scholarly journals Association between neighbourhood deprivation and hypertension in a US-wide Cohort

2021 ◽  
pp. jech-2021-216445
Author(s):  
Jing Xu ◽  
Kaitlyn G Lawrence ◽  
Katie M O'Brien ◽  
Chandra L Jackson ◽  
Dale P Sandler
Keyword(s):  
Household Income ◽  
White Women ◽  
Contrast Ratio ◽  
Area Deprivation ◽  
Study Cohort ◽  
Annual Household Income ◽  
Neighbourhood Deprivation ◽  
Individual Level ◽  
Hypertension Risk ◽  
Race Ethnicity

BackgroundSocioeconomic status (SES) at the individual level is associated with hypertension risk. Less is known about neighbourhood level SES or how neighbourhood and individual level SES may jointly affect hypertension risk.MethodsThe Area Deprivation Index (ADI) includes 17 census-based measures reflecting neighbourhood SES. The ADI was linked to enrolment addresses of 47 329 women in the Sister Study cohort and categorised as ≤10% (low deprivation), 11%–20%, 21%–35%, 36%–55% and >55% (high deprivation). Hypertension was defined as either high systolic (≥140 mm Hg) or diastolic (≥90 mm Hg) blood pressure or taking antihypertensive medication. We used log binomial regression to investigate the cross-sectional association between ADI and hypertension and evaluated interactions between ADI and race/ethnicity and between ADI and individual SES.ResultsThe highest ADI level of >55% was associated with increased prevalence of hypertension, compared with the lowest level of ADI≤10%, in a model adjusted for age, race/ethnicity, educational attainment and annual household income (prevalence ratio=1.26, 95% CI 1.21 to 1.32). We observed interaction between race/ethnicity and ADI (interaction contrast ratio (ICR)=1.9; 95% CI 0.94 to 2.8 comparing non-Hispanic Black women with ADI >55% to non-Hispanic White women with ADI≤10%) and between household income and ADI (ICR 0.38; 95% CI 0.12 to 0.65 comparing participants with household income ≤US$49 999 and ADI>55% to those with household income >US$100 000 and ADI≤10%).ConclusionsThese findings suggest that neighbourhood deprivation measured by ADI may be a risk factor for hypertension and that ADI may act synergistically with race/ethnicity and individual household income to contribute to hypertension.

scholarly journals Recurrent Atherosclerotic Cardiovascular Event Rates Differ Among Patients Meeting the Very High Risk Definition According to Age, Sex, Race/Ethnicity, and Socioeconomic Status

2020 ◽  
Vol 9 (23) ◽  
Author(s):  
Jaejin An ◽  
Yiyi Zhang ◽  
Paul Muntner ◽  
Andrew E. Moran ◽  
Jin‐Wen Hsu ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
High Risk ◽  
Sociodemographic Factors ◽  
Study Cohort ◽  
Atherosclerotic Cardiovascular Disease ◽  
Annual Household Income ◽  
History Of ◽  
Race Ethnicity ◽  
Definition Of ◽  
Very High

Background The risk for atherosclerotic cardiovascular disease (ASCVD) events may differ by sociodemographic factors among patients meeting the definition of very high risk according to the 2018 American Heart Association/American College of Cardiology cholesterol guideline, leading to treatment disparities. We estimated the risk for recurrent ASCVD events among adults meeting the definition of very high risk by age, sex, race/ethnicity, and socioeconomic status in a US integrated healthcare system. Methods and Results The study cohort included Kaiser Permanente Southern California members aged ≥21 years with a history of clinical ASCVD on September 30, 2009. Very high risk for recurrent ASCVD was defined by a history of ≥2 major ASCVD events or a history of 1 major event along with ≥2 high‐risk conditions. Patients were followed through 2015 for a first recurrent ASCVD event. Of 77 101 patients with ASCVD, 50.8% met the definition for very high risk. Among patients meeting the definition of very high risk, recurrent ASCVD rates were higher in older (>75 years) versus younger patients (21–40 years) (sex‐adjusted hazard ratio [HR] [95% CI] 1.85; 1.23–2.79), non‐Hispanic Black patients versus non‐Hispanic White patients (age‐, sex‐adjusted HR, 1.32; 1.23–1.41), those who lived in neighborhoods with lower (<$35k) versus higher annual household income (≥$80k) (HR, 1.20; 1.11–1.30), or with lower (≥31.2%) versus higher education levels (<8.8% high school or lower) (HR, 1.26; 1.19–1.34). Conclusions Disparities in the risk for recurrent ASCVD events were present across sociodemographic factors among very high risk patients. The addition of sociodemographic factors to current definitions of very high risk could reduce health disparities.

scholarly journals Evaluating for Differences by Race/Ethnicity in the Association Between Income and Gambling Disorder

2020 ◽  
Vol 36 (4) ◽  
pp. 1093-1105
Author(s):  
Brendan Day ◽  
Geoffrey Rosenthal ◽  
Fiyinfolu Adetunji ◽  
Andrea Monaghan ◽  
Christina Scheele ◽  
...  
Keyword(s):  
Low Income ◽  
Household Income ◽  
Gambling Disorder ◽  
The United States ◽  
Multivariable Logistic Regression Analysis ◽  
Annual Household Income ◽  
Interview Schedule ◽  
Veteran Status ◽  
Race Ethnicity ◽  
Racial Ethnic

AbstractMultiple studies show an increased prevalence of gambling disorder among African Americans compared to whites. However, few studies take an analytic approach to understanding differences in risk factors by race/ethnicity. Income is inversely associated with gambling disorder; we hypothesized that this association would vary by race/ethnicity. The main objective was to evaluate whether the association between income and gambling disorder varies by race/ethnicity. With data from the baseline visit of a prospective cohort study, Prevention and Etiology of Gambling Addiction Study in the United States, we used multivariable logistic regression analysis to determine whether the association between income and gambling disorder varies by race/ethnicity. 1164 participants were included in the final analyses. Measures included: demographics (age, sex, race/ethnicity, education, employment, annual household income), veteran status, marital status, homelessness, smoking, substance abuse, alcohol abuse, marijuana use, and lifetime gambling disorder diagnosis as derived from Alcohol Use Disorder and Associated Disabilities Interview Schedule. There was no evidence of effect modification by race/ethnicity in the association between income and gambling disorder (global p value = 0.17). Income was associated with increased odds of gambling disorder, but only for those with low income (< $15,000; OR 2.27, 95% CI 1.46, 3.53). There was no evidence that the effect of income on gambling disorder varies by race/ethnicity. For all race/ethnicities combined, low income was associated with significantly increased odds of gambling disorder (OR 2.27, 95% CI 1.46, 3.53). Further research is needed to better understand racial/ethnic differences in gambling disorder.

scholarly journals Body Mass Index Trajectory–Specific Changes in Economic Circumstances: A Person-Oriented Approach Among Midlife and Ageing Finns

2020 ◽  
Vol 17 (10) ◽  
pp. 3668 ◽  
Author(s):  
Jatta Salmela ◽  
Tea Lallukka ◽  
Elina Mauramo ◽  
Ossi Rahkonen ◽  
Noora Kanerva
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Household Income ◽  
Health Study ◽  
Study Cohort ◽  
Healthy Weight ◽  
Individual Level ◽  
Class I Obesity ◽  
Bmi Trajectories

Economic disadvantage is related to a higher risk of adulthood obesity, but few studies have considered whether changes in economic circumstances depend on a person’s body mass index (BMI) trajectory. We identified latent BMI trajectories among midlife and ageing Finns and captured individual-level changes in economic circumstances within the BMI trajectories utilizing sequence analysis. We used the Helsinki Health Study cohort data of initially 40–60-year-old Finnish municipal employees, with four survey questionnaire phases (2000–2017). Each survey included identical questions on height and weight, and on economic circumstances incorporating household income and current economic difficulties. Based on computed BMI, we identified participants’ (n = 7105; 82% women) BMI trajectories over the follow-up using group-based trajectory modeling. Four BMI trajectories were identified: stable healthy weight (34% of the participants), stable overweight (42%), overweight to class I obesity (20%), and stable class II obesity (5%). Lower household income level and having economic difficulties became more common and persistent when moving from lower- to higher-level BMI trajectories. Differences in household income widened over the follow-up between the trajectory groups, whereas economic difficulties decreased equally in all trajectory groups over time. Our study provides novel information on the dynamic interplay between long-term BMI changes and economic circumstances.

318 Area Deprivation and Sleep Health among White, Black, and Hispanic/Latina Women

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A127-A128
Author(s):  
Symielle Gaston ◽  
Kaitlyn Lawrence ◽  
Dale Sandler ◽  
Chandra Jackson
Keyword(s):  
White Women ◽  
Deprivation Level ◽  
Area Deprivation ◽  
Poor Sleep ◽  
Latina Women ◽  
Sleep Health ◽  
Neighborhood Deprivation ◽  
Sleep Debt ◽  
Race Ethnicity ◽  
Insomnia Symptoms

Abstract Introduction Although neighborhood environments have been shown to affect sleep health, few studies have directly measured multiple indicators of both neighborhood deprivation and sleep while considering modification by race/ethnicity. Methods Among 49,833 eligible U.S. women enrolled in the Sister Study from 2003 to 2009, we investigated associations between neighborhood deprivation (e.g., percentage of residents unemployed, household crowding) and multiple sleep dimensions. Participants’ addresses were linked to U.S. census block group level Area Deprivation Index rankings (range: 1–100) for the year 2000, and participant rankings were divided into quintiles where the highest quintile represented the highest deprivation level. Participants self-reported habitual sleep duration, sleep debt, frequent napping, and insomnia symptoms. Adjusting for sociodemographic and clinical characteristics, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for sleep dimensions among participants within quintiles (Qs) 2–5 vs. Q1. Interaction terms were used to assess modification by race/ethnicity. Results Mean age ± standard deviation was 55 ± 9 years. Women with higher neighborhood deprivation were more likely to self-identify as a racial/ethnic minority and had higher unadjusted prevalence of poor sleep dimensions. After adjustment, higher ADI was positively associated with very short sleep (≤5 hours), and race/ethnicity was a modifier (e.g., race-stratified results for Q5 vs. Q1:PRWhite=1.31 [95% CI: 1.14–1.51], PRBlack=0.91 [0.71–1.18], PRHispanic/Latina= 1.17 [0.68–2.04], p-interaction &lt;0.05). Although race/ethnicity did not modify remaining associations, women with higher neighborhood deprivation also had a higher prevalence of sleep debt, frequent napping, and insomnia symptoms. When compared to White women with the lowest neighborhood deprivation, Black women across all deprivation levels and Hispanic/Latina women in Q2-Q5 were substantially more likely to report each poor sleep dimension (PR range: 1.21 to 5.01). Conclusion A multidimensional measure of neighborhood deprivation was associated with poor sleep and sleep disparities among a diverse cohort of U.S. women. Support (if any):

Disparities Associated with Sepsis Mortality in Critically Ill Children

2020 ◽  
Author(s):  
Anireddy R. Reddy ◽  
Gia M. Badolato ◽  
James M. Chamberlain ◽  
Monika K. Goyal
Keyword(s):  
Socioeconomic Status ◽  
Critically Ill ◽  
Household Income ◽  
Diagnosis Related Groups ◽  
Pediatric Population ◽  
Multivariable Analysis ◽  
Ethnic Disparities ◽  
Critically Ill Children ◽  
Annual Household Income ◽  
Race Ethnicity

AbstractDisparities in health care related to socioeconomic status and race/ethnicity are well documented in adult and neonatal sepsis, but they are less characterized in the critically ill pediatric population. This study investigated whether socioeconomic status and/or race/ethnicity is associated with mortality among children treated for sepsis in the pediatric intensive care unit (PICU). A retrospective cohort study was conducted using information from 48 children's hospitals included in the Pediatric Health Information System database. We included visits by children ≤ 21 years with All Patients Refined Diagnosis-Related Groups (APR-DRG) diagnosis codes of septicemia and disseminated infections that resulted in PICU admission from 2010 to 2016. Multivariable logistic regression was used to measure the effect of race/ethnicity and socioeconomic status (insurance status and median household income for zip code) on mortality after adjustment for age, gender, illness severity, and presence of complex chronic condition. Among the 14,276 patients with sepsis, the mortality rate was 6.8%. In multivariable analysis, socioeconomic status, but not race/ethnicity, was associated with mortality. In comparison to privately insured children, nonprivately insured children had increased odds of mortality (public: adjusted odds ratio [aOR]: 1.2 [1.0, 1.5]; uninsured: aOR: 2.1 [1.2, 3.7]). Similarly, children living in zip codes with the lowest quartile of annual household income had higher odds of mortality than those in the highest quartile (aOR: 1.5 [1.0, 2.2]). These data suggest the presence of socioeconomic, but not racial/ethnic, disparities in mortality among children treated for sepsis. Further research is warranted to understand why such differences exist and how they may be addressed.

Neighborhood Privilege, Preterm Delivery, and Related Racial/Ethnic Disparities: An Intergenerational Application of the Index of Concentration at the Extremes

2020 ◽  
Vol 189 (5) ◽  
pp. 412-421 ◽  
Author(s):  
Bina Patel Shrimali ◽  
Michelle Pearl ◽  
Deborah Karasek ◽  
Carolina Reid ◽  
Barbara Abrams ◽  
...  
Keyword(s):  
Early Childhood ◽  
Black Women ◽  
Preterm Delivery ◽  
White Women ◽  
Hispanic Women ◽  
Ethnic Disparities ◽  
Estimating Equation ◽  
Individual Level ◽  
Race Ethnicity ◽  
Racial Ethnic

Abstract We assessed whether early childhood and adulthood experiences of neighborhood privilege, measured by the Index of Concentration at the Extremes (ICE), were associated with preterm delivery and related racial/ethnic disparities using intergenerationally linked birth records of 379,794 California-born primiparous mothers (born 1982–1997) and their infants (born 1997–2011). ICE measures during early childhood and adulthood approximated racial/ethnic and economic dimensions of neighborhood privilege and disadvantage separately (ICE-income, ICE-race/ethnicity) and in combination (ICE–income + race/ethnicity). Results of our generalized estimating equation models with robust standard errors showed associations for ICE-income and ICE–income + race/ethnicity. For example, ICE–income + race/ethnicity was associated with preterm delivery in both early childhood (relative risk (RR) = 1.12, 95% confidence interval (CI): 1.08, 1.17) and adulthood (RR = 1.07, 95% CI: 1.03, 1.11). Non-Hispanic black and Hispanic women had higher risk of preterm delivery than white women (RR = 1.32, 95% CI: 1.28, 1.37; and RR = 1.11, 95% CI: 1.08, 1.14, respectively, adjusting for individual-level confounders). Adjustment for ICE–income + race/ethnicity at both time periods yielded the greatest declines in disparities (for non-Hispanic black women, RR = 1.23, 95% CI: 1.18, 1.28; for Hispanic women, RR = 1.05, 95% CI: 1.02, 1.09). Findings support independent effects of early childhood and adulthood neighborhood privilege on preterm delivery and related disparities.

Associations of Quantity Smoked and Socioeconomic Status With Smoke-Free Homes and Cars Among Daily Smokers

2021 ◽  
pp. 109019812110104
Author(s):  
Annie Pelekanakis ◽  
Jennifer L. O’Loughlin ◽  
Katerina Maximova ◽  
Annie Montreuil ◽  
Jodi Kalubi ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Logistic Regression ◽  
Household Income ◽  
Employment Status ◽  
Telephone Survey ◽  
Low Ses ◽  
Annual Household Income ◽  
Cross Sectional ◽  
Shs Exposure ◽  
Independent Association

Introduction An association between socioeconomic status (SES) and smoke-free private spaces among smokers could be due to heavier smoking among low SES smokers. We assessed whether quantity smoked or SES are independently associated with smoke-free homes or cars in daily smokers. Method Data were drawn from a cross-sectional telephone survey (2011–2012) of 750 daily smokers age ≥18 years in Quebec, Canada (45% response). Multivariable logistic regression was used to model the independent association between (a) number of cigarettes smoked per day, and (b) each of educational attainment, annual household income, or active employment status and smoke-free homes or cars. Results Participants were 41.0 years old on average, 57% were female. Median (IQR) number of cigarettes smoked per day was 14 (10, 20). Forty-eight percent of participants reported smoke-free homes; 34% reported smoke-free cars. Quantity smoked was strongly associated with both smoke-free homes and cars. Income and education (but not actively employed) were associated with smoke-free homes. None of the SES indicators were associated with smoke-free cars. Conclusions Interventions targeting smokers to promote smoke-free homes and cars should incorporate components to help smokers reduce quantity smoked or preferably, to quit. Interventions targeting smoke-free homes will also need to address SES inequalities by education and income. Our data suggest that reduction in quantity smoked may help smokers reduce SHS exposure in cars, but that an inequality lens may not be relevant.

An Application of the Theory of Representative Bureaucracy, Gender Concordance, and Symbolic Representation in the Health Care Context

2021 ◽  
pp. 027507402110493
Author(s):  
Kenicia Wright
Keyword(s):  
Health Care ◽  
Black Women ◽  
Health Outcomes ◽  
White Women ◽  
The United States ◽  
Symbolic Representation ◽  
Representative Bureaucracy ◽  
Female Physicians ◽  
Individual Level ◽  
Gender Concordance

Although the United States spends more on health care than comparable nations, many Americans suffer from poor health. Many factors are emphasized as being important for improved health outcomes, including social and economic indicators, living and working conditions, and individual-level behavior. However, I argue the overwhelming attention to male health outcomes—compared to female health outcomes—and focus on factors that are “traditionally understood” as important in shaping health are two limitations of existing health-related research. I adopt an innovative approach that combines the theory of representative bureaucracy, gender concordance, and symbolic representation to argue that increase in female physicians contribute to improved female health outcomes. Using an originally collected dataset that contains information on female physicians, health outcomes, and state and individual-level factors, I study how female physicians influence the health outcomes of non-Hispanic White women, non-Hispanic Black women, and Latinas in the United States from 2000 to 2012. The findings suggest female physicians contribute to improved health outcomes for non-Hispanic White women and non-Hispanic Black women, but not Latinas. Supplemental Analysis bolsters confidence that the findings are not the result of increased access to health care professionals. This study highlights the importance of applying the theory of representative bureaucracy and symbolic representation to health care, the promise of greater female representation in health, and the insight gleaned from incorporating intersectionality in public administration research.

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