.81-0.92) and 0.92 (CI 0.87-0.97) for GDP). A higher city Gini index was associated with higher homicide rates (RR 1.28 (CI 1.10-1.48) and 1.21 (CI 1.07-1.36) in male and female, respectively). Greater isolation da was also associated with higher homicide rates (RR 1.13 (CI 1.07-1.21) and 1.07 (CI 1.02-1.12) in male and female, respectively). INTERPRETATION City and sub-city factors are associated with homicide rates. Improvements to education, social conditions and inequality and physical integration of cities may contribute to the reduction of homicides in the region. FUNDING The Wellcome Trust [205177/Z/16/Z].
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Affiliation(s)
- Amélia Augusta de Lima Friche
- Observatory for Urban Health in Belo Horizonte, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Speech, Language and Hearing Sciences, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Corresponding author. Observatory for Urban Health in Belo Horizonte, School of Medicine, Federal University of Minas Gerais, Av. Alfredo Balena, 190, sala 730, Belo Horizonte, Minas Gerais, 30190-100, Brazil.
| | - Uriel Moreira Silva
- Observatory for Urban Health in Belo Horizonte, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Maria Angélica de Salles Dias
- Observatory for Urban Health in Belo Horizonte, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Francisco Javier Prado-Galbarro
- Population Health Research Center, National Institute of Public Health, Cuernavaca, Mexico
- Department of Research, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Roberto Briceño-León
- Federal University of Ceará, Fortaleza, Brazil & Venezuelan Observatory of Violence, Caracas, Venezuela
| | - Marcio Alazraqui
- Instituto de Salud Colectiva, Universidad Nacional de Lanús, Buenos Aires, Argentina
| | - Ana V. Diez-Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Waleska Teixeira Caiaffa
- Observatory for Urban Health in Belo Horizonte, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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21
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Díez J, Taulet G, Fontán-Vela M, González-Rábago Y, Cereijo L, Sandín-Vázquez M, Rodríguez E, Franco M, Borrell C, Bilal U, Gullón P. Trends and determinants of social inequities in cardiovascular risk factors in Spain: a mixed-methods study. Gaceta Sanitaria 2023; 37:102298. [PMID: 37004266 DOI: 10.1016/j.gaceta.2023.102298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 04/03/2023]
Abstract
This sequential mixed-methods study aims to: 1) assess spatial and temporal trends in cardiovascular risk factors by socioeconomic position from 2001 to 2020 in Spain; 2) explore public health professionals' perspectives regarding interventions that might have impacted these inequities; and 3) analyze determinants on social inequities in cardiovascular risk factors. First, we will measure the change in absolute and relative social inequities in eight cardiovascular risk factors through time trend analysis using repeated cross-sectional data from both National and European Health Surveys for Spain from 2001 to 2020. Second, we will interview key informants -both at the regional and national level-, to contextualize data obtained in phase 1 and capture the content and variation of policies across regions. Third, we will use econometric methods to analyze how these identified interventions have impacted these social inequities within and across regions.
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22
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Vela E, Cleries M, Bilal U, Banach M, McEvoy JW, Mortensen MB, Blaha MJ, Nasir K, Comin-Colet J, Mauri J, Cainzos-Achirica M. Implications of the 2021 ESC cardiovascular risk classification among 283,000 European immigrants living in a low-risk region: a population-based analysis in Catalonia. Arch Med Sci 2023; 19:35-45. [PMID: 36817660 PMCID: PMC9897087 DOI: 10.5114/aoms/144631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The ESC recently classified European countries into 4 cardiovascular risk regions. However, whether Europeans from higher-risk countries living in lower-risk regions may benefit from intensive cardiovascular prevention efforts is unknown. We described the burden of risk factors and cardiovascular disease (CVD) among European-born immigrants living in Catalonia, a low-risk region. MATERIAL AND METHODS A retrospective cohort study of 5.6 million adults of European origin living in Catalonia in 2019, including 282,789 European-born immigrants, was performed. We used the regionwide healthcare database and classified participants into 5 groups: low-, moderate-, high-, and very high-risk, and local-born. Age-standardized prevalence was estimated as of December 31st, 2019 and incidence was computed during 2019 among at-risk individuals. RESULTS The very high-risk group was the largest immigrant group (N = 136,910; 48.4%), while the high-risk group was the smallest (N = 15,739; 5.6%). These two had the highest burden of coronary heart disease across all groups evaluated, in both men and women. The very high-risk group also had the highest prevalence of hypertension and obesity at young-to-middle age, and the burden of risk factors newly diagnosed during 2019 was highest in high- and very high-risk participants. The mean age at first diagnosis of risk factors and CVD was lower in these groups. CONCLUSIONS In Catalonia, residents born in high- and very-high-risk European countries are at increased risk of coronary heart disease and newly diagnosed risk factors. Low-risk European countries may consider tailored prevention efforts, early screening of risk factors, and adequate healthcare resource planning to better address the health needs of men and women from higher-risk countries.
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Affiliation(s)
- Emili Vela
- Healthcare Information and Knowledge Unit, Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Barcelona, Spain
| | - Montse Cleries
- Healthcare Information and Knowledge Unit, Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Barcelona, Spain
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia (PA), USA
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz (MUL), Lodz, Poland
| | - John W. McEvoy
- National University of Ireland and National Institute for Preventive Cardiology, Galway, Ireland
- Division of Cardiology, Department of Medicine, Saolta University Healthcare Group, University College Hospital Galway, Galway, Ireland
| | - Martin Bødtker Mortensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (MD), USA
| | - Michael Joseph Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (MD), USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore (MD), USA
| | - Khurram Nasir
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (MD), USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston (TX), USA
- Center for Outcomes Research, Houston Methodist, Houston (TX), USA
| | - Josep Comin-Colet
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Pla Director de Malalties Cardiovasculars, Health Department of the Government of Catalonia, Catalonia, Spain
| | - Josepa Mauri
- Pla Director de Malalties Cardiovasculars, Health Department of the Government of Catalonia, Catalonia, Spain
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain, Spain
| | - Miguel Cainzos-Achirica
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (MD), USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston (TX), USA
- Pla Director de Malalties Cardiovasculars, Health Department of the Government of Catalonia, Catalonia, Spain
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23
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Braverman-Bronstein A, Ortigoza AF, Vidaña-Pérez D, Barrientos-Gutiérrez T, Baldovino-Chiquillo L, Bilal U, Friche AADL, Diez-Canseco F, Maslowsky J, Vives V. A, Diez Roux AV. Gender inequality, women's empowerment, and adolescent birth rates in 363 Latin American cities. Soc Sci Med 2023; 317:115566. [PMID: 36446141 PMCID: PMC7613905 DOI: 10.1016/j.socscimed.2022.115566] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/10/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gender inequality is high in Latin America (LA). Empowering girls and young women and reducing gender gaps has been proposed as a pathway to reduce adolescent pregnancy. We investigated the associations of urban measures of women's empowerment and gender inequality with adolescent birth rates (ABR) in 366 Latin American cities in nine countries. METHODS We created a gender inequality index (GII) and three Women Achievement scores reflecting domains of women's empowerment (employment, education, and health care access) using censuses, surveys, and political participation data at city and sub-city levels. We used 3-level negative binomial models (sub-city-city-countries) to assess the association between the GII and scores, with ABR while accounting for other city and sub-city characteristics. RESULTS We found within country heterogeneity in gender inequality and women's empowerment measures. The ABR was 4% higher for each 1 standard deviation (1-SD) higher GII (RR 1.04; 95%CI 1.01,1.06), 8% lower for each SD higher autonomy score (RR 0.92; 95%CI 0.86, 0.99), and 12% lower for each SD health care access score (RR 0.88; 95%CI 0.82,0.95) after adjustment for city level population size, population growth, homicide rates, and sub-city population educational attainment and living conditions scores. CONCLUSION Our findings show the key role cities have in reducing ABR through the implementation of strategies that foster women's socioeconomic progress such as education, employment, and health care access.
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Affiliation(s)
- Ariela Braverman-Bronstein
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA.
| | - Ana F. Ortigoza
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Dèsirée Vidaña-Pérez
- Center for Survey Research and Evaluation, National Institute of Public Health Cuernavaca, Mexico
| | | | | | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA,Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Amélia Augusta de Lima Friche
- Observatory for Urban Health in Belo Horizonte, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Julie Maslowsky
- Center of Excellence in Maternal and Child Health School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alejandra Vives V.
- Department of Public Health, School of Medicine / CEDEUS. Pontificia Universidad Católica de Chile. Santiago de Chile, Chile
| | - Ana V. Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA,Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
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24
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Correa-Salazar C, Braverman-Bronstein A, Bilal U, Groves AK, Page KR, Amon JJ, Vera A, Ballesteros L, Martínez-Donate A. The impact of social violence on HIV risk for women in Colombia: A concurrent mixed methods study. PLOS Glob Public Health 2023; 3:e0001571. [PMID: 36963089 PMCID: PMC10021609 DOI: 10.1371/journal.pgph.0001571] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/01/2023] [Indexed: 02/26/2023]
Abstract
Gender, violence, and migration structurally impact health. The Venezuelan humanitarian crisis comprises the largest transnational migration in the history of the Americas. Colombia, a post-conflict country, is the primary recipient of Venezuelans. The Colombian context imposes high levels of violence on women across migration phases. There is little information on the relationship between violence and HIV risk in the region and how it impacts these groups. Evidence on how to approach the HIV response related to Venezuela's humanitarian crisis is lacking. Our study seeks to 1) understand how violence is associated with newly reported HIV/AIDS case rates for women in Colombian municipalities; and 2) describe how social violence impacts HIV risk, treatment, and prevention for Venezuelan migrant and refugee women undergoing transnational migration and resettlement in Colombia. We conducted a concurrent mixed-methods design. We used negative binomial models to explore associations between social violence proxied by Homicide Rates (HR) at the municipality level (n = 84). The also conducted 54 semi-structured interviews with Venezuelan migrant and refugee women and key informants in two Colombian cities to expand and describe contextual vulnerabilities to HIV risk, prevention and care related to violence. We found that newly reported HIV cases in women were 25% higher for every increase of 18 homicides per 100,000, after adjusting for covariates. Upon resettlement, participants cited armed actors' control, lack of government accountability, gender-based violence and stigmatization of HIV as sources of increased HIV risk for VMRW. These factors impose barriers to testing, treatment and care. Social violence in Colombian municipalities is associated with an increase in newly reported HIV/AIDS case rates in women. Violence hinders Venezuelan migrant and refugee women's access and engagement in available HIV prevention and treatment interventions.
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Affiliation(s)
- Catalina Correa-Salazar
- Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Ariela Braverman-Bronstein
- Epidemiology and Biostatistics Department, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Usama Bilal
- Epidemiology and Biostatistics Department, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Ali K Groves
- Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Kathleen R Page
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Joseph J Amon
- Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Alejandra Vera
- Corporación Mujer Denuncia y Muévete NGO, Cúcuta, Colombia
| | | | - Ana Martínez-Donate
- Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, United States of America
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25
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Anza-Ramirez C, Lazo M, Zafra-Tanaka JH, Avila-Palencia I, Bilal U, Hernández-Vásquez A, Knoll C, Lopez-Olmedo N, Mazariegos M, Moore K, Rodriguez DA, Sarmiento OL, Stern D, Tumas N, Miranda JJ. The urban built environment and adult BMI, obesity, and diabetes in Latin American cities. Nat Commun 2022; 13:7977. [PMID: 36581636 PMCID: PMC9800402 DOI: 10.1038/s41467-022-35648-w] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
Latin America is the world's most urbanized region and its heterogeneous urban development may impact chronic diseases. Here, we evaluated the association of built environment characteristics at the sub-city -intersection density, greenness, and population density- and city-level -fragmentation and isolation- with body mass index (BMI), obesity, and type 2 diabetes (T2D). Data from 93,280 (BMI and obesity) and 122,211 individuals (T2D) was analysed across 10 countries. Living in areas with higher intersection density was positively associated with BMI and obesity, whereas living in more fragmented and greener areas were negatively associated. T2D was positively associated with intersection density, but negatively associated with greenness and population density. The rapid urban expansion experienced by Latin America provides unique insights and vastly expand opportunities for population-wide urban interventions aimed at reducing obesity and T2D burden.
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Affiliation(s)
- Cecilia Anza-Ramirez
- grid.11100.310000 0001 0673 9488CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Mariana Lazo
- grid.166341.70000 0001 2181 3113Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA ,grid.166341.70000 0001 2181 3113Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA
| | - Jessica Hanae Zafra-Tanaka
- grid.11100.310000 0001 0673 9488CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ione Avila-Palencia
- grid.166341.70000 0001 2181 3113Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA ,grid.4777.30000 0004 0374 7521Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland UK
| | - Usama Bilal
- grid.166341.70000 0001 2181 3113Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA ,grid.166341.70000 0001 2181 3113Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA
| | - Akram Hernández-Vásquez
- grid.11100.310000 0001 0673 9488CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carolyn Knoll
- grid.166341.70000 0001 2181 3113Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA
| | - Nancy Lopez-Olmedo
- grid.415771.10000 0004 1773 4764Center for Population and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Mónica Mazariegos
- grid.418867.40000 0001 2181 0430INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Kari Moore
- grid.166341.70000 0001 2181 3113Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA
| | - Daniel A. Rodriguez
- grid.47840.3f0000 0001 2181 7878Department of City and Regional Planning, University of California, Berkeley, CA USA
| | - Olga L. Sarmiento
- grid.7247.60000000419370714School of Medicine, Universidad de los Andes, Bogota, Colombia
| | - Dalia Stern
- grid.415771.10000 0004 1773 4764CONACyT- Center for Population and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Natalia Tumas
- grid.5612.00000 0001 2172 2676Department of Political and Social Sciences, Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain ,grid.5612.00000 0001 2172 2676Johns Hopkins University - Pompeu Fabra University Public Policy Center (UPF-BSM), Universitat Pompeu Fabra, Barcelona, Spain ,grid.10692.3c0000 0001 0115 2557Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) y Universidad Nacional de Córdoba, Córdoba, Argentina
| | - J. Jaime Miranda
- grid.11100.310000 0001 0673 9488CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru ,grid.11100.310000 0001 0673 9488School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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D'Adamo A, Schnake-Mahl A, Mullachery PH, Lazo M, Diez Roux AV, Bilal U. Health disparities in past influenza pandemics: A scoping review of the literature. SSM Popul Health 2022; 21:101314. [PMID: 36514788 PMCID: PMC9733119 DOI: 10.1016/j.ssmph.2022.101314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/14/2022] [Accepted: 12/08/2022] [Indexed: 12/13/2022] Open
Abstract
Objective The COVID-19 pandemic has exacerbated existing health disparities. To provide a historical perspective on health disparities for pandemic acute respiratory viruses, we conducted a scoping review of the public health literature of health disparities in influenza outcomes during the 1918, 1957, 1968, and 2009 influenza pandemics. Methods We searched for articles examining socioeconomic or racial/ethnic disparities in any population, examining any influenza-related outcome (e.g., incidence, hospitalizations, mortality), during the 1918, 1957, 1968, and 2009 influenza pandemics. We conducted a structured search of English-written articles in PubMed supplemented by a snowball of articles meeting inclusion criteria. Results A total of 29 articles met inclusion criteria, all but one focusing exclusively on the 1918 or 2009 pandemics. Individuals of low socioeconomic status, or living in low socioeconomic status areas, experienced higher incidence, hospitalizations, and mortality in the 1918 and 2009 pandemics. There were conflicting results regarding racial/ethnic disparities during the 1918 pandemic, with differences in magnitude and direction by outcome, potentially due to issues in data quality by race/ethnicity. Racial/ethnic minorities had generally higher incidence, mortality, and hospitalization rates in the 1957 and 2009 pandemics. Conclusion Individuals of low socioeconomic status and racial/ethnic minorities have historically experienced worse influenza outcomes during pandemics. These historical patterns can inform current research to understand disparities in the ongoing COVID-19 pandemic and future pandemics.
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Affiliation(s)
- Angela D'Adamo
- Edward J. Bloustein School of Planning and Public Policy, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alina Schnake-Mahl
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA,Department of Health Management and Policy, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Pricila H. Mullachery
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Mariana Lazo
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA,Department of Community Health and Prevention, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Ana V. Diez Roux
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA,Corresponding author. Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St. Suite 730, Philadelphia, PA, USA
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Schnake-Mahl AS, Jahn JL, Purtle J, Bilal U. Considering multiple governance levels in epidemiologic analysis of public policies. Soc Sci Med 2022; 314:115444. [PMID: 36274459 PMCID: PMC9896379 DOI: 10.1016/j.socscimed.2022.115444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/04/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
Abstract
Epidemiology is increasingly asking questions about the use of policies to address structural inequities and intervene on health disparities and public health challenges. However, there has been limited explicit consideration of governance structures in the design of epidemiologic policy analysis. To advance empirical and theoretical inquiry in this space, we propose a model of governance analysis in which public health researchers consider at what level 1) decision-making authority for policy sits, 2) policy is implemented, 3) and accountability for policy effects appear. We follow with examples of how these considerations might improve the evaluation of the policy drivers of population health. Consideration and integration of multiple levels of governance, as well as interactions between levels, can help epidemiologists design studies including new opportunities for quasi-experimental designs and stronger counterfactuals, better quantify the policy drivers of inequities, and aid research evidence and policy development work in targeting multiple levels of governance, ultimately supporting evidence-based policy making.
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Affiliation(s)
- Alina S Schnake-Mahl
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
| | - Jaquelyn L Jahn
- The Ubuntu Center on Racism, Global Movements & Population Health Equity, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Jonathan Purtle
- Department of Public Health Policy & Management, Global Center for Implementation Science, New York University School of Global Public Health, New York University, New York, NY, USA
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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28
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Mullachery PH, Quistberg DA, Lazo M, Indvik K, Perez-Ferrer C, López-Olmedo N, Colchero MA, Bilal U. Evaluation of the national sobriety checkpoints program in Mexico: a difference-in-difference approach with variation in timing of program adoption. Inj Epidemiol 2022; 9:32. [PMID: 36411475 PMCID: PMC9680121 DOI: 10.1186/s40621-022-00407-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/03/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Up to a third of global road traffic deaths, and one in five in Mexico, are attributable to alcohol. In 2013, Mexico launched a national sobriety checkpoints program designed to reduce drink-driving in municipalities with high rates of alcohol-related collisions. Our study measured the association between the sobriety checkpoints program and road traffic mortality rates in 106 urban municipalities. METHODS We leveraged data from the Salud Urbana en America Latina (SALURBAL), which compiles health and environmental data from cities with over 100,000 residents. Death data from 2005 to 2019 (i.e., outcome) were from official vital statistics. Among 106 Mexican municipalities defined as priority areas for intervention, 54 adopted the program (i.e., treatment) in 2013, 16 municipalities did so in 2014, 16 in 2015, 10 in 2016, 7 in 2017, and 2 in 2019. We used a difference-in-difference approach with inverse probability weighting adapted to a context where program adoption is staggered over time. RESULTS There was a 12.3% reduction in road traffic fatalities per 10,000 passenger vehicles in the post-treatment period compared to the pre-treatment period (95% Confidence Interval, - 17.8; - 6,5). There was a clear trend of decline in mortality in municipalities that adopted the program (vs. comparison) particularly after year 2 of the program. CONCLUSIONS In this study of 106 municipalities in Mexico, we found a 12.3% reduction in traffic fatalities associated with the adoption of sobriety checkpoints. There was a clear trend indicating that this association increased over time, which is consistent with sustained changes in drink-driving behavior. These findings provide support and insight for efforts to implement and evaluate the impact of sobriety checkpoint policies across Latin America.
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Affiliation(s)
- Pricila H. Mullachery
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA 19104 USA ,grid.264727.20000 0001 2248 3398Present Address: Department of Health Services Administration and Policy, Temple University College of Public Health, 1301 Cecil B. Moore Ave, Philadelphia, PA 19122 USA
| | - D. Alex Quistberg
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA 19104 USA ,Department of Environmental and Occupational Health, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA 19104 USA
| | - Mariana Lazo
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA 19104 USA ,Department of Community Health and Prevention, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA 19104 USA
| | - Katherine Indvik
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA 19104 USA
| | - Carolina Perez-Ferrer
- grid.418270.80000 0004 0428 7635National Council for Science and Technology, 03940 Mexico City, Mexico ,grid.415771.10000 0004 1773 4764Center for Nutrition and Health Research, Instituto Nacional de Salud Pública, 62100 Cuernavaca, Morelos Mexico
| | - Nancy López-Olmedo
- grid.415771.10000 0004 1773 4764Center for Population and Health Research, Instituto Nacional de Salud Pública, 62100 Cuernavaca, Morelos Mexico
| | - M. Arantxa Colchero
- grid.415771.10000 0004 1773 4764Center for Health Systems Research, Instituto Nacional de Salud Pública, 62100 Cuernavaca, Morelos Mexico
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA 19104 USA ,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA 19104 USA
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Avila-Palencia I, Sánchez BN, Rodríguez DA, Perez-Ferrer C, Miranda JJ, Gouveia N, Bilal U, Useche AF, Wilches-Mogollon MA, Moore K, Sarmiento OL, Diez Roux AV. Health and Environmental Co-Benefits of City Urban Form in Latin America: An Ecological Study. Sustainability 2022; 14:14715. [PMID: 36926000 PMCID: PMC7614319 DOI: 10.3390/su142214715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
We investigated the association of urban landscape profiles with health and environmental outcomes, and whether those profiles are linked to environmental and health co-benefits. In this ecological study, we used data from 208 cities in 8 Latin American countries of the SALud URBana en América Latina (SALURBAL) project. Four urban landscape profiles were defined with metrics for the fragmentation, isolation, and shape of patches (contiguous area of urban development). Four environmental measures (lack of greenness, PM2.5, NO2, and carbon footprint), two cause-specific mortality rates (non-communicable diseases and unintentional injury mortality), and prevalence of three risk factors (hypertension, diabetes, and obesity) for adults were used as the main outcomes. We used linear regression models to evaluate the association of urban landscape profiles with environmental and health outcomes. In addition, we used finite mixture modeling to create co-benefit classes. Cities with the scattered pixels profile (low fragmentation, high isolation, and compact shaped patches) were most likely to have positive co-benefits. Profiles described as proximate stones (moderate fragmentation, moderate isolation, and irregular shape) and proximate inkblots (moderate-high fragmentation, moderate isolation, and complex shape) were most likely to have negative co-benefits. The contiguous large inkblots profile (low fragmentation, low isolation, and complex shape) was most likely to have mixed benefits.
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Affiliation(s)
- Ione Avila-Palencia
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast BT12 6BA, Northern Ireland, UK
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
| | - Brisa N. Sánchez
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
| | - Daniel A. Rodríguez
- Department of City and Regional Planning, University of California—Berkeley, Berkeley, CA 94720, USA
- Institute for Transportation Studies, University of California—Berkeley, Berkeley, CA 94720, USA
| | | | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima 15074, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | - Nelson Gouveia
- Department of Preventive Medicine, University of São Paulo Medical School, São Paulo 01246-903, Brazil
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
| | - Andrés F. Useche
- Department of Industrial Engineering, School of Engineering, Universidad de los Andes, Bogotá 111711, Colombia
| | - Maria A. Wilches-Mogollon
- Department of Industrial Engineering, School of Engineering, Universidad de los Andes, Bogotá 111711, Colombia
| | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
| | - Olga L. Sarmiento
- School of Medicine, Universidad de los Andes, Bogotá 111711, Colombia
| | - Ana V. Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
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30
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Schnake-Mahl AS, O'Leary G, Mullachery PH, Skinner A, Kolker J, Diez Roux AV, Raifman JR, Bilal U. Higher COVID-19 Vaccination And Narrower Disparities In US Cities With Paid Sick Leave Compared To Those Without. Health Aff (Millwood) 2022; 41:1565-1574. [PMID: 36343316 PMCID: PMC9913883 DOI: 10.1377/hlthaff.2022.00779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Paid sick leave provides workers with paid time off to receive COVID-19 vaccines and to recover from potential vaccine adverse effects. We hypothesized that US cities with paid sick leave would have higher COVID-19 vaccination coverage and narrower coverage disparities than those without such policies. Using county-level vaccination data and paid sick leave data from thirty-seven large US cities in 2021, we estimated the association between city-level paid sick leave policies and vaccination coverage in the working-age population and repeated the analysis using coverage in the population ages sixty-five and older as a negative control. We also examined associations by neighborhood social vulnerability. Cities with a paid sick leave policy had 17 percent higher vaccination coverage than cities without such a policy. We found stronger associations between paid sick leave and vaccination in the most socially vulnerable neighborhoods compared with the least socially vulnerable ones, and no association in the population ages sixty-five and older. Paid sick leave policies are associated with higher COVID-19 vaccination coverage and narrower coverage disparities. Increasing access to these policies may help increase vaccination and reduce inequities in coverage.
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Affiliation(s)
| | | | - Pricila H Mullachery
- Pricila H. Mullachery, Drexel University and Temple University, Philadelphia, Pennsylvania
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Abstract
BACKGROUND Life expectancy in the United States has declined since 2014 but characterization of disparities within and across metropolitan areas of the country is lacking. METHODS Using census tract-level life expectancy from the 2010 to 2015 US Small-area Life Expectancy Estimates Project, we calculate 10 measures of total and income-based disparities in life expectancy at birth, age 25, and age 65 within and across 377 metropolitan statistical areas (MSAs) of the United States. RESULTS We found wide heterogeneity in disparities in life expectancy at birth across MSAs and regions: MSAs in the West show the narrowest disparities (absolute disparity: 8.7 years, relative disparity: 1.1), while MSAs in the South (absolute disparity: 9.1 years, relative disparity: 1.1) and Midwest (absolute disparity: 9.8 years, relative disparity: 1.1) have the widest life expectancy disparities. We also observed greater variability in life expectancy across MSAs for lower income census tracts (coefficient of variation [CoV] 3.7 for first vs. tenth decile of income) than for higher income census tracts (CoV 2.3). Finally, we found that a series of MSA-level variables, including larger MSAs and greater proportion college graduates, predicted wider life expectancy disparities for all age groups. CONCLUSIONS Sociodemographic and policy factors likely help explain variation in life expectancy disparities within and across metro areas.
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Affiliation(s)
- Alina S Schnake-Mahl
- From the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
- Department of Health Management and Policy, Drexel University, Philadelphia, PA
| | - Pricila H Mullachery
- From the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Jonathan Purtle
- Department of Public Health Policy & Management, New York University School of Global Public Health, New York, NY
| | - Ran Li
- From the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Ana V Diez Roux
- From the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Usama Bilal
- From the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
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32
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Kondo MC, McIntire RK, Bilal U, Schinasi LH. Reduction in socioeconomic inequalities in self-reported mental health conditions with increasing greenspace exposure. Health Place 2022; 78:102908. [PMID: 36193582 DOI: 10.1016/j.healthplace.2022.102908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Michelle C Kondo
- USDA Forest Service, Northern Research Station, 100 North 20th Street, Suite 205, Philadelphia, PA, 19103, USA.
| | - Russell K McIntire
- Jefferson College of Population Health, Thomas Jefferson University, 901 Walnut St., 10th Floor, Philadelphia, PA, USA.
| | - Usama Bilal
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA; Urban Health Collaborative, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
| | - Leah H Schinasi
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Environmental and Occupational Health, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
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Fernández-Escobar C, Díez J, Martínez-García A, Bilal U, O'Flaherty M, Franco M. Food availability and affordability in a Mediterranean urban context: associations by store type and area-level socio-economic status. Public Health Nutr 2022; 26:1-9. [PMID: 36274648 DOI: 10.1017/s1368980022002348] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Although food environments have been highlighted as potentially effective targets to improve population diets, evidence on Mediterranean food environments is lacking. We examined differences in food availability and affordability in Madrid (Spain) by store type and area-level socio-economic status (SES). DESIGN Cross-sectional study. Trained researchers conducted food store audits using the validated Nutrition Environment Measures Survey in Stores for Mediterranean contexts (NEMS-S-MED) tool to measure the availability and price of twelve food groups (specific foods = 35). We computed NEMS-S-MED scores and summarised price data with a Relative Price Index (RPI, comparing prices across stores) and an Affordability Index (normalising prices by area-level income). We compared the availability and affordability of 'healthier-less healthy' food pairs, scores between food store types (supermarkets, specialised, convenience stores and others) and area-level SES using ANOVA and multi-level regression models. SETTING City of Madrid. 2016 and 2019 to cover a representative sample. PARTICIPANTS Food stores within a socio-economically diverse sample of sixty-three census tracts (n 151). RESULTS Supermarkets had higher food availability (37·5/49 NEMS-S-MED points), compared to convenience stores (13·5/49) and specialised stores (8/49). Supermarkets offered lower prices (RPI: 0·83) than specialised stores (RPI: 0·97) and convenience stores (RPI: 2·06). Both 'healthy' and 'less healthy' items were more available in supermarkets. We found no differences in food availability or price by area-level SES, but affordability was higher in higher-income areas. CONCLUSIONS Supermarkets offered higher food availability and affordability for healthy and less healthy food items. Promoting healthy food availability through supermarkets and specialised stores and/or limiting access to convenience stores are promising policy options to achieve a healthier food environment.
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Affiliation(s)
- Carlos Fernández-Escobar
- National School of Public Health, Institute of Health Carlos III, Madrid, Spain
- Public Health and Epidemiology Research Group, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
| | - Julia Díez
- Public Health and Epidemiology Research Group, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
| | - Alba Martínez-García
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690Alicante, Spain
| | - Usama Bilal
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Martin O'Flaherty
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Manuel Franco
- Public Health and Epidemiology Research Group, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Mullachery PH, Li R, Melly S, Kolker J, Barber S, Diez Roux AV, Bilal U. Inequities in spatial accessibility to COVID-19 testing in 30 large US cities. Soc Sci Med 2022; 310:115307. [PMID: 36049353 PMCID: PMC9420026 DOI: 10.1016/j.socscimed.2022.115307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/16/2022] [Accepted: 08/17/2022] [Indexed: 12/24/2022]
Abstract
Testing for SARS-CoV-2 infection has been a key strategy to mitigate and control the COVID-19 pandemic. Wide spatial and racial/ethnic disparities in COVID-19 outcomes have emerged in US cities. Previous research has highlighted the role of unequal access to testing as a potential driver of these disparities. We described inequities in spatial accessibility to COVID-19 testing locations in 30 large US cities. We used location data from Castlight Health Inc corresponding to October 2021. We created an accessibility metric at the level of the census block group (CBG) based on the number of sites per population in a 15-minute walkshed around the centroid of each CBG. We also calculated spatial accessibility using only testing sites without restrictions, i.e., no requirement for an appointment or a physician order prior to testing. We measured the association between the social vulnerability index (SVI) and spatial accessibility using a multilevel negative binomial model with random city intercepts and random SVI slopes. Among the 27,195 CBG analyzed, 53% had at least one testing site within a 15-minute walkshed, and 36% had at least one site without restrictions. On average, a 1-decile increase in the SVI was associated with a 3% (95% Confidence Interval: 2% - 4%) lower accessibility. Spatial inequities were similar across various components of the SVI and for sites with no restrictions. Despite this general pattern, several cities had inverted inequity, i.e., better accessibility in more vulnerable areas, which indicates that some cities may be on the right track when it comes to promoting equity in COVID-19 testing. Testing is a key component of the strategy to mitigate transmission of SARS-CoV-2 and efforts should be made to improve accessibility to testing, particularly as new and more contagious variants become dominant.
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Affiliation(s)
- Pricila H. Mullachery
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA,Department of Health Services Administration and Policy, Temple University College of Public Health, 1301 Cecil B. Moore Ave, Philadelphia, PA, 19122, USA,Corresponding author. 1301 Cecil B. Moore Ave., 539, Philadelphia, PA, 19122, United States
| | - Ran Li
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA
| | - Steven Melly
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA
| | - Jennifer Kolker
- Department of Health Management and Policy, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Sharrelle Barber
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA,Ubuntu Center on Racism, Global Movements, and Population Health Equity, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA
| | - Ana V. Diez Roux
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA
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Abstract
We estimated excess mortality in Chilean cities during the COVID-19 pandemic and its association with city-level factors. We used mortality, and social and built environment data from the SALURBAL study for 21 Chilean cities, composed of 81 municipalities or "comunas", grouped in 4 macroregions. We estimated excess mortality by comparing deaths from January 2020 up to June 2021 vs 2016-2019, using a generalized additive model. We estimated a total of 21,699 (95%CI 21,693 to 21,704) excess deaths across the 21 cities. Overall relative excess mortality was highest in the Metropolitan (Santiago) and the North regions (28.9% and 22.2%, respectively), followed by the South and Center regions (17.6% and 14.1%). At the city-level, the highest relative excess mortality was found in the Northern cities of Calama and Iquique (around 40%). Cities with higher residential overcrowding had higher excess mortality. In Santiago, capital of Chile, municipalities with higher educational attainment had lower relative excess mortality. These results provide insight into the heterogeneous impact of COVID-19 in Chile, which has served as a magnifier of preexisting urban health inequalities, exhibiting different impacts between and within cities. Delving into these findings could help prioritize strategies addressed to prevent deaths in more vulnerable communities.
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Affiliation(s)
- Tania Alfaro
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Independencia 939, Santiago, Chile.
| | - Kevin Martinez-Folgar
- Urban Health Collaborative; and Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Alejandra Vives
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, CEDEUS, Santiago, Chile
| | - Usama Bilal
- Urban Health Collaborative; and Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
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Rodríguez López S, Tumas N, Bilal U, Moore KA, Acharya B, Quick H, Quistberg DA, Acevedo GE, Diez Roux AV. Intraurban socioeconomic inequalities in life expectancy: a population-based cross-sectional analysis in the city of Córdoba, Argentina (2015-2018). BMJ Open 2022; 12:e061277. [PMID: 36691155 PMCID: PMC9442478 DOI: 10.1136/bmjopen-2022-061277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 08/18/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To evaluate variability in life expectancy at birth in small areas, describe the spatial pattern of life expectancy, and examine associations between small-area socioeconomic characteristics and life expectancy in a mid-sized city of a middle-income country. DESIGN Cross-sectional, using data from death registries (2015-2018) and socioeconomic characteristics data from the 2010 national population census. PARTICIPANTS/SETTING 40 898 death records in 99 small areas of the city of Córdoba, Argentina. We summarised variability in life expectancy at birth by using the difference between the 90th and 10th percentile of the distribution of life expectancy across small areas (P90-P10 gap) and evaluated associations with small-area socioeconomic characteristics by calculating a Slope Index of Inequality in linear regression. PRIMARY OUTCOME Life expectancy at birth. RESULTS The median life expectancy at birth was 80.3 years in women (P90-P10 gap=3.2 years) and 75.1 years in men (P90-P10 gap=4.6 years). We found higher life expectancies in the core and northwest parts of the city, especially among women. We found positive associations between life expectancy and better small-area socioeconomic characteristics, especially among men. Mean differences in life expectancy between the highest versus the lowest decile of area characteristics in men (women) were 3.03 (2.58), 3.52 (2.56) and 2.97 (2.31) years for % adults with high school education or above, % persons aged 15-17 attending school, and % households with water inside the dwelling, respectively. Lower values of % overcrowded households and unemployment rate were associated with longer life expectancy: mean differences comparing the lowest versus the highest decile were 3.03 and 2.73 in men and 2.57 and 2.34 years in women, respectively. CONCLUSION Life expectancy is substantially heterogeneous and patterned by socioeconomic characteristics in a mid-sized city of a middle-income country, suggesting that small-area inequities in life expectancy are not limited to large cities or high-income countries.
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Affiliation(s)
- Santiago Rodríguez López
- Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas, Córdoba, Argentina
- Cátedra de Antropología, Departamento de Fisiología, Facultad de Ciencias Exactas Físicas y Naturales, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Natalia Tumas
- Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas, Córdoba, Argentina
- Research Group on Health Inequalities, Environment, and Employment Conditions Network (GREDS-EMCONET), Department of Social and Political Science, Universitat Pompeu Fabra, Barcelona, Spain
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Kari A Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Binod Acharya
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Harrison Quick
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - D Alex Quistberg
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Gabriel E Acevedo
- Cátedra de Medicina Preventiva y Social, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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De Ramos IP, Auchincloss AH, Bilal U. Exploring inequalities in life expectancy and lifespan variation by race/ethnicity and urbanicity in the United States: 1990 to 2019. SSM Popul Health 2022; 19:101230. [PMID: 36148325 PMCID: PMC9485214 DOI: 10.1016/j.ssmph.2022.101230] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background/Objective Investigating trends in life expectancy and lifespan variation can highlight disproportionate mortality burdens among population subgroups. We examined inequalities in life expectancy and lifespan variation by race/ethnicity and by urbanicity in the US from 1990 to 2019. Methods Using vital registration data for 322.0 million people in 3,141 counties from the National Center for Health Statistics, we obtained life expectancy at birth and lifespan variation for 16 race/ethnicity-gender-urbanicity combinations in six 5-year periods (1990-1994 to 2015-2019). Race/ethnicity was categorized as Hispanic, and non-Hispanic White, Black, and Asian/Pacific Islander. Urbanicity was categorized as metropolitan vs nonmetropolitan areas, or in six further detailed categorizations. Life expectancy and lifespan variation (coefficient of variation) were computed using life tables. Results In 2015-2019, residents in metropolitan areas had higher life expectancies than their nonmetropolitan counterparts (79.6 years compared to 77.0 years). The widest inequality in life expectancy occurred between Asian/Pacific Islander women and Black men, with a 17.7-year gap for residents in metropolitan areas and a 16.9-year gap for residents in nonmetropolitan areas. Nonmetropolitan areas had greater dispersion around average age at death. Black individuals had the highest lifespan variations in both metropolitan and nonmetropolitan areas. Until the mid-2010s, life expectancy increased while lifespan variation decreased; however, recent trends show stagnation in life expectancy and increases in lifespan variation. Metropolitan-nonmetropolitan inequalities in both life expectancy and lifespan variation widened over time. Conclusion Despite previous improvements in longevity, life expectancy is now stagnating while lifespan variation is increasing. Our results highlight that early-life deaths (i.e., young- and middle-age mortality) disproportionately affect Black individuals, who not only live the shortest lifespans but also have the most variability with respect to age at death.
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Affiliation(s)
- Isabel P. De Ramos
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Amy H. Auchincloss
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
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38
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Mullachery PH, Vela E, Cleries M, Comin-Colet J, Nasir K, Diez Roux AV, Cainzos-Achirica M, Mauri J, Bilal U. Inequalities by Income in the Prevalence of Cardiovascular Disease and Its Risk Factors in the Adult Population of Catalonia. J Am Heart Assoc 2022; 11:e026587. [PMID: 36000437 PMCID: PMC9496415 DOI: 10.1161/jaha.122.026587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Understanding the magnitude of cardiovascular disease (CVD) inequalities is the first step toward addressing them. The linkage of socioeconomic and clinical data in universal health care settings provides critical information to characterize CVD inequalities. Methods and Results We employed a prospective cohort design using electronic health records data from all residents of Catalonia aged 18+ between January and December of 2019 (N=6 332 228). We calculated age‐adjusted sex‐specific prevalence of 5 CVD risk factors (diabetes, hypertension, hyperlipidemia, obesity, and smoking), and 4 CVDs (coronary heart disease, cerebrovascular disease, atrial fibrillation, and heart failure). We categorized income into high, moderate, low, and very low according to individual income (tied to prescription copayments) and receipt of welfare support. We found large inequalities in CVD and CVD risk factors among men and women. CVD risk factors with the largest inequalities were diabetes, smoking, and obesity, with prevalence rates 2‐ or 3‐fold higher for those with very low (versus high) income. CVDs with the largest inequalities were cerebrovascular disease and heart failure, with prevalence rates 2 to 4 times higher for men and women with very low (versus high) income. Inequalities varied by age, peaking at midlife (30–50 years) for most diseases, while decreasing gradually with age for smoking. Conclusions We found wide and heterogeneous inequalities by income in 5 CVD risk factors and 4 CVD. Our findings in a region with a high‐quality public health care system and universal coverage stress that strong equity‐promoting policies are necessary to reduce disparities in CVD.
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Affiliation(s)
- Pricila H Mullachery
- Urban Health Collaborative Drexel Dornsife School of Public Health Philadelphia PA.,Department of Health Services Administration and Policy Temple University College of Public Health Philadelphia PA
| | - Emili Vela
- Healthcare Information and Knowledge Unit Health Department of the Government of Catalonia Spain.,Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya Barcelona Spain
| | - Montse Cleries
- Healthcare Information and Knowledge Unit Health Department of the Government of Catalonia Spain.,Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya Barcelona Spain
| | - Josep Comin-Colet
- Pla Director de Malalties de l'Aparell Circulatori, Health Department of the Government of Catalonia Spain.,Community Heart Failure Program, Department of Cardiology Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL) L'Hospitalet de Llobregat, Barcelona Spain.,Department of Clinical Sciences Universitat de Barcelona Spain
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX
| | - Ana V Diez Roux
- Urban Health Collaborative Drexel Dornsife School of Public Health Philadelphia PA.,Department of Epidemiology and Biostatistics Drexel Dornsife School of Public Health Philadelphia PA
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX
| | - Josepa Mauri
- Pla Director de Malalties de l'Aparell Circulatori, Health Department of the Government of Catalonia Spain.,Department of Cardiology Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Usama Bilal
- Urban Health Collaborative Drexel Dornsife School of Public Health Philadelphia PA.,Department of Epidemiology and Biostatistics Drexel Dornsife School of Public Health Philadelphia PA
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Bilal U, Mullachery PH, Schnake-Mahl A, Rollins H, McCulley E, Kolker J, Barber S, Diez Roux AV. Heterogeneity in Spatial Inequities in COVID-19 Vaccination Across 16 Large US Cities. Am J Epidemiol 2022; 191:1546-1556. [PMID: 35452081 PMCID: PMC9047229 DOI: 10.1093/aje/kwac076] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/02/2022] [Accepted: 04/14/2022] [Indexed: 01/29/2023] Open
Abstract
Differences in vaccination coverage can perpetuate coronavirus disease 2019 (COVID-19) disparities. We explored the association between neighborhood-level social vulnerability and COVID-19 vaccination coverage in 16 large US cities from the beginning of the vaccination campaign in December 2020 through September 2021. We calculated the proportion of fully vaccinated adults in 866 zip code tabulation areas (ZCTAs) of 16 large US cities: Long Beach, Los Angeles, Oakland, San Diego, San Francisco, and San Jose, all in California; Chicago, Illinois; Indianapolis, Indiana; Minneapolis, Minnesota; New York, New York; Philadelphia, Pennsylvania; and Austin, Dallas, Fort Worth, Houston, and San Antonio, all in Texas. We computed absolute and relative total and Social Vulnerability Index-related inequities by city. COVID-19 vaccination coverage was 0.75 times (95% confidence interval: 0.69, 0.81) or 16 percentage points (95% confidence interval: 12.1, 20.3) lower in neighborhoods with the highest social vulnerability as compared with those with the lowest. These inequities were heterogeneous, with cities in the West generally displaying narrower inequities in both the absolute and relative scales. The Social Vulnerability Index domains of socioeconomic status and of household composition and disability showed the strongest associations with vaccination coverage. Inequities in COVID-19 vaccinations hamper efforts to achieve health equity, as they mirror and could lead to even wider inequities in other COVID-19 outcomes.
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Affiliation(s)
- Usama Bilal
- Correspondence to Dr. Usama Bilal, 3600 Market Street, Suite 730, Philadelphia, PA, 19104 (e-mail: )
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40
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Ramírez-Toscano Y, Pérez-Ferrer C, Bilal U, Auchincloss AH, Barrientos-Gutierrez T. Socioeconomic deprivation and changes in the retail food environment of Mexico from 2010 to 2020. Health Place 2022; 77:102865. [PMID: 35932595 PMCID: PMC7613304 DOI: 10.1016/j.healthplace.2022.102865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/26/2022] [Accepted: 07/12/2022] [Indexed: 11/04/2022]
Abstract
We aimed to analyze the change in the retail food environment of Mexican municipalities from 2010 to 2020, and to assess if these trends were modified by socioeconomic deprivation. We used data from the National Statistical Directory of Economic Units. Changes in the food store count were estimated using fixed-effects Poisson regression models, including coefficients for time, socioeconomic deprivation, and their interaction. We found a rapid growth in convenience stores, seed-grain stores, and supermarkets while small food retail stores declined. Urban areas had a higher count of all types of food stores; however, the steepest increases in food stores were observed in non-urban areas. The increase in convenience stores, supermarkets, specialty food stores, fruit-vegetable stores, and seed-grain stores was greater in the most deprived areas, compared to the least deprived areas. There has been a substantial expansion and rapid change in Mexico's food environment, mainly driven by increases in convenience stores and supermarkets in more deprived and less urbanized areas.
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Affiliation(s)
- Yenisei Ramírez-Toscano
- Center for Population Health Research, National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, Cuernavaca, Morelos, CP 62100, Mexico
| | - Carolina Pérez-Ferrer
- Center for Nutrition and Health Research, National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, Cuernavaca, Morelos, CP 62100, Mexico; National Council for Science and Technology (CONACYT), Av. Insurgentes Sur 1582, Crédito Constructor, Benito Juárez, CP 03940, Ciudad de México, Mexico
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market Street, Philadelphia, PA, 19104, USA; Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Nesbitt Hall, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Amy H Auchincloss
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market Street, Philadelphia, PA, 19104, USA; Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Nesbitt Hall, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Tonatiuh Barrientos-Gutierrez
- Center for Population Health Research, National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, Cuernavaca, Morelos, CP 62100, Mexico.
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Schnake-Mahl A, Bilal U. Disaggregating disparities: A case study of heterogenous COVID-19 disparities across waves, geographies, social vulnerability, and political lean in Louisiana. Prev Med Rep 2022; 28:101833. [PMID: 35637894 PMCID: PMC9132785 DOI: 10.1016/j.pmedr.2022.101833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/30/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022] Open
Abstract
While the first wave of COVID-19 primarily impacted urban areas, subsequent waves were more widespread. Most analysis of Covid-19 rates examine state or metropolitan areas, ignoring potential heterogeneity within states and metro areas, over time, and between populations with differing contextual and compositional features. In this study, we compare spatial and temporal trends in Covid-19 cases and deaths in Louisiana, USA, over time and across populations and geographies (New Orleans, other urban areas, suburban, rural) and parish-level political lean. We employ publicly available longitudinal census tract and parish-level Covid-19 data reported from February 27th, 2020 to October 27th, 2021. We find that incidence and mortality rates were initially highest in New Orleans and Democratic areas and higher in other geographies and more conservative areas during subsequent waves. We also find wide relative disparities during the first wave, where increased social vulnerability was associated with increased positivity and incidence across geographies and political contexts. However, relative disparities diverged by geography and political lean and outcome across the remaining waves. This work draws attention to the differential rates of Covid-19 cases and deaths by geography, time, and population throughout the pandemic, and importance of political and geographic boundaries for rates of Covid-19.
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Affiliation(s)
- Alina Schnake-Mahl
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
- Department of Health Management and Policy, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
- Corresponding author at: 3600 Market St. Suite 730, Philadelphia, PA 19104, USA.
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
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Moran KM, Mullachery PH, Lankenau S, Bilal U. Changes in Racial/Ethnic Disparities in Opioid-Related Outcomes in Urban Areas during the COVID-19 Pandemic: A Rapid Review of the Literature. IJERPH 2022; 19:ijerph19159283. [PMID: 35954640 PMCID: PMC9368442 DOI: 10.3390/ijerph19159283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/08/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023]
Abstract
Opioid use disorders (OUDs) are increasingly common among minoritized populations, who have historically experienced limited access to healthcare, a situation that may have worsened during the COVID-19 pandemic. Using a structured keyword search in Pubmed, we reviewed the literature to synthesize the evidence on changes in racial/ethnic disparities in OUD-related outcomes in urban areas during the COVID-19 pandemic in the US. Nine articles were included in the final analysis. Six found increases in OUD-related outcomes during the pandemic, with four showing a widening of disparities. Results also point to the worsening of opioid outcomes among Black and Latinx individuals related to shelter-in-place or stay-at-home orders. Studies examining the use of telehealth and access to OUD treatment showed that minoritized groups have benefited from telehealth programs. The limited number of studies in a small number of jurisdictions indicate a gap in research examining the intersection between COVID-19 and OUD-related outcomes with a focus on disparities. More research is needed to understand the impact of the COVID-19 pandemic and related policies on OUD outcomes among racial/ethnic minoritized groups, including examining the impact of service disruptions on vulnerable groups with OUD.
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Affiliation(s)
- Kara M. Moran
- College of Nursing and Health Professions, Drexel University, 1601 Cherry Street, Philadelphia, PA 19102, USA;
| | - Pricila H. Mullachery
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street, Philadelphia, PA 19104, USA;
- Correspondence:
| | - Stephen Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA;
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street, Philadelphia, PA 19104, USA;
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA
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43
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Lazo M, Martinez-Folgar K, Bilal U. Racial/Ethnic Disparities in Hepatocellular Carcinoma: The Role of Neighborhood Socioeconomic Deprivation. Cancer Epidemiol Biomarkers Prev 2022; 31:1254-1256. [PMID: 35775232 DOI: 10.1158/1055-9965.epi-22-0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022] Open
Abstract
The prevention of hepatocellular carcinoma (HCC) and reduction of its disparities necessitates research on the role of contextual social determinants of health. Empirical evidence on the role of contextual factors (e.g., neighborhood built and social environment) in these disparities is extremely limited. Oluyomi and colleagues conducted a Texas-wide study examining the contribution of neighborhood-level socioeconomic deprivation, proxied by the area deprivation index on HCC disparities. Future studies are needed to complement and extend these findings. See related article by Oluyomi et al., p. 1402.
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Affiliation(s)
- Mariana Lazo
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania.,Department of Community Health and Prevention, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Kevin Martinez-Folgar
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania.,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania.,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania
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44
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De Ramos IP, Lazo M, Schnake-Mahl A, Li R, Martinez-Donate AP, Roux AVD, Bilal U. COVID-19 Outcomes Among the Hispanic Population of 27 Large US Cities, 2020-2021. Am J Public Health 2022; 112:1034-1044. [PMID: 35588187 PMCID: PMC9222469 DOI: 10.2105/ajph.2022.306809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To examine racial/ethnic disparities in COVID-19 outcomes between Hispanics and Whites across 27 US jurisdictions whose health departments are members of the Big Cities Health Coalition (BCHC). Methods. Using surveillance data from the BCHC COVID-19 dashboard as of mid-June 2021, we computed crude incidence, age-adjusted hospitalization and mortality, and full vaccination coverage rates for Hispanics and Whites by city. We estimated relative and absolute disparities cumulatively and for 2020 and 2021 and explored associations between city-level social vulnerability and the magnitude of disparities. Results. In most of the cities with available COVID-19 incidence data, rates among Hispanics were 2.2 to 6.7 times higher than those among Whites. In all cities, Hispanics had higher age-adjusted hospitalization (1.5-8.6 times as high) and mortality (1.4-6.2 times as high) rates. Hispanics had lower vaccination coverage in all but 1 city. Disparities in incidence and hospitalizations narrowed in 2021, whereas disparities in mortality remained similar. Disparities in incidence, hospitalization, mortality, and vaccination rates were wider in cities with lower social vulnerability. Conclusions. A deeper exploration of racial/ethnic disparities in COVID-19 outcomes is essential to understand and prevent disparities among marginalized communities. (Am J Public Health. 2022;112(7): 1034-1044. https://doi.org/10.2105/AJPH.2022.306809).
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Affiliation(s)
- Isabel P De Ramos
- Isabel P. De Ramos, Mariana Lazo, Alina Schnake-Mahl, Ran Li, Ana V. Diez Roux, and Usama Bilal are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Ana P. Martinez-Donate is with the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University
| | - Mariana Lazo
- Isabel P. De Ramos, Mariana Lazo, Alina Schnake-Mahl, Ran Li, Ana V. Diez Roux, and Usama Bilal are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Ana P. Martinez-Donate is with the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University
| | - Alina Schnake-Mahl
- Isabel P. De Ramos, Mariana Lazo, Alina Schnake-Mahl, Ran Li, Ana V. Diez Roux, and Usama Bilal are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Ana P. Martinez-Donate is with the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University
| | - Ran Li
- Isabel P. De Ramos, Mariana Lazo, Alina Schnake-Mahl, Ran Li, Ana V. Diez Roux, and Usama Bilal are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Ana P. Martinez-Donate is with the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University
| | - Ana P Martinez-Donate
- Isabel P. De Ramos, Mariana Lazo, Alina Schnake-Mahl, Ran Li, Ana V. Diez Roux, and Usama Bilal are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Ana P. Martinez-Donate is with the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University
| | - Ana V Diez Roux
- Isabel P. De Ramos, Mariana Lazo, Alina Schnake-Mahl, Ran Li, Ana V. Diez Roux, and Usama Bilal are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Ana P. Martinez-Donate is with the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University
| | - Usama Bilal
- Isabel P. De Ramos, Mariana Lazo, Alina Schnake-Mahl, Ran Li, Ana V. Diez Roux, and Usama Bilal are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Ana P. Martinez-Donate is with the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University
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Spoer BR, McCulley E, Lampe TM, Hsieh PY, Chen A, Ofrane R, Rollins H, Thorpe LE, Bilal U, Gourevitch MN. Validation of a neighborhood-level COVID Local Risk Index in 47 large U.S. cities. Health Place 2022; 76:102814. [PMID: 35623163 PMCID: PMC9128556 DOI: 10.1016/j.healthplace.2022.102814] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To present the COVID Local Risk Index (CLRI), a measure of city- and neighborhood-level risk for SARS COV-2 infection and poor outcomes, and validate it using sub-city SARS COV-2 outcome data from 47 large U.S. cities. METHODS Cross-sectional validation analysis of CLRI against SARS COV-2 incidence, percent positivity, hospitalization, and mortality. CLRI scores were validated against ZCTA-level SARS COV-2 outcome data gathered in 2020-2021 from public databases or through data use agreements using a negative binomial model. RESULTS CLRI was associated with each SARS COV-2 outcome in pooled analysis. In city-level models, CLRI was positively associated with positivity in 11/14 cities for which data were available, hospitalization in 6/6 cities, mortality in 13/14 cities, and incidence in 33/47 cities. CONCLUSIONS CLRI is a valid tool for assessing sub-city risk of SARS COV-2 infection and illness severity. Stronger associations with positivity, hospitalization and mortality may reflect differential testing access, greater weight on components associated with poor outcomes than transmission, omitted variable bias, or other reasons. City stakeholders can use the CLRI, publicly available on the City Health Dashboard (www.cityhealthdashboard.com), to guide SARS COV-2 resource allocation.
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Affiliation(s)
- Ben R Spoer
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA.
| | - Edwin McCulley
- Department of Epidemiology and Biostatistics, Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Taylor M Lampe
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Pei Yang Hsieh
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Alexander Chen
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Rebecca Ofrane
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Heather Rollins
- Department of Epidemiology and Biostatistics, Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Lorna E Thorpe
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Usama Bilal
- Department of Epidemiology and Biostatistics, Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Marc N Gourevitch
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
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Langellier BA, Stankov I, Hammond RA, Bilal U, Auchincloss AH, Barrientos-Gutierrez T, Cardoso LDO, Diez Roux AV. Potential impacts of policies to reduce purchasing of ultra-processed foods in Mexico at different stages of the social transition: an agent-based modelling approach. Public Health Nutr 2022; 25:1711-1719. [PMID: 34895382 PMCID: PMC7612742 DOI: 10.1017/s1368980021004833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/21/2021] [Accepted: 12/04/2021] [Indexed: 12/02/2022]
Abstract
OBJECTIVES To develop a simulation framework for assessing how combinations of taxes, nutrition warning labels and advertising levels could affect purchasing of ultra-processed foods (UPF) in Latin American countries and to understand whether policies reinforce or reduce pre-existing social disparities in UPF consumption. DESIGN We developed an agent-based simulation model using international evidence regarding the effect of price, nutrition warning labels and advertising on UPF purchasing. SETTING We estimated policy effects in scenarios representing two stages of the 'social transition' in UPF purchasing: (1) a pre-transition scenario, where UPF purchasing is higher among high-income households, similar to patterns in Mexico; and (2) a post-transition scenario where UPF purchasing is highest among low-income households, similar to patterns in Chile. PARTICIPANTS A population of 1000 individual agents with levels of age, income, educational attainment and UPF purchasing similar to adult women in Mexico. RESULTS A 20 % tax would decrease purchasing by 24 % relative to baseline in both the pre- and post-transition scenarios, an effect that is similar in magnitude to that of a nutrition warning label policy. A 50 % advertising increase or decrease had a comparatively small effect. Nutrition warning labels were most effective among those with higher levels of educational attainment. Labelling reduced inequities in the pre-transition scenario (i.e. highest UPF purchasing among the highest socio-economic group) but widened inequities in the post-transition scenario. CONCLUSIONS Effective policy levers are available to reduce UPF purchasing, but policymakers should anticipate that equity impacts will differ depending on existing social patterns in UPF purchasing.
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Affiliation(s)
- Brent A Langellier
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, 3215 Market St, Office 356, Philadelphia, PA19104, USA
| | - Ivana Stankov
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Ross A Hammond
- Center on Social Dynamics & Policy, Brookings Institution, Washington, DC, USA
- Public Health and Social Policy, Washington University in St. Louis, St. Louis, MO, USA
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Amy H Auchincloss
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | | | | | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Bilal U, McCulley E, Li R, Rollins H, Schnake-Mahl A, Mullachery PH, Vaidya V, Koh C, Dureja K, Sharaf A, Furukawa A, Juliano C, Barber S, Kolker J, Diez Roux AV. Tracking COVID-19 Inequities Across Jurisdictions Represented in the Big Cities Health Coalition (BCHC): The COVID-19 Health Inequities in BCHC Cities Dashboard. Am J Public Health 2022; 112:904-912. [PMID: 35420892 PMCID: PMC9137009 DOI: 10.2105/ajph.2021.306708] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To describe the creation of an interactive dashboard to advance the understanding of the COVID-19 pandemic from an equity and urban health perspective across 30 large US cities that are members of the Big Cities Health Coalition (BCHC). Methods. We leveraged the Drexel‒BCHC partnership to define the objectives and audience for the dashboard and developed an equity framework to conceptualize COVID-19 inequities across social groups, neighborhoods, and cities. We compiled data on COVID-19 trends and inequities by race/ethnicity, neighborhood, and city, along with neighborhood- and city-level demographic and socioeconomic characteristics, and built an interactive dashboard and Web platform to allow interactive comparisons of these inequities across cities. Results. We launched the dashboard on January 21, 2021, and conducted several dissemination activities. As of September 2021, the dashboard included data on COVID-19 trends for the 30 cities, on inequities by race/ethnicity in 21 cities, and on inequities by neighborhood in 15 cities. Conclusions. This dashboard allows public health practitioners to contextualize racial/ethnic and spatial inequities in COVID-19 across large US cities, providing valuable insights for policymakers. (Am J Public Health. 2022;112(6):904-912. https://doi.org/10.2105/AJPH.2021.306708).
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Affiliation(s)
- Usama Bilal
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Edwin McCulley
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Ran Li
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Heather Rollins
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Alina Schnake-Mahl
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Pricila H Mullachery
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Vaishnavi Vaidya
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Celina Koh
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Kristina Dureja
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Asma Sharaf
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Alyssa Furukawa
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Chrissie Juliano
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Sharrelle Barber
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Jennifer Kolker
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
| | - Ana V Diez Roux
- Usama Bilal, Celina Koh, Alyssa Furukawa, Kristina Dureja, Asma Sharaf, Sharrelle Barber, and Ana V. Diez Roux are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Edwin McCulley, Ran Li, Heather Rollins, Alina Schnake-Mahl, Pricila H. Mullachery, and Vaishnavi Vaidya are with the Urban Health Collaborative, Dornsife School of Public Health. Chrissie Juliano is with the Big Cities Health Coalition (BCHC), Bethesda, MD. Jennifer Kolker is with the Department of Health Management and Policy and the Urban Health Collaborative, Dornsife School of Public Health
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Rich JA, Miech EJ, Bilal U, Corbin TJ. How education and racial segregation intersect in neighborhoods with persistently low COVID-19 vaccination rates in Philadelphia. BMC Public Health 2022; 22:1044. [PMID: 35614426 PMCID: PMC9130689 DOI: 10.1186/s12889-022-13414-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/13/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND COVID-19 infection has disproportionately affected socially disadvantaged neighborhoods. Despite this disproportionate burden of infection, these neighborhoods have also lagged in COVID-19 vaccinations. To date, we have little understanding of the ways that various types of social conditions intersect to explain the complex causes of lower COVID-19 vaccination rates in neighborhoods. METHODS We used configurational comparative methods (CCMs) to study COVID-19 vaccination rates in Philadelphia by neighborhood (proxied by zip code tabulation areas). Specifically, we identified neighborhoods where COVID-19 vaccination rates (per 10,000) were persistently low from March 2021 - May 2021. We then assessed how different combinations of social conditions (pathways) uniquely distinguished neighborhoods with persistently low vaccination rates from the other neighborhoods in the city. Social conditions included measures of economic inequities, racial segregation, education, overcrowding, service employment, public transit use, health insurance and limited English proficiency. RESULTS Two factors consistently distinguished neighborhoods with persistently low COVID-19 vaccination rates from the others: college education and concentrated racial privilege. Two factor values together - low college education AND low/medium concentrated racial privilege - identified persistently low COVID-19 vaccination rates in neighborhoods, with high consistency (0.92) and high coverage (0.86). Different values for education and concentrated racial privilege - medium/high college education OR high concentrated racial privilege - were each sufficient by themselves to explain neighborhoods where COVID-19 vaccination rates were not persistently low, likewise with high consistency (0.93) and high coverage (0.97). CONCLUSIONS Pairing CCMs with geospatial mapping can help identify complex relationships between social conditions linked to low COVID-19 vaccination rates. Understanding how neighborhood conditions combine to create inequities in communities could inform the design of interventions tailored to address COVID-19 vaccination disparities.
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Affiliation(s)
- John A Rich
- Department of Health Management and Policy, Center for Nonviolence and Social Justice, Dornsife School of Public Health, Drexel University, 1505 Race Street, MS 1047, 6th floor, Philadelphia, PA, 19102, USA.
| | - Edward J Miech
- Regenstrief Institute, Center for Health Services Research, 1101 West 10th Street, Indianapolis, IN, 46202, USA
| | - Usama Bilal
- Department of Epidemiology and Biostatistics, Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St. Suite 730, Philadelphia, PA, 19104, USA
| | - Theodore J Corbin
- Department of Emergency Medicine, Rush University Medical Center, 1750 W. Harrison Street, Suite 108 Kellogg, Chicago, IL, 60612, USA
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Satish P, Vela E, Bilal U, Cleries M, Kanaya AM, Kandula N, Virani SS, Islam N, Valero-Elizondo J, Yahya T, Comin-Colet J, Nasir K, Mauri J, Cainzos-Achirica M. Burden of cardiovascular risk factors and disease in five Asian groups in Catalonia: a disaggregated, population-based analysis of 121 000 first-generation Asian immigrants. Eur J Prev Cardiol 2022; 29:916-924. [PMID: 33969397 PMCID: PMC9793716 DOI: 10.1093/eurjpc/zwab074] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/07/2021] [Accepted: 04/18/2021] [Indexed: 12/30/2022]
Abstract
AIMS To evaluate the burden of cardiovascular risk factors and disease (CVD) among five Asian groups living in Catalonia (Spain): Indian, Pakistani, Bangladeshi, Filipino, and Chinese. METHODS AND RESULTS Retrospective cohort study using the Catalan Health Surveillance System database including 42 488 Pakistanis, 40 745 Chinese, 21 705 Indians, 9544 Filipinos, and 6907 Bangladeshis; and 5.3 million native individuals ('locals'). We estimated the age-adjusted prevalence (as of 31 December 2019) and incidence (during 2019) of diabetes, hypertension, hyperlipidaemia, obesity, tobacco use, coronary heart disease (CHD), cerebrovascular disease, atrial fibrillation, and heart failure (HF). Bangladeshis had the highest prevalence of diabetes (17.4% men, 22.6% women) followed by Pakistanis. Bangladeshis also had the highest prevalence of hyperlipidaemia (23.6% men, 18.3% women), hypertension among women (24%), and incident tobacco use among men. Pakistani women had the highest prevalence of obesity (28%). For CHD, Bangladeshi men had the highest prevalence (7.3%), followed by Pakistanis (6.3%); and Pakistanis had the highest prevalence among women (3.2%). For HF, the prevalence in Pakistani and Bangladeshi women was more than twice that of locals. Indians had the lowest prevalence of diabetes across South Asians, and of CHD across South Asian men, while the prevalence of CHD among Indian women was twice that of local women (2.6% vs. 1.3%). Filipinos had the highest prevalence of hypertension among men (21.8%). Chinese men and women had the lowest prevalence of risk factors and CVD. CONCLUSIONS In Catalonia, preventive interventions adapted to the risk profile of different Asian immigrant groups are needed, particularly for Bangladeshis and Pakistanis.
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Affiliation(s)
- Priyanka Satish
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St Brown Bldg. B5-019, Houston, TX 77030, USA
| | - Emili Vela
- Healthcare Information and Knowledge Unit, Catalan Health Service, Travessera de les Corts, 131-159 - Pavelló Ave Maria; 08028 Barcelona, Spain,Pla Director de Malalties de l’Aparell Circulatori (PDMAC), Health Department of the Government of Catalonia, Travessera de les Corts, 131-159 - Pavelló Ave Maria; 08028 Barcelona, Spain
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Nesbitt Hall, 3215 Market St, Philadelphia, PA 19104, USA
| | - Montse Cleries
- Healthcare Information and Knowledge Unit, Catalan Health Service, Travessera de les Corts, 131-159 - Pavelló Ave Maria; 08028 Barcelona, Spain,Pla Director de Malalties de l’Aparell Circulatori (PDMAC), Health Department of the Government of Catalonia, Travessera de les Corts, 131-159 - Pavelló Ave Maria; 08028 Barcelona, Spain
| | - Alka M. Kanaya
- Department of Medicine, University of California, San Francisco (CA), 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - Namratha Kandula
- Feinberg School of Medicine, Northwestern University, Chicago(IL), 303 E Chicago Ave, Chicago, IL 60611, USA
| | - Salim S. Virani
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center and Section of Cardiology, Department of Medicine, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX 77030, USA
| | - Nadia Islam
- Department of Population Health, NYU Langone Health, 550 1st Avenue, New York, NY 10016, USA
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St Brown Bldg. B5-019, Houston, TX 77030, USA,Center for Outcomes Research, Houston Methodist, 6670 Bertner Ave, Houston, TX 77030, USA
| | - Tamer Yahya
- Center for Outcomes Research, Houston Methodist, 6670 Bertner Ave, Houston, TX 77030, USA
| | - Josep Comin-Colet
- Pla Director de Malalties de l’Aparell Circulatori (PDMAC), Health Department of the Government of Catalonia, Travessera de les Corts, 131-159 - Pavelló Ave Maria; 08028 Barcelona, Spain,Department of Cardiology, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907, L’Hospitalet de Llobregat, Barcelona, Spain,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Gran Via de les Corts Catalanes, 585, 08007 Barcelona, Spain
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St Brown Bldg. B5-019, Houston, TX 77030, USA,Center for Outcomes Research, Houston Methodist, 6670 Bertner Ave, Houston, TX 77030, USA
| | - Josepa Mauri
- Pla Director de Malalties de l’Aparell Circulatori (PDMAC), Health Department of the Government of Catalonia, Travessera de les Corts, 131-159 - Pavelló Ave Maria; 08028 Barcelona, Spain,Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St Brown Bldg. B5-019, Houston, TX 77030, USA,Center for Outcomes Research, Houston Methodist, 6670 Bertner Ave, Houston, TX 77030, USA,Corresponding author. Tel: +1 443 413 6350,
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Mullachery PH, Lankenau S, Diez Roux AV, Li R, Henson RM, Bilal U. Urban scaling of opioid overdose deaths in the USA: a cross-sectional study in three periods between 2005 and 2017. BMJ Open 2022; 12:e048831. [PMID: 35241464 PMCID: PMC8896002 DOI: 10.1136/bmjopen-2021-048831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe the association between population size, population growth and opioid overdose deaths-overall and by type of opioid-in US commuting zones (CZs) in three periods between 2005 and 2017. SETTINGS 741 CZs covering the entirety of the US CZs are aggregations of counties based on commuting patterns that reflect local economies. PARTICIPANTS We used mortality data at the county level from 2005 to 2017 from the National Center for Health Statistics. OUTCOME Opioid overdose deaths were defined using underlying and contributory causes of death codes from the International Classification of Diseases, 10th revision (ICD-10). We used the underlying cause of death to identify all drug poisoning deaths. Contributory cause of death was used to classify opioid overdose deaths according to the three major types of opioid, that is, prescription opioids, heroin and synthetic opioids other than methadone. RESULTS Opioid overdose deaths were disproportionally higher in largely populated CZs. A CZ with 1.0% larger population had 1.10%, 1.10%, and 1.16% higher opioid death count in 2005-2009, 2010-2014, and 2015-2017, respectively. This pattern was largely driven by a high number of deaths involving heroin and synthetic opioids, particularly in 2015-2017. Population growth over time was associated with lower age-adjusted opioid overdose mortality rate: a 1.0% increase in population over time was associated with 1.4% (95% CI: -2.8% to 0.1%), 4.5% (95% CI: -5.8% to -3.2%), and 1.2% (95% CI: -4.2% to 1.8%) lower opioid overdose mortality in 2005-2009, 2010-2014, and 2015-2017, respectively. The association between positive population growth and lower opioid mortality rates was stronger in larger CZs. CONCLUSIONS Opioid overdose mortality in the USA was disproportionately higher in mid-sized and large CZs, particularly those affected by declines in population over time, regardless of the region where they are located.
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Affiliation(s)
- Pricila H Mullachery
- Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA
| | - Stephen Lankenau
- Dornsife School of Public Health, Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, USA
| | - Ana V Diez Roux
- Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA
- Dornsife School of Public Health, Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Ran Li
- Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA
| | - Rosie Mae Henson
- Dornsife School of Public Health, Department of Health Management and Policy, Drexel University, Philadelphia, Pennsylvania, USA
| | - Usama Bilal
- Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA
- Dornsife School of Public Health, Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
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