Where Are We on the Animal Welfare Map? Using GIS to Assess Stakeholder Diversity and Inclusion

Inequities exist in all facets of society, and animal welfare organizations (AWOs) and their communities are no exception. These organizations interface with multiple stakeholder groups. An active analysis of stakeholder groups to identify under-served areas and communities has not been performed. Using stakeholder data from Toronto Humane Society (THS) from 2015–2019, this study performed a retrospective spatial analysis to identify well served and under-served geographic areas for adopters, surrenders, public veterinary service (PVS) clients, volunteers and foster parents, using Hot Spot analysis. Correlation analysis was performed to determine whether the spatial distribution of the groups correlated with the four socioeconomic metrics of the 2016 Ontario Marginalization Index (residential instability, material deprivation, dependency, and ethnic concentration), and a metric representing the distribution of Indigenous residents. For each stakeholder group, there were well served areas, typically in central Toronto where THS is located, and under-served areas, typically in the north-west and north-east corners of Toronto and in the surrounding cities of the Greater Toronto Area. The area served by THS PVS extended further north than the other hot spot areas. The number of adopters increased as the residential instability metric increased, whereas the number of adopters decreased as the ethnic concentration metric increased. The rate of surrenders increased as the Indigenous metric increased. Public Veterinary Service clients increased as the residential instability, material deprivation, and Indigenous metrics increased. One of the primary limitations of this study was the confounding factor of distance from THS. Individuals living further from THS are less likely to utilize its services, particularly if there is another accessible AWO nearby, and therefore may appear to reflect an under-served population that may not truly be under-served. A regional approach would help to overcome this limitation. The results provide useful insights into stakeholder engagement and provide a foundation for analysis of more targeted areas, as well as for strategies to reach under-served demographics. Similar analyses by other AWOs would be helpful to address inequities in a larger geographic area. Animal welfare organizations can improve program effectiveness by adding data analytics skills to the more traditional skills associated with this sector.

The Impact of Marginalization on Diffuse Large B-Cell Lymphoma Overall Survival: A Retrospective Cohort Study

Introduction: While health disparities in diffuse large B-cell lymphoma (DLBCL) have been previously noted, literature systematically describing the impact of social determinants of health (SDOH) on DLBCL overall survival (OS) is sparse. Furthermore, existing data largely examine SDOH of health in isolation, not accounting for key covariates or disease-related variables. Marginalization, which accounts for various SDOH, is a process of systemic discrimination and exclusion. Given the paucity of literature to date, we examined how marginalization influences DLBCL OS in the Canadian setting. The objectives of this study were: 1) To describe the impact of marginalization on DLBCL OS and 2) To identify which dimensions of marginalization, if any, impacted OS. Methods: We conducted a population-based retrospective cohort study of adult patients with newly diagnosed DLBCL in Ontario between January 1, 2005 to December 31, 2017 receiving a rituximab-containing chemotherapy regimen for curative intent, followed until March 1, 2020. Our primary exposure of interest was the Ontario Marginalization Index (ON-Marg), an administrative database tool which combines demographic indicators into four distinct marginalization dimensions: residential instability (% renters and % living alone), material deprivation (% low income and % lone parent families), dependency (% seniors and % employment), and ethnic concentration (% recent immigrants and % visible minority). Our primary outcome was 2-year OS, defined as time from the date of first rituximab-based treatment to date of death or completion of follow-up. Survival curves were generated using Kaplan-Meier methods, and Cox regression analyses were used to identify covariates that were independently associated with OS. Our final model adjusted for age (as increments of 10 years), sex, and comorbidity burden as measured by aggregate diagnostic groups (ADGs). Results: A total of 10,344 patients were diagnosed with DLBCL and treated with a rituximab-containing regimen in Ontario between January 1, 2005 and December 31, 2017. The median age was 67 (IQR, 55-75) and 46% were female. Of patients who had staging data (49%), 54% were advanced stage at diagnosis, and the median number of cycles of chemoimmunotherapy received was 6 (4-6). Median number of ADGs was 10 (8-12), indicating a moderate-to-high burden of comorbidities within this cohort, and 13% of patients resided in a rural area. Cohort characteristics and mortality rates per ON-Marg quintile (Q5 = most marginalized) are provided in Table 1. Overall, group characteristics were evenly distributed, except that the most marginalized group had a higher proportion of patients residing in urban settings and nearer to treatment hospitals. Two-year overall survival was 73.2%. After controlling for relevant confounders, material deprivation (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.02 - 1.10, p=0.003) and ethnic concentration (HR 1.05, 95% CI 1.01 - 1.09, p=0.013) contributed to increased risk of all-cause mortality. Residential instability and dependency had no significant effect. Increasing age (HR 1.29, 95% CI 1.25 - 1.33, p<0.0001) and increasing number of ADGs (HR 1.028, 95% CI 1.025 - 1.031, p<0.0001) were also associated with increased risk of all-cause mortality, while female sex was found to be protective (HR 0.89, 95% CI 0.83 - 0.97, p=0.005). Discussion: To our knowledge, no study has examined the impact of marginalization and collective SDOH on DLBCL outcomes. We found that increased material deprivation and ethnic concentration conferred increased mortality. While Canada's largely single-payer system and previously documented healthy immigrant effect may have been expected to attenuate effects of income and immigration, our study suggests otherwise. Possible explanations may include barriers to healthcare access for patient subsets, who may have less support for treatment. Structural factors such as systemic racism, health literacy, and caregiver burden must also be taken into account. These factors require further evaluation to inform targeted interventions and establish support for increased access to timely care amongst this patient population. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Immigrant Political Representation and Local Ethnic Concentration: Evidence from a Swedish Refugee Placement Program

This study leverages population registry data from Sweden to examine whether immigrants who live in areas with a high concentration of ethnic minorities are more or less likely to be nominated for political office. It exploits a refugee placement program in place in Sweden during the late 1980s and early 1990s that restricted refugees' opportunities to freely choose their place of residence. The article presents evidence that immigrants who live in areas with a high ethnic density are less likely to be nominated for political office. The findings have important implications for local integration policies as well as refugee placement policies, as many countries consider local context when resettling refugees.

Risk factors for retirement home COVID-19 outbreaks in Ontario, Canada: A population-level cohort study

BackgroundThe epidemiology of COVID-19 in retirement homes (also known as assisted living facilities) is largely unknown. We examined the association between retirement home and community level characteristics and the risk of COVID-19 outbreaks in retirement homes during the first wave of the COVID-19 epidemic.MethodsWe conducted a population-based retrospective cohort study of licensed retirement homes in Ontario, Canada, from March 1st - September 24th, 2020. Our primary outcome was a COVID-19 outbreak (≥1 resident or staff confirmed case by validated nucleic acid amplification assay). We used time-dependent proportional hazards methods to model the associations between retirement home and community level characteristics and COVID-19 outbreaks.ResultsOur cohort included all 770 licensed retirement homes in Ontario, which housed 56,491 residents. There were 172 (22.3%) COVID-19 retirement home outbreaks involving 1,045 (1.9%) residents and 548 staff (1.5%). COVID-19 cases were distributed unevenly across retirement homes, with 1,593 (92.2%) resident and staff cases occurring in 77 (10%) of homes. The adjusted hazard of a COVID-19 outbreak in a retirement home was positively associated with homes that had a large resident capacity, homes that were co-located with a long-term care facility, large corporate owned chains, homes that offered many services onsite, increases in regional COVID-19 incidence, and a higher community-level ethnic concentration.InterpretationReadily identifiable retirement home-level characteristics are independently associated with COVID-19 outbreaks and may support risk identification. A higher ethnic concentration of the community surrounding a retirement home is associated COVID-19 outbreaks, with an uncertain mechanism.

Using Electronic Medical Record Data to Better Understand Obesity in Hispanic Neighborhoods in El Paso, Texas

The prevalence of obesity has been persistent amongst Hispanics over the last 20 years. Socioeconomic inequities have led to delayed diagnosis and treatment of chronic medical conditions related to obesity. Factors contributing include lack of insurance and insufficient health education. It is well-documented that obesity amongst Hispanics is higher in comparison to non-Hispanics, but it is not well-understood how the socioeconomic context along with Hispanic ethnic concentration impact the prevalence of obesity within a community. Specifically studying obesity within Hispanic dominant regions of the United States, along the Texas–Mexico border will aid in understanding this relationship. El Paso, Texas is predominantly Mexican-origin Hispanic, making up 83% of the county’s total population. Through the use of electronic medical records, BMI averages along with obesity prevalence were analyzed for 161 census tracts in the El Paso County. Geographic weighted regression and Hot Spot technology were used to analyze the data. This study did identify a positive association between Hispanic ethnic concentration and obesity prevalence within the El Paso County. Median income did have a direct effect on obesity prevalence while evidence demonstrates that higher education is protective for health.

S131. NEIGHBOURHOOD-LEVEL SOCIAL CAPITAL, MARGINALIZATION, AND THE INCIDENCE OF PSYCHOTIC DISORDERS IN TORONTO, CANADA: A RETROSPECTIVE POPULATION-BASED COHORT STUDY

Background Previous studies have shown mixed results regarding the relationship between social capital and the risk of developing a psychotic disorder, and this has yet to be studied in North America. This study aims to examine the relationship between neighbourhood-level social capital, marginalization, and the incidence of psychotic disorders in Toronto, Canada. Methods A retrospective cohort of people aged 14 to 40 years residing in Toronto, Canada in 1999 (followed to 2008) was constructed from population-based health administrative data. Incident cases of schizophrenia spectrum psychotic disorders were identified using a validated algorithm. Voter participation rates in a municipal election were used as a proxy neighbourhood-level indicator of social capital. Exposure to neighbourhood-level marginalization was obtained from the Ontario Marginalization Index. Poisson regression models adjusting for age and sex were used to calculate incidence rate ratios (IRR) for each social capital quintiles and marginalization quintile. Results In the study cohort (n = 640,000) over the 10-year follow-up period, we identified 4,841 incident cases of schizophrenia spectrum psychotic disorders. We observed elevated rates of psychotic disorders in areas with the highest levels (IRR = 1.13, 95% CI 1.00–1.27) and moderate levels (IRR = 1.23, 95% CI 1.12–1.36) of social capital, when compared to areas with the lowest levels of social capital, after adjusting for neighbourhood-level indicators of marginalization. The risk associated with social capital was not present when analyzed in only the females in the cohort. All neighbourhood marginalization indicators, other than ethnic concentration, were significantly associated with risk. Discussion The risk of developing a psychotic disorder in Toronto, Canada is associated with socioenvironmental exposures. Social capital is associated with risk, however, the impact of social capital on risk differs by sex and social capital quintile. Across the entire cohort, exposure to all neighbourhood-level marginalization indicators, except ethnic concentration, impacts risk. Future research should examine how known individual-level risk factors, including immigration, ethnicity, and family history of a mental disorder may interact with these findings.

Do Enclaves Matter in Immigrant Adjustment?

This chapter is concerned with the determinants and consequences of immigrant/linguistic concentrations (enclaves). The reasons for the formation of these concentrations are discussed. Hypotheses are developed regarding “ethnic goods” and the effect of concentrations on the immigrant's language skills, as well as the effects on immigrant earnings of destination language skills and the linguistic concentration. These hypotheses are tested using PUMS data from the 1990 U.S. Census on adult male immigrants from non-English-speaking countries. Linguistic concentrations reduce the immigrant’s own English language skills. Moreover, immigrants’ earnings are lower the lower their English language proficiency and the greater the linguistic/ethnic concentration in their origin language of the area in which they live. The adverse effects on earnings of poor destination language skills and of immigrant concentrations exist independently of each other. The hypotheses regarding ethnic goods are supported by the data.