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

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.

Geographic Differences and Social Determinants of Health Among People With HIV Attributed to Injection Drug Use, United States, 2017

2021 ◽  
pp. 003335492110071
Author(s):  
Chan Jin ◽  
Ndidi Nwangwu-Ike ◽  
Zanetta Gant ◽  
Shacara Johnson Lyons ◽  
Anna Satcher Johnson
Keyword(s):  
United States ◽  
Health Insurance ◽  
Drug Use ◽  
Hiv Infection ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Census Tract ◽  
People Who Inject Drugs ◽  
Hiv Diagnosis ◽  
Census Tract Level

Objective People who inject drugs are among the groups most vulnerable to HIV infection. The objective of this study was to describe differences in the geographic distribution of HIV diagnoses and social determinants of health (SDH) among people who inject drugs (PWID) who received an HIV diagnosis in 2017. Methods We used data from the National HIV Surveillance System (NHSS) to determine the counts and percentages of PWID aged ≥18 with HIV diagnosed in 2017. We combined these data with data from the US Census Bureau’s American Community Survey at the census tract level to examine regional, racial/ethnic, and population-area-of-residence differences in poverty status, education level, income level, employment status, and health insurance coverage. Results We observed patterns of disparity in HIV diagnosis counts and SDH among the 2666 PWID with a residential address linked to a census tract, such that counts of HIV diagnosis increased as SDH outcomes became worse. The greatest proportion of PWID lived in census tracts where ≥19% of the residents lived below the federal poverty level, ≥18% of the residents had <high school diploma, the median annual household income was <$40 000, and ≥16% of the residents did not have health insurance or a health coverage plan. Conclusion To our knowledge, our study is the first large-scale, census tract–level study to describe SDH among PWID with diagnosed HIV in the United States. The findings of substantial disparities in SDH among people with HIV infection attributed to injection drug use should be further examined. Understanding the SDH among PWID is crucial to reducing disparities in HIV diagnoses in this population.

scholarly journals A Census Tract–Level Examination of Differences in Social Determinants of Health Among People With HIV, by Race/Ethnicity and Geography, United States and Puerto Rico, 2017

2021 ◽  
pp. 003335492199037
Author(s):  
Shacara Johnson Lyons ◽  
Zanetta Gant ◽  
Chan Jin ◽  
André Dailey ◽  
Ndidi Nwangwu-Ike ◽  
...  
Keyword(s):  
United States ◽  
Puerto Rico ◽  
Health Insurance ◽  
Census Tract ◽  
Hiv Diagnosis ◽  
Census Tract Level ◽  
Race Ethnicity ◽  
Vacant Housing ◽  
Racial Ethnic ◽  
Hispanic White

Objective Social and structural factors, referred to as social determinants of health (SDH), create pathways or barriers to equitable sexual health, and information on these factors can provide critical insight into rates of diseases such as HIV. Our objectives were to describe and identify differences, by race/ethnicity and geography, in SDH among adults with HIV. Methods We conducted an ecological study to explore SDH among people with HIV diagnosed in 2017, by race/ethnicity and geography, at the census-tract level in the United States and Puerto Rico. We defined the least favorable SDH as the following: low income (<$40 000 in median annual household income), low levels of education (≥18% of residents have <high school diploma), high levels of poverty (≥19% of residents live below the federal poverty level), unemployment (≥6% of residents in the workface do not have a job), lack of health insurance (≥16% of residents lack health insurance), and vacant housing (≥15% of housing units are vacant). Results HIV diagnosis rates increased 1.4 to 4.0 times among men and 1.5 to 5.5 times among women as census-tract poverty levels increased, education levels decreased, income decreased, unemployment increased, lack of health insurance increased, and vacant housing increased. Among racial/ethnic groups by region and SDH, we observed higher HIV diagnosis rates per 100 000 population among non-Hispanic Black (49.6) and non-Hispanic White (6.5) adults in the South and among Hispanic/Latino (27.4) adults in the Northeast than in other regions. We observed higher HIV diagnosis rates per 100 000 population among non-Hispanic Black (44.3) and Hispanic/Latino (21.1) adults than among non-Hispanic White (5.1) adults. Conclusion Our findings highlight the importance of SDH in HIV infection and support the need for effective, targeted local interventions to specific populations based on HIV diagnoses and prevalence to prevent infection and reduce racial/ethnic disparities.

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

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.

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

Stroke ◽  
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.

scholarly journals Social Determinants of Polypharmacy in First Generation Mexican Immigrants in the United States

2019 ◽  
Vol 7 (3) ◽  
pp. 86-90
Author(s):  
Shervin Assari ◽  
Mohammed Saqib ◽  
Cheryl Wisseh ◽  
Mohsen Bazargan
Keyword(s):  
United States ◽  
Health Insurance ◽  
Physical Health ◽  
Social Determinants ◽  
Mexican Americans ◽  
Mexican American ◽  
First Generation ◽  
Mexican Immigrants ◽  
The United States ◽  
Foreign Born

Introduction: Socioeconomic status (SES) indicators are among the main social determinants of health and illness. Less, however, is known about the role of SES in the epidemiology of polypharmacy in immigrant Latino Americans living in the United States. This research studied the association between three SES indicators, education, income, and employment, and polypharmacy in older first generation Latino American immigrant adults. Methods: Data was obtained from the Sacramento Area Latino Study on Aging (SALSA, 1996-2008). A total of 632 older first generation Mexican-American immigrants to the U.S. entered this analysis. The independent variables were education, income, and employment. Polypharmacy was the outcome. Age, gender, physical health, smoking, and drinking were the covariates. Binary logistic regression was used to analyze the data. Results: Employment was associated with lower odds of polypharmacy. The association between education and polypharmacy was above and beyond demographic factors, physical health, health behaviors, and health insurance. Neither education nor income were associated with polypharmacy. Other determinants of polypharmacy were poor self-rated health (SRH) and a higher number of chronic medical conditions (CMCs). Conclusion: Employment appears to be the major SES determinant of polypharmacy in older foreign-born Mexican Americans. Unemployed older Mexican American immigrants with multiple chronic diseases and those who have poor SRH have the highest need for an evaluation of polypharmacy. Given the age group of this population, most of them have health insurance, which provides an opportunity for reducing their polypharmacy.

Geographic Differences in Social Determinants of Health Among US-Born and Non–US-Born Hispanic/Latino Adults With Diagnosed HIV Infection, United States and Puerto Rico, 2017

2021 ◽  
pp. 003335492097053
Author(s):  
Zanetta Gant ◽  
Shacara Johnson Lyons ◽  
Chan Jin ◽  
André Dailey ◽  
Ndidi Nwangwu-Ike ◽  
...  
Keyword(s):  
United States ◽  
Puerto Rico ◽  
Household Income ◽  
The United States ◽  
Median Household Income ◽  
Federal Poverty Level ◽  
Poverty Level ◽  
Hiv Diagnosis ◽  
Latino Adults ◽  
Us Census

Objective HIV disproportionately affects Hispanic/Latino people in the United States, and factors other than individual attributes may be contributing to these differences. We examined differences in the distribution of HIV diagnosis and social determinants of health (SDH) among US-born and non–US-born Hispanic/Latino adults in the United States and Puerto Rico. Methods We used data reported to the Centers for Disease Control and Prevention’s National HIV Surveillance System (NHSS) to determine US census tract–level HIV diagnosis rates and percentages among US-born and non–US-born Hispanic/Latino adults aged ≥18 for 2017. We merged data from the US Census Bureau’s American Community Survey with NHSS data to examine regional differences in federal poverty level, education, median household income, employment, and health insurance coverage among 8648 US-born (n = 3328) and non–US-born (n = 5320) Hispanic/Latino adults. Results A comparison of US-born and non–US-born men by region showed similar distributions of HIV diagnoses. The largest percentages occurred in census tracts where ≥19% of residents lived below the federal poverty level, ≥18% did not finish high school, the median household income was <$40 000 per year, ≥6% were unemployed, and ≥16% did not have health insurance. A comparison of US-born and non–US-born women by region showed similar distributions. Conclusion The findings of higher numbers of HIV diagnoses among non–US-born Hispanic/Latino adults than among US-born Hispanic/Latino adults, regional similarities in patterns of SDH and HIV percentages and rates, and Hispanic/Latino adults faring poorly in each SDH category are important for understanding SDH barriers that may be affecting Hispanic/Latino adults with HIV in the United States.

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