Abstract MP021: Identification of “At Risk” and “Resilient” CVD Census Tracts in the Morehouse-Emory Cardiovascular (MECA) Study

The MECA study is unique in that it will study CVD resilience in blacks at both the individual and community (census tract) level in the Atlanta Metropolitan Area. It is well established that blacks suffer from greater cardiovascular morbidity and mortality than whites in the United States. Not all blacks suffer from poor cardiovascular health, some individuals manage to live long healthy lives without ever developing cardiovascular conditions. The causes of this resilience are not known. Both individual and community level factors may be responsible for cardiovascular risk and resilience in blacks. The first stage of the MECA study was to identify “at risk” and resilient communities based on their rates of CVD related ED visits, hospitalizations and mortality. Objectives: To determine if in fact a wide distribution of CVD rates exist among Blacks in census tracts in Metro Atlanta. To determine if there were still large differences in rates when black household income was controlled for. Methods: Count data on CVD related emergency department and hospitalizations for blacks aged 35-64 living in census tracts in the Atlanta--Athens-Clarke--Sandy Springs combined statistical area during 2010-2014 were obtained from the Georgia Hospital Association. CVD mortality data for the same population for the same time period were obtained from the Georgia Department of Public Health. In order to control for the socioeconomic status, age and gender distribution of the neighborhoods, negative binomial regression models controlling for median black household income, percent of 5-year age groupings, and percent male were estimated for each of the outcomes. Residuals in top 25% were considered to be “at risk tracts (high rate) while residuals in the bottom 25% were considered resilient (low rate tracts). Results: 106 tracts were resilient for at least 2 of the 3 outcomes, 188 were “at risk” for 2 out of 3 outcomes. Both types of tracts were located throughout the Atlanta metropolitan area. Mean black household income in the tracts are similar (resilient: $46,335, “at risk”: $44,721). Black CVD hospitalization event rate was 28 vs. 132 per 1000 population(p<.0001) for resilient tracts vs “at risk” tracts. Black CVD ED visit event rate and CVD mortality rate was also lower in resilient (ED: 33 per 1000 pop; Mortality: 8 deaths per 1000 pop) than “at risk” (ED: 147/ 1000 pop; Mortality: 14 deaths per 1000 pop) census tracts. Conclusion: We have identified census tracts in Metro Atlanta that have large differences in premature CVD outcomes for Blacks despite having similar mean income levels. The next phase of the MECA study will examine census tract and survey data to elucidate what contextual (demographic, food environment, reported neighborhood characteristics) and individual level (behavioral, psychological, social) factors may be associated with the different rates of CVD in resilient and “at risk” census tracts.

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Associations between Greenspace and Gentrification-Related Sociodemographic and Housing Cost Changes in Major Metropolitan Areas across the United States

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18063315 ◽

2021 ◽

Vol 18 (6) ◽

pp. 3315

Author(s):

Leah H. Schinasi ◽

Helen V. S. Cole ◽

Jana A. Hirsch ◽

Ghassan B. Hamra ◽

Pedro Gullon ◽

...

Keyword(s):

United States ◽

Census Tract ◽

Household Income ◽

The United States ◽

Effect Modification ◽

Ethnic Composition ◽

Housing Cost ◽

Census Tract Level ◽

Specific Distribution ◽

Meta Analyses

Neighborhood greenspace may attract new residents and lead to sociodemographic or housing cost changes. We estimated relationships between greenspace and gentrification-related changes in the 43 largest metropolitan statistical areas (MSAs) of the United States (US). We used the US National Land Cover and Brown University Longitudinal Tracts databases, as well as spatial lag models, to estimate census tract-level associations between percentage greenspace (years 1990, 2000) and subsequent changes (1990–2000, 2000–2010) in percentage college-educated, percentage working professional jobs, race/ethnic composition, household income, percentage living in poverty, household rent, and home value. We also investigated effect modification by racial/ethnic composition. We ran models for each MSA and time period and used random-effects meta-analyses to derive summary estimates for each period. Estimates were modest in magnitude and heterogeneous across MSAs. After adjusting for census-tract level population density in 1990, compared to tracts with low percentage greenspace in 1992 (defined as ≤50th percentile of the MSA-specific distribution in 1992), those with high percentage greenspace (defined as >75th percentile of the MSA-specific distribution) experienced higher 1990–2000 increases in percentage of the employed civilian aged 16+ population working professional jobs (β: 0.18, 95% confidence interval (CI): 0.11, 0.26) and in median household income (β: 0.23, 95% CI: 0.15, 0.31). Adjusted estimates for the 2000–2010 period were near the null. We did not observe evidence of effect modification by race/ethnic composition. We observed evidence of modest associations between greenspace and gentrification trends. Further research is needed to explore reasons for heterogeneity and to quantify health implications.

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RACE AND THE DISTRIBUTION OF SOCIAL AND PHYSICAL ENVIRONMENTAL RISK

Du Bois Review Social Science Research on Race ◽

10.1017/s1742058x16000163 ◽

2016 ◽

Vol 13 (2) ◽

pp. 285-304 ◽

Cited By ~ 22

Author(s):

Amy J. Schulz ◽

Graciela B. Mentz ◽

Natalie Sampson ◽

Melanie Ward ◽

Rhonda Anderson ◽

...

Keyword(s):

Health Equity ◽

Health Risks ◽

Metropolitan Area ◽

Cumulative Risk ◽

Environmental Exposures ◽

The United States ◽

People Of Color ◽

Census Tracts ◽

Detroit Metropolitan Area ◽

Social Vulnerabilities

AbstractSince W. E. B. Du Bois documented the physical and social environments of Philadelphia’s predominantly African American Seventh Ward over a century ago, there has been continued interest in understanding the distribution of social and physical environments by racial make-up of communities. Characterization of these environments allows for documentation of inequities, identifies communities which encounter heightened risk, and can inform action to promote health equity. In this paper, we apply and extend Du Bois’s approach to examine the contemporary distribution of physical environmental exposures, health risks, and social vulnerabilities in the Detroit metropolitan area, one of the most racially-segregated areas in the United States. We begin by mapping the proximity of sensitive populations to hazardous land uses, their exposure to air pollutants and associated health risks, and social vulnerabilities, as well as cumulative risk (combined proximity, exposure, and vulnerability), across Census tracts. Next, we assess, quantitatively, the extent to which communities of color experience excess burdens of environmental exposures and associated health risks, economic and age-related vulnerabilities, and cumulative risk. The results, depicted in maps presented in the paper, suggest that Census tracts with greater proportions of people of color disproportionately encounter physical environmental exposures, socioeconomic vulnerabilities, and combined risk. Quantitative tests of inequality confirm these distributions, with statistically greater exposures, vulnerabilities, and cumulative risk in Census tracts with larger proportions of people of color. Together, these findings identify communities that experience disproportionate cumulative risk in the Detroit metropolitan area and quantify the inequitable distribution of risk by Census tract relative to the proportion of people of color. They identify clear opportunities for prioritizing communities for legislative, regulatory, policy, and local actions to promote environmental justice and health equity.

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Demographic Disparities in Proximity to Certified Stroke Care in the United States

Stroke ◽

10.1161/strokeaha.121.034493 ◽

2021 ◽

Author(s):

Cathy Y. Yu ◽

Timothy Blaine ◽

Peter D. Panagos ◽

Akash P. Kansagra

Keyword(s):

United States ◽

American Indian ◽

Census Tract ◽

Urban Areas ◽

Stroke Care ◽

The United States ◽

Median Income ◽

Census Tracts ◽

Median Distance ◽

Stroke Center

Background and Purpose: Demographic disparities in proximity to stroke care influence time to treatment and clinical outcome but remain understudied at the national level. This study quantifies the relationship between distance to the nearest certified stroke hospital and census-derived demographics. Methods: This cross-sectional study included population data by census tract from the United States Census Bureau’s 2014–2018 American Community Survey, stroke hospitals certified by a state or national body and providing intravenous thrombolysis, and geographic data from a public mapping service. Data were retrieved from March to November 2020. Quantile regression analysis was used to compare relationships between road distance to the nearest stroke center for each census tract and tract-level demographics of age, race, ethnicity, medical insurance status, median annual income, and population density. Results: Two thousand three hundred eighty-eight stroke centers and 71 929 census tracts including 316 995 649 individuals were included. Forty-nine thousand nine hundred eighteen (69%) tracts were urban. Demographic disparities in proximity to certified stroke care were greater in nonurban areas than urban areas. Higher representation of individuals with age ≥65 years was associated with increased median distance to a certified stroke center in nonurban areas (0.51 km per 1% increase [99.9% CI, 0.42–0.59]) but not in urban areas (0.00 km [−0.01 to 0.01]). In urban and nonurban tracts, median distance was greater with higher representation of American Indian (urban: 0.10 km per 1% increase [0.06–0.14]; nonurban: 1.06 km [0.98–1.13]) or uninsured populations (0.02 km [0.00–0.03]; 0.27 km [0.15–0.38]). Each $10 000 increase in median income was associated with a decrease in median distance of 5.04 km [4.31–5.78] in nonurban tracts, and an increase of 0.17 km [0.10–0.23] in urban tracts. Conclusions: Disparities were greater in nonurban areas than in urban areas. Nonurban census tracts with greater representation of elderly, American Indian, or uninsured people, or low median income were substantially more distant from certified stroke care.

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Assessing the Impact of Person-level Matching Algorithms to Identify Risk of Fatal Opioid Overdose Across Disparate Datasets: Retrospective Analysis (Preprint)

10.2196/preprints.18088 ◽

2020 ◽

Author(s):

Lindsey Ferris ◽

Jonathan P. Weiner ◽

Brendan Saloner ◽

Hadi Kharrazi

Keyword(s):

Public Health ◽

Risk Factors ◽

At Risk ◽

Area Under The Curve ◽

The United States ◽

Risk Indicators ◽

Mortality Data ◽

Opioid Overdose ◽

Fatal Overdose ◽

The Impact

BACKGROUND The opioid epidemic in the United States has precipitated a need for public health agencies to better understand risk factors associated with fatal overdoses. Matching person-level information stored in public health, medical, and human services datasets can enhance the understanding of opioid overdose risk factors and interventions. A major impediment to using datasets from separate agencies, has been the lack of a cross-organization unique identifier. Although different matching techniques that leverage patient demographic information can be used, the impact of using a particular matching approach is not well understood. OBJECTIVE This study compares the impact of using probabilistic versus deterministic matching algorithms to link disparate datasets together for identifying persons at risk of a fatal overdose. METHODS This study used statewide prescription drug monitoring program (PDMP), arrest, and mortality data matched at the person-level using a probabilistic and two deterministic matching algorithms. Impact of matching was assessed by comparing the prevalence of key risk indicators, the outcome, and performance of a multivariate logistic regression for fatal overdose using the combined datasets. RESULTS The probabilistically matched population had the highest degree of matching within the PDMP data and with arrest and mortality data, resulting in the highest prevalence of high-risk indicators and the outcome. Model performance using area under the curve (AUC) was comparable across the algorithms (probabilistic: 0.847; deterministic-basic: 0.854; deterministic+zip: 0.826), but demonstrated tradeoffs between sensitivity and specificity. CONCLUSIONS The probabilistic algorithm was more successful in linking patients with PDMP data with death and arrest data, resulting in a larger at-risk population. However, deterministic-basic matching may be a suitable option for understanding high-level risk based on the model’s area under the curve (0.854). The clinical use case should be considered when selecting a matching approach, as probabilistic algorithms can be more resource-intensive and costly to maintain compared with deterministic algorithms.

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Approximate Mortality Risks between Hyperuricemia and Diabetes in the United States

Journal of Clinical Medicine ◽

10.3390/jcm8122127 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2127 ◽

Cited By ~ 2

Author(s):

Po-Hsun Chen ◽

Yu-Wei Chen ◽

Wei-Ju Liu ◽

Ssu-Wei Hsu ◽

Ching-Hsien Chen ◽

...

Keyword(s):

Mortality Risk ◽

Reference Group ◽

The United States ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Low Risk ◽

Mortality Data ◽

Mortality Risks ◽

All Cause Mortality ◽

Cvd Mortality

Aim: This study aimed to compare mortality risks across uric acid (UA) levels between non-diabetes adults and participants with diabetes and to investigate the association between hyperuricemia and mortality risks in low-risk adults. Methods: We analyzed data from adults aged >18 years without coronary heart disease and chronic kidney disease (n = 29,226) from the National Health and Nutrition Examination Survey (1999–2010) and the associated mortality data (up to December 2011). We used the Cox proportional hazards models to examine the risk of all-cause and cause-specific (cardiovascular disease (CVD) and cancer) mortality at different UA levels between adults with and without diabetes. Results: Over a median follow-up of 6.6 years, 2069 participants died (495 from CVD and 520 from cancers). In non-diabetes adults at UA ≥ 5 mg/dL, all-cause and CVD mortality risks increased across higher UA levels (p-for-trend = 0.037 and 0.058, respectively). The lowest all-cause mortality risk in participants with diabetes was at the UA level of 5–7 mg/dL. We set the non-diabetes participants with UA levels of <7 mg/dL as a reference group. Without considering the effect of glycemic control, the all-cause mortality risk in non-diabetes participants with UA levels of ≥7 mg/dL was equivalent to risk among diabetes adults with UA levels of <7 mg/dL (hazard ratio = 1.44 vs. 1.57, p = 0.49). A similar result was shown in CVD mortality risk (hazard ratio = 1.80 vs. 2.06, p = 0.56). Conclusion: Hyperuricemia may be an indicator to manage multifaceted cardiovascular risk factors in low-risk adults without diabetes, but further studies and replication are warranted.

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Compared the Burden of Cardiovascular Disease attributable to Tobacco Exposure in China, Japan, USA and World

10.21203/rs.3.rs-16505/v2 ◽

2020 ◽

Author(s):

Xiaomei Wu ◽

Bo Zhu ◽

Shuang Xu ◽

Yifei Bi ◽

Yong Liu ◽

...

Keyword(s):

Control Measure ◽

Temporal Trends ◽

The United States ◽

Mortality Data ◽

Tobacco Exposure ◽

Significant Downward Trend ◽

The World ◽

The Usa ◽

Disease Study ◽

Cvd Mortality

Abstract Background Tobacco exposure (TE) is the major contributor for CVD mortality, but few published studies on CVD mortality attributable to TE have analyzed the potential reasons underlying long-term trends in China. Our study sought to find the potential reasons and compared CVD mortality attributable to TE in China, Japan, the United States of America (USA), and the world between 1990 and 2017.Methods The mortality data in China, Japan, the USA, and the world were obtained from Global Burden of Disease Study 2017 (GBD 2017). Joinpoint regression was used to assess the trend magnitude and directions over time for CVD mortality, while the age-period-cohort method was used to analyze the temporal trends of CVD mortality according to age, period, and cohort.Results A significant downward trend was found in the age-standardised mortality rate (ASMR) of CVD attributable to smoking in four regions. China had the smallest decline and the Chinese ASMR became the highest in 2017. All the annual net drifts in the four regions were negative and the local drifts were below zero. The longitudinal age curves of CVD mortality attributable to smoking increased in four regions, with China having the largest increase. The period or cohort RRs indicated a decline, and China had the smallest decline. The researchers further analyzed the IHD and stroke trends, finding that the morality and period or cohort RR of IHD in China was always at a high level.Conclusions CVD mortality attributable to TE declined in four regions, and was highest in China. The proportion of IHD mortality attributable to TE was similar to stroke which significantly changed the traditional cognition of CVD composition, but the control measure was not sufficient for IHD in China.

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Census Tract Food Tweets and Chronic Disease Outcomes in the U.S., 2015–2018

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16060975 ◽

2019 ◽

Vol 16 (6) ◽

pp. 975 ◽

Cited By ~ 2

Author(s):

Yuru Huang ◽

Dina Huang ◽

Quynh C. Nguyen

Keyword(s):

Chronic Disease ◽

Census Tract ◽

Food Environment ◽

Fast Food ◽

Application Programming Interface ◽

Local Area ◽

The United States ◽

Census Tracts ◽

Disease Outcomes ◽

Application Programming

There is a growing recognition of social media data as being useful for understanding local area patterns. In this study, we sought to utilize geotagged tweets—specifically, the frequency and type of food mentions—to understand the neighborhood food environment and the social modeling of food behavior. Additionally, we examined associations between aggregated food-related tweet characteristics and prevalent chronic health outcomes at the census tract level. We used a Twitter streaming application programming interface (API) to continuously collect ~1% random sample of public tweets in the United States. A total of 4,785,104 geotagged food tweets from 71,844 census tracts were collected from April 2015 to May 2018. We obtained census tract chronic disease outcomes from the CDC 500 Cities Project. We investigated associations between Twitter-derived food variables and chronic outcomes (obesity, diabetes and high blood pressure) using the median regression. Census tracts with higher average calories per tweet, less frequent healthy food mentions, and a higher percentage of food tweets about fast food had higher obesity and hypertension prevalence. Twitter-derived food variables were not predictive of diabetes prevalence. Food-related tweets can be leveraged to help characterize the neighborhood social and food environment, which in turn are linked with community levels of obesity and hypertension.

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An Examination of Geographic Differences in Social Determinants of Health Among Women with Diagnosed HIV in the United States and Puerto Rico, 2017

The Open AIDS Journal ◽

10.2174/1874613602115010010 ◽

2021 ◽

Vol 15 (1) ◽

pp. 10-20

Author(s):

Ndidi Nwangwu-Ike ◽

Chan Jin ◽

Zanetta Gant ◽

Shacara Johnson ◽

Alexandra B. Balaji

Keyword(s):

United States ◽

Puerto Rico ◽

Health Insurance ◽

Social Determinants ◽

Census Tract ◽

The United States ◽

Adult Women ◽

Hiv Diagnosis ◽

Census Tracts ◽

Census Tract Level

Objective: To examine differences, at the census tract level, in the distribution of human immunodeficiency virus (HIV) diagnoses and social determinants of health (SDH) among women with diagnosed HIV in 2017 in the United States and Puerto Rico. Background: In the United States, HIV continues to disproportionately affect women, especially minority women and women in the South. Methods: Data reported in the National HIV Surveillance System (NHSS) of the Centers for Disease Control and Prevention were used to determine census tract-level HIV diagnosis rates and percentages among adult women (aged ≥18 years) in 2017. Data from the American Community Survey were combined with NHSS data to examine regional differences in federal poverty status, education level, income level, employment status, and health insurance coverage among adult women with diagnosed HIV infection in the United States and Puerto Rico. Results: In the United States and Puerto Rico, among 6,054 women who received an HIV diagnosis in 2017, the highest rates of HIV diagnoses generally were among those who lived in census tracts where the median household income was less than $40,000; at least 19% lived below the federal poverty level, at least 18% had less than a high school diploma, and at least 16% were without health insurance. Conclusion: This study is the first of its kind and gives insight into how subpopulations of women are affected differently by the likelihood of an HIV diagnosis. The findings show that rates of HIV diagnosis were highest among women who lived in census tracts having the lowest income and least health coverage.

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Gut Microbiota Metabolites of Dietary Lignans and Risk of All-Cause and Cause-Specific Mortality in Adults

Current Developments in Nutrition ◽

10.1093/cdn/nzaa061_067 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1439-1439 ◽

Cited By ~ 1

Author(s):

Buyun Liu ◽

Shuang Rong ◽

Yangbo Sun ◽

Robert Wallace ◽

Linda Snetselaar ◽

...

Keyword(s):

Cancer Mortality ◽

Proportional Hazards ◽

The United States ◽

Epidemiological Studies ◽

Biological Properties ◽

Cox Proportional Hazards ◽

Mortality Data ◽

All Cause Mortality ◽

Race Ethnicity ◽

Cvd Mortality

Abstract Objectives Lignans are bioactive compounds exhibiting various biological properties, including anti-inflammatory, antioxidant and antitumor activities. Epidemiological studies regarding long-term health effects of lignans are sparse. In humans, most lignans in plant-based foods are converted by the intestinal microbiota to enterolactone and enterodiol after ingestion. We examined the association of urinary levels of enterolactone and enterodiol with the risk of mortality among adults in the United States. Methods This is a prospective cohort study including 6262 adults aged 40 years or older who participated in the National Health and Nutrition Examination Survey 1999–2010. These participants were linked to mortality data through December 31, 2015. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of urinary enterolactone and enterodiol levels with mortality from all causes, cardiovascular disease (CVD), and cancer. Results During on average 9.3 years (maximum 16.8 years) of observation, 1456 death occurred including 329 death from CVD, and 330 death from cancer. After adjustment for age, sex, race/ethnicity, socioeconomic status, dietary and lifestyle factors, and urinary creatinine levels, the HRs (95% CIs) of all-cause mortality across increasing quartiles of urinary enterolactone levels were 1.00 (reference), 0.90 (0.77–1.05), 0.83 (0.71–0.97), and 0.81 (0.66–0.99), respectively (P for trend 0.02). We did not observe significant associations of urinary enterolactone levels with CVD mortality (HR for the highest vs. lowest quartiles 1.17, 95% CI 0.71–1.91) or cancer mortality (HR 0.82, 95% CI 0.55–1.21). For enterodiol, the HRs (95% CIs) of all-cause mortality, CVD mortality, and cancer mortality comparing the highest with lowest quartile of urinary enterodiol levels were 1.17 (0.94–1.45), 1.23 (0.83–1.81), and 1.05 (0.69–1.58), respectively. There was no significant interaction effects by sex and race/ethnicity for the observed associations. Conclusions In this nationally representative sample of US adults, urinary enterolactone levels was inversely associated with all-cause mortality. Further studies are needed to replicate the findings and determine the underlying mechanisms. Funding Sources N/A.

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Reports and Victims of Sex and Labor Trafficking in a Major Midwest Metropolitan Area, 2008-2017

Public Health Reports ◽

10.1177/0033354919854479 ◽

2019 ◽

Vol 134 (4) ◽

pp. 432-440

Author(s):

Erica Koegler ◽

Amanda Mohl ◽

Kathleen Preble ◽

Michelle Teti

Keyword(s):

Risk Factors ◽

At Risk ◽

Social Services ◽

Metropolitan Area ◽

Sex Trafficking ◽

The United States ◽

Coalition Building ◽

Foreign Born ◽

Labor Trafficking ◽

Trafficking Victims

Objective: The objective of this study was to determine the number, risk factors, and demographic characteristics of potential human trafficking victims from tips reported to a social services agency in a major Midwest metropolitan area from 2008 through 2017. Methods: The agency, comprising 90 employees serving more than 10 000 persons annually, received federal funding to raise awareness about trafficking and to identify and support persons who are at risk for trafficking through training, coalition building, direct outreach and service, and case management. We, the authors, counted the numbers of tips and potential victims reported to the agency by year, type of trafficking, economic sector, sex, region of origin, and age and looked for new risk factors for trafficking. Results: Data were available for 213 tips received from September 1, 2008, through June 30, 2017, and for 82 potential victims identified from July 1, 2011, through June 30, 2017. Labor trafficking (126 tips, 57 potential victims) was more common than sex trafficking (59 tips, 17 potential victims). The number of tips varied during the study period. Tips and potential victims were diverse and included male and female children and adults. Most victims were from Mexico (n = 68), the United States (n = 47), Asia (n = 31), and Central and South America (n = 23). Potential victims were exploited in several industries including agriculture, construction, commercial sex, and landscaping. New risk factors for trafficking were exploitation within marriage and work in the sales industry. Conclusions: Domestic and foreign-born men, women, and children are all at risk for labor and sex trafficking. Direct outreach to foreign-born victims should be a priority. The new risk factors should be explored.

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