What explains the association between neighborhood-level income inequality and the risk of fatal overdose in New York City?

Background The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected socially disadvantaged populations. Whether disparities in COVID-19 incidence related to race/ethnicity and socioeconomic factors exist in the hemodialysis population is unknown. Methods Our study involved patients receiving in-center hemodialysis in New York City. We used a validated index of neighborhood social vulnerability, the Social Vulnerability Index (SVI), which comprises 15 census tract-level indicators organized into four themes: socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. We examined the association of race/ethnicity and the SVI with symptomatic COVID-19 between March 1, 2020, and August 3, 2020. COVID-19 cases were ascertained using PCR testing. We performed multivariable logistic regression to adjust for demographics, individual-level social factors, dialysis-related medical history, and dialysis facility factors. Results Of the 1378 patients on hemodialysis in the study, 247 (17.9%) developed symptomatic COVID-19. In adjusted analyses, non-Hispanic Black and Hispanic patients had significantly increased odds of COVID-19 compared with non-Hispanic White patients. Census tract-level overall SVI, modeled continuously or in quintiles, was not associated with COVID-19 in unadjusted or adjusted analyses. Among non-Hispanic White patients, the socioeconomic status SVI theme, the minority status and language SVI theme, and housing crowding were significantly associated with COVID-19 in unadjusted analyses. Conclusions Among patients on hemodialysis in New York City, there were substantial racial/ethnic disparities in COVID-19 incidence not explained by neighborhood-level social vulnerability. Neighborhood-level socioeconomic status, minority status and language, and housing crowding were positively associated with acquiring COVID-19 among non-Hispanic Whites. Our findings suggest that socially vulnerable patients on dialysis face disparate COVID-19-related exposures, requiring targeted risk-mitigation strategies.

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Alcohol-related emergency department visits and income inequality in New York City, USA: an ecological study

Epidemiology and Health ◽

10.4178/epih.e2019041 ◽

2019 ◽

Vol 41 ◽

pp. e2019041

Author(s):

Kathleen H. Reilly ◽

Katherine Bartley ◽

Denise Paone ◽

Ellenie Tuazon

Keyword(s):

Emergency Department ◽

New York ◽

New York City ◽

Alcohol Use ◽

Income Inequality ◽

Gini Coefficient ◽

York City ◽

Visit Rate ◽

Ed Visits ◽

Neighborhood Income

OBJECTIVES: Previous research has found that greater income inequality is related to problematic alcohol use across a variety of geographical areas in the USA and New York City (NYC). Those studies used self-reported data to assess alcohol use. This study examined the relationship between within-neighborhood income inequality and alcohol-related emergency department (ED) visits.METHODS: The study outcome was the alcohol-related ED visit rate per 10,000 persons between 2010 and 2014, using data obtained from the New York Statewide Planning and Research Cooperative System. The main predictor of interest was income inequality, measured using the Gini coefficient from the American Community Survey (2010-2014) at the public use microdata area (PUMA) level (n=55) in NYC. Variables associated with alcohol-related ED visits in bivariate analyses were considered for inclusion in a multivariable model.RESULTS: There were 420,568 alcohol-related ED visits associated with a valid NYC address between 2010 and 2014. The overall annualized NYC alcohol-related ED visit rate was 100.7 visits per 10,000 persons. The median alcohol ED visit rate for NYC PUMAs was 88.0 visits per 10,000 persons (interquartile range [IQR], 64.5 to 133.5), and the median Gini coefficient was 0.48 (IQR, 0.45 to 0.51). In the multivariable model, a higher neighborhood Gini coefficient, a lower median age, and a lower percentage of male residents were independently associated with the alcohol-related ED visit rate.CONCLUSIONS: This study found that higher neighborhood income inequality was associated with higher neighborhood alcohol-related ED visit rates. The precise mechanism of this relationship is not understood, and further investigation is warranted to determine temporality and to assess whether the results are generalizable to other locales.

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Cocaine- and opiate-related fatal overdose in New York City, 1990–2000

BMC Public Health ◽

10.1186/1471-2458-7-31 ◽

2007 ◽

Vol 7 (1) ◽

Cited By ~ 23

Author(s):

Kyle T Bernstein ◽

Angela Bucciarelli ◽

Tinka Markham Piper ◽

Charles Gross ◽

Ken Tardiff ◽

...

Keyword(s):

New York ◽

New York City ◽

York City ◽

Fatal Overdose

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The Influence of Tobacco Retailer Density and Poverty on Tobacco Use in a Densely Populated Urban Environment

Public Health Reports ◽

10.1177/0033354918824330 ◽

2019 ◽

Vol 134 (2) ◽

pp. 164-171 ◽

Cited By ~ 2

Author(s):

Shannon M. Farley ◽

Andrew R. Maroko ◽

Shakira F. Suglia ◽

Lorna E. Thorpe

Keyword(s):

New York ◽

New York City ◽

Population Density ◽

Urban Environment ◽

York City ◽

Smoking Prevalence ◽

Sociodemographic Characteristics ◽

Housing Type ◽

Neighborhood Poverty ◽

Neighborhood Level

Objectives: Researchers have identified associations between neighborhood-level factors (eg, income level, tobacco retailer density) and smoking behavior, but few studies have assessed these factors in urban environments. We explored the effect of tobacco retailer density, neighborhood poverty, and housing type (multiunit and public) on smoking in a large urban environment (New York City). Methods: We used data on smoking prevalence and individual sociodemographic characteristics from the 2011-2013 New York City Community Health Survey, data on tobacco retailers from the 2012 New York City Department of Consumer Affairs, data on neighborhood sociodemographic characteristics and population density from the 2009-2013 American Community Survey, and data on multiunit and public housing from the 2012 New York City Primary Land Use Tax Lot Output data set. We used aggregate neighborhood-level variables and ordinary least squares regression, geographic weighted regression, and multilevel models to assess the effects of tobacco retailer density and neighborhood poverty on smoking prevalence, adjusting for sociodemographic characteristics (age, sex, race/ethnicity, and education) and neighborhood population density. We also assessed interactions between tobacco retailer density and poverty and each housing type on smoking. Results: Neighborhood poverty positively and significantly modified the association between tobacco retailer density and prevalence of neighborhood smoking ( β = 0.003, P = .01) when we controlled for population density, sociodemographic characteristics, and types of housing. Neighborhood poverty was positively associated with the prevalence of individual smoking ( β = 0.0099, P < .001) when we adjusted for population density, sociodemographic characteristics, and type of housing. Conclusion: More research is needed to determine all the environmental factors associated with smoking prevalence in a densely populated urban environment.

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