Defining Spatial Epidemiology: A Systematic Review and Re-orientation.

BACKGROUND: Spatial epidemiology has emerged as an important subfield of epidemiology over the past quarter century. We trace the origins of spatial epidemiology and note that its emergence coincided with technological developments in spatial statistics and geography. We hypothesize that spatial epidemiology makes important contributions to descriptive epidemiology and analytic risk-factor studies but is not yet aligned with epidemiology's current focus on causal inference and intervention. METHODS: We conducted a systematic review of studies indexed in PubMed that used the term "spatial epidemiolog*" in the title, abstract, or keywords. Excluded articles were not written in English, examined disease in animals, or reported biologic pathogen distribution only. We coded the included papers into five categories (review, demonstration of method, descriptive, analytic, and intervention) and recorded the unit of analysis (i.e., individual vs. ecological). We additionally examined articles coded as analytic ecologic studies using scales for lexical content. RESULTS: A total of 482 articles met the inclusion criteria, including 76 reviews, 117 demonstrations of methods, 122 descriptive studies, 167 analytic studies, and 0 intervention studies. Demonstration studies were most common from 2006 to 2014, and analytic studies were most common after 2015. Among the analytic ecologic studies, those published in later years used more terms relevant to spatial statistics (incidence rate ratio =1.3; 95% confidence interval [CI] = 1.1, 1.5) and causal inference (incidence rate ratio =1.1; 95% CI = 1.1, 1.2). CONCLUSIONS: Spatial epidemiology is an important and growing subfield of epidemiology. We suggest a re-orientation to help align its practice with the goals of contemporary epidemiology.

Physical environmental roadway interventions and injury and death for vulnerable road users: a natural experiment in New York City.

INTRODUCTION: This study examined the effectiveness of three physical environmental roadway interventions (enhanced crossings, speed humps, and turn traffic calming) in preventing crashes involving pedestrian and cyclist injury and mortality in New York City. METHODS: We examined crashes that occurred within a 100-foot radius of intervention and control sites from 2015 to 2019. We used a staggered difference-in-difference design to estimate the association between each intervention type and pedestrian and cyclist crash outcomes. RESULTS: Estimates for enhanced crossings and speed humps included the possibility of no association with crashes, but estimates for turn traffic calming interventions showed reduced odds of crashes involving pedestrian injury by 16% (OR 0.84, 95% CI 0.74 to 0.95) and crashes involving pedestrian fatality by 80% (OR 0.20, 95% CI 0.08 to 0.47). When stratifying by street segment length as a proxy for areas with high speeding risk, turn traffic calming treatments appeared to be most effective at intersections connected to long street segments. DISCUSSION: Turn traffic calming may substantially reduce crash risks for pedestrians. Municipalities can prioritise this physical environmental intervention, especially at turns near long street segments, as a low-cost intervention with substantial public health impact.

Temperature and firearm violence in four US cities: testing competing hypotheses.

INTRODUCTION: Firearm violence is a major public health issue in the USA. There is growing evidence that firearm violence is associated with higher ambient temperatures. The aim of this study was to test competing hypotheses that could explain associations between temperature and firearm violence: temperature-aggression theory and routine activities theory. METHODS: We examined associations between elevated daily temperatures and shooting incidents in four US cities: Chicago, Illinois; Cincinnati, Ohio; New York, New York and Philadelphia, Pennsylvania. Temperature was operationalised using two different measures: daily maximum temperature and deviations of the daily maximum temperature from 30-year averages. Generalised linear autoregressive moving average models related temperature to shooting incidence while controlling for seasonal effects. RESULTS: As maximum daily temperature deviates from the expected, there was an association with increased shooting incidents in all four cities (eg, New York: b=0.014, 95% CI=0.011 to 0.017). An interaction term created by multiplying daily maximum temperature by the daily difference of maximum temperature from a 30-year average was also found to have a positive association in all four cities (eg, New York: b=0.020, 95% CI=0.016 to 0.025). DISCUSSION: These findings accord with previous studies demonstrating a positive relationship between temperature and firearm violence and further support temperature-aggression theory as the primary causal mechanism.

Gun shows and universal background check laws across state lines.

States with more gun laws have fewer gun assaults, and associations are strongest for background check laws. However, sales between private buyers and sellers (i.e., gun shows) are exempt from some background check requirements according to federal and most state laws. The aim of this study was to determine whether gun shows are more likely to take place in counties that are near states with universal background check laws. This cross-sectional study used gun show data from a 2018 public online listing aggregated within 3107 counties in the contiguous 48 states. The main independent variable was the presence of a universal background check law in neighboring states. We controlled for potential drivers of demand for gun shows, including the total number of gun laws within-state and in neighboring states, local and in-flowing population size, and proportion of the local and in-flowing population who were gun owners. Bayesian conditional autoregressive Poisson models estimated associations between neighboring-state universal background check law and the presence of a gun show in each county while accounting for spatial dependencies and nesting of counties within states. Of the 1869 identified gun shows, nine of the states in which they occurred had a universal background check law. The presence of excess gun shows in counties near states with universal background check laws is consistent with the hypothesis that gun shows service demand from people seeking to circumvent prohibitions against gun purchases.

Historical redlining and the epidemiology of present-day firearm violence in the United States: A multi-city analysis.

Firearm violence is a major cause of morbidity, mortality, and racial health disparities in the United States. Previous studies have identified associations between historically racist housing discrimination (i.e., redlining practices) and firearm violence; however, these studies generally have been limited to a single city and have yet to provide sufficient evidence through which to determine the extent and dynamics of the impact of this relationship across the country. The aim of our study was (1) to estimate the association of historical redlining on both violent and firearm death across the country in nested models; and (2) to examine spatial non-stationarity to determine whether the impact of historical redlining on violent and firearm death was the same across the U.S. We used multilevel Bayesian conditional autoregressive Poisson models to determine the relationship between redlining as illustrated through Home Owners' Loan Corporation maps and 2019 violent and firearm deaths at the ZIP code-level nested within 21 cities across the U.S. We found that at the ZIP code level, there was a dose-responsive relationship between HOLC grading and the incidence of present-day firearm deaths. In general, redlined ZIP codes had higher relative incidence of firearm deaths. Associations were not stable across cities. For example, associations were relatively stronger in Baltimore, MD and weaker in Los Angeles, CA. This research reinforces the findings of previous studies examining the impact of redlining on firearm death across the extent of the entire country in 21 cities and claim that HOLC grades are associated with present-day violence.

Ridesharing and motor vehicle crashes: a spatial ecological case-crossover study of trip-level data.

BACKGROUND: Ridesharing services (eg, Uber, Lyft) have facilitated over 11 billion trips worldwide since operations began in 2010, but the impacts of ridesharing on motor vehicle injury crashes are largely unknown. - METHODS: This spatial ecological case-cross over used highly spatially and temporally resolved trip-level rideshare data and incident-level injury crash data for New York City (NYC) for 2017 and 2018. The space-time units of analysis were NYC taxi zone polygons partitioned into hours. For each taxi zone-hour we calculated counts of rideshare trip origins and rideshare trip destinations. Case units were taxi zone-hours in which any motor vehicle injury crash occurred, and matched control units were the same taxi zone from 1 week before (-168 hours) and 1 week after (+168 hours) the case unit. Conditional logistic regression models estimated the odds of observing a crash (separated into all injury crashes, motorist injury crashes, pedestrian injury crashes, cyclist injury crashes) relative to rideshare trip counts. Models controlled for taxi trips and other theoretically relevant covariates (eg, precipitation, holidays). RESULTS: Each additional 100 rideshare trips originating within a taxi zone-hour was associated with 4.6% increased odds of observing any injury crash compared with the control taxi zone-hours (OR=1.046; 95% CI 1.032 to 1.060). Associations were detected for motorist injury and pedestrian injury crashes, but not cyclist injury crashes. Findings were substantively similar for analyses conducted using trip destinations as the exposure of interest. CONCLUSIONS: Ridesharing contributes to increased injury burden due to motor vehicle crashes, particularly for motorist and pedestrian injury crashes at trip nodes.

Automated Reminders Improve Retinal Screening Rates in Low Income, Minority Patients with Diabetes and Correct the African American Disparity.

Diabetic retinopathy (DR) is a major cause of blindness in the United States. Prevention relies on periodic DR screening, yet overall national screening rates are not optimal, especially in low-income, minority patients. We prospectively evaluated show rates for prescheduled teleretinal DR screening appointments in diabetic patients (n = 301) in a large safety-net clinic in South Central Los Angeles. Patients were predominately African American (n = 88) and Latino (n = 200). Patients received either usual care telephone reminders or automated reminder calls in addition to usual care. The overall mean (SEM) show rate for DR screening, irrespective of reminder method, was low: 54 + 1.03%. Show rates with usual care alone were 46.3 + 2.6%, and with automated reminders added, 59.9 + 1.47% (p = 0.036). Show rate with usual care amongst African Americans was 23.6 + 6.46% compared with 53.2 + 3.41% for Latinos (p = 0.025). When automated calling was added, the show rate doubled amongst African Americans, to 51.6 + 3.96% (p = 0.002) with a slightly higher, non-significant show rate in Latinos. In summary, show rates for pre-scheduled teleretinal DR screening appointments were low with usual care alone in a safety-net clinic, with evidence for a racial disparity amongst low-income, minority patients with diabetes. Addition of a pre-recorded automated reminder call improved show rates, and corrected much of the racial disparity observed. Greater focus on failed appointments as an explanation for low DR screening rates and racial disparities, and as a potentially remediable target with automated reminders, may improve DR screening rates and reduce blindness in low-income minority patients with diabetes.

Individuals' travel to alcohol outlets: The fallacy of the local bar.

INTRODUCTION: Studies relating alcohol outlet density around homes to alcohol consumption produce mixed results. One possible explanation is that people travel to outlets away from their homes. This study aims to characterise individuals' trips to outlets, describe these trip locations relative to other activities and estimate associations between alcohol outlet density and trips to outlets. METHODS: This cross-sectional study used 2014-2018 household travel data from the Victoria Integrated Survey of Travel and Activity. We estimated the average change in the cumulative travel characteristics associated with each additional trip to bars and liquor stores, accounting for complex trips to multiple destinations. Logistic regression models estimated odds that individuals travelled to outlets in relation to outlet density in their home local government area (LGA). RESULTS: Among 23,512 respondents, 378 (1.6%) travelled to any bar and 79 (0.3%) any liquor store the survey day. Bar trips added 8.2 km (95% confidence interval [CI] 4.6, 11.8) and 18.1 min (95% CI 13.6, 22.6) to cumulative travel; 41% of attended bars were co-located in participants' home LGA. Greater bar and liquor store density within the home LGA were associated with overall trips to these outlet types. DISCUSSION AND CONCLUSIONS: Individuals travel beyond their residential area to bars, but travel to liquor stores closer to home. Bar and liquor store density within individuals' home LGA were associated with trips to outlets. Trips to local bars in near home comprised a minority of trips to bars in this sample. Studies of retail alcohol access should account for trips to bars away from home.

The association between street construction projects and community violence in New York City.

Introduction: Community violence is a major cause of injury and death in the United States. Empirical studies have identified that some place-based interventions of urban private places, such as remediations of vacant lots and buildings, are associated with reductions in community violence in surrounding areas. The aim of this study was to examine whether routine maintenance and repair of urban public places (e.g., street construction projects) are also associated with reductions in community violence, proxied by violent crime. Method: This staggered adoption difference-in-difference analysis investigated the association between street construction projects and community violence in New York City from 2010-2019, divided into 40 calendar quarters. The units of analysis were street-quarters (n = 155,280). Intervention street-quarters were those with completed projects in 2010-2019; control streets were those where projects were scheduled but not completed before 2019. The outcome of community violence was proxied by counts of crime and violence incidents reported to the New York Police Department, within street-quarters. Results: There were 79,592 street-quarters with any community violence incidents (51.2%). We found that street construction projects were associated with a decrease in reckless endangerment (ATT = -0.013; 95% CI = -0.021, -0.004), robbery (ATT = -0.035; 95% CI = -0.063, -0.007), and weapons offenses (ATT = -0.016; 95% CI = -0.031, -0.001) occurring on street-quarters. Conclusion: Street construction projects may be yet another type of place-based intervention to reduce community violence.

Trends in police complaints and arrests on New York City subways, 2018 to 2023: an interrupted time-series analysis.

BACKGROUND: Public transportation use is influenced by perceptions of safety. Concerns related to crime on New York City (NYC) transit have risen following NYC's COVID-19 pandemic state of emergency declaration in 2020, leading to declines in subway ridership. In response, the most recent mayoral administration implemented a Subway Safety Plan in 2022. This study aimed to quantify the effects of the COVID-19 pandemic and the Subway Safety Plan on rates of complaints to and arrests by the New York City Police Department (NYPD) Transit Bureau. METHODS: Using publicly available data on complaints and arrests, we conducted interrupted time-series analyses using autoregressive integrated moving average models applied to monthly data for the period from September 2018 to August 2023. We estimated changes in the rates of complaints to and arrests by the NYPD Transit Bureau before and after: (1) the COVID-19 pandemic state of emergency declaration (i.e., March 2020), and (2) the announcement of the Subway Safety Plan (i.e., February 2022). We also examined trends by complaint and arrest type as well as changes in proportion of arrests by demographic and geographic groups. RESULTS: After the COVID-19 pandemic declaration, there was an 84% increase (i.e., an absolute increase of 6.07 per 1,000,000 riders, CI 1.42, 10.71) in complaints to the NYPD Transit Bureau, including a 99% increase (0.91 per 1,000,000 riders, CI 0.42, 1.41) in complaints for assault and a 125% increase in complaints for harassment (0.94 per 1,000,000 riders, CI 0.29, 1.60). Following the Subway Safety Plan there was an increase in the rate of arrests for harassment (0.004 per 1,000,000 riders, CI 0.001, 0.007), as well as decreases in the proportion of arrests for individuals racialized as White (- 0.02, CI - 0.04, - 0.01) and proportion of arrests in the borough of Manhattan (- 0.13, CI - 0.17, - 0.09). CONCLUSIONS: The increased rates of complaints to the NYPD Transit Bureau following the onset of the COVID-19 pandemic remained elevated following the enactment of the Subway Safety Plan. Further evaluation efforts can help identify effective means of promoting safety on public transportation.

Interstate Highway Connections and Traced Gun Transfers Between the 48 Contiguous United States.

Importance: Interstate gun flow has critical implications for gun violence prevention, as gun transfers across state lines can undermine local gun control policies. Objective: To identify possible gun trafficking routes along interstate highways in the US. Design, Setting, and Participants: This repeated-measures, ecological, cross-sectional study used data from the Bureau of Alcohol, Tobacco, Firearms and Explosives from January 1, 2010, to December 31, 2019, to examine associations between interstate connections via 13 highways that each spanned at least 1000 miles and interstate traced gun transfer counts for the 48 contiguous United States. Analyses were completed in November 2023. Exposures: Characteristics of the origin states and the transportation connections between the destination state and the origin states. Main Outcomes and Measures: The main outcome was the total count of guns used in crimes in each destination state per year that were originally purchased in the origin state. Bayesian conditional autoregressive Poisson models were used to examine associations between the count of guns used in crime traced to interstate purchases and interstate highway connections between origin and destination states. Results: Between 2010 and 2019, 526 801 guns used in crimes in the contiguous 48 states were traced to interstate purchases. Northbound gun transfers along the Interstate 95 corridor were greater than expected to New Jersey (incidence rate ratio [IRR], 2.80; 95% credible interval [CrI], 1.01-7.68) and Maryland (IRR, 3.07; 95% CrI, 1.09-8.61); transfers were similarly greater along Interstate 15 southbound, Interstate 25 southbound, Interstate 35 southbound, Interstate 75 northbound and southbound, Interstate 10 westbound, and Interstate 20 eastbound and westbound. Conclusions and Relevance: This repeated-measures, ecological, cross-sectional study identified that guns used in crimes traced to interstate purchases moved routinely between states along multiple major transportation routes. Interstate gun transfers are a major contributor to gun crime, injury, and death in the US. National policies and interstate cooperation are needed to address this issue.

Impact and Equity of New York City's Tobacco Retail Reduction Initiative.

INTRODUCTION: High levels of tobacco retailer density in communities is associated with a range of tobacco use behaviors and is a key structural driver of tobacco-related disparities. This study evaluates the impacts of New York City's (NYC) novel policy intervention to cap tobacco retail licenses on tobacco retailer density levels and neighborhood inequities in tobacco access. METHODS: Using geocoded tobacco retail licensing data from 2010 to 2022, Bayesian conditional autoregressive Poisson panel models estimated the association between policy implementation in 2018 and retailer density per 1,000 population, controlling for neighborhood-level sociodemographic factors. Data were analyzed in 2023. RESULTS: The number of tobacco retail licenses decreased from 9,304 in 2010 to 5,107 in 2022, with the rate of decline significantly accelerating post-policy (-14·2% versus -34·2%). Policy effects were stronger in districts with lower income and greater proportions of non-Hispanic Black residents. CONCLUSIONS: NYC's policy substantially reduced tobacco retailer density and appeared to close longstanding patterns of inequity in tobacco access, serving as a rare example of a tobacco control policy that may effectively reduce tobacco-related disparities. This emergent approach to restructure tobacco retail in communities may reach populations that have not benefitted from traditional tobacco control policies and should be considered by other localities.

Casino accessibility and suicide: A county-level study of 50 US states, 2000 to 2016.

BACKGROUND AND AIMS: Suicide is the tenth leading cause of death in the United States (US). Research over many decades identifies that its etiology is complex, with risk factors operating in multiple domains. One such risk factor is gambling. Over the past three decades, exposure to gambling has increased dramatically in the United States. The aim of this study was to measure the magnitude of the association between casino density and absolute risk of suicide in US counties. DESIGN, SETTING, CASES: This spatial panel analysis used data for 3131 counties from 50 US states from 2000 to 2016, for an overall sample of 53 227 county-year units. Using Bayesian conditional autoregressive Poisson models, we measured incidence rate ratios and credible intervals for the association between the density per population of casinos and other gambling outlets and the incidence of suicide. MEASUREMENTS: The outcome of interest was counts of suicides. The main exposures of interest were casinos and other gambling outlets. FINDINGS: A total of 527 401 suicides occurred during the study period. On average, there was a mean of 1.3 casinos (SD = 9.1) and 1.4 other gambling venues (SD = 5.9) in each county-year. After controlling for confounding, the incidence rate ratio for casinos was 1.016, and the credible interval was between 1.010 and 1.023. CONCLUSIONS: The density of casinos and other gambling venues is positively associated with suicide mortality in the United States.

Unintended reductions in assaults near sobriety checkpoints: A longitudinal spatial analysis.

BACKGROUND: Sobriety checkpoints are a form of proactive policing in which law enforcement officers concentrate at a point on the roadway to systematically perform sobriety tests for all passing drivers. We investigated whether sobriety checkpoints unintentionally reduce assaults in surrounding areas. METHODS: Exposures of interest were sobriety checkpoints conducted by the Los Angeles Police Department between 2012 and 2017. Comparison units were matched 1:2 to sobriety checkpoints, selected as the same point location temporally lagged by exactly ±168 hours. The outcome was the density of police-reported assaults around the checkpoint location. RESULTS: In mixed effects regression analyses, assault incidence was lower when sobriety checkpoints were in operation compared to the same location ±168 hours [b= -0.0108, 95% CI: (-0.0203, -0.0012)]. CONCLUSIONS: Sobriety checkpoints were associated with decreased assault incidence, but estimated effect sizes were small and effects did not endure long after checkpoints ended.

Assessing the Gun Violence Archive as an Epidemiologic Data Source for Community Firearm Violence in 4 US Cities.

Importance: Firearm injury is a major public health burden in the US, and yet there is no single, validated national data source to study community firearm violence, including firearm homicide and nonfatal shootings that result from interpersonal violence. Objective: To assess the validity of the Gun Violence Archive as a source of data on events of community firearm violence and to examine the characteristics of individuals injured in shootings. Design, Setting, and Participants: This cross-sectional observational study compared data on community firearm violence from the Gun Violence Archive with publicly available police department data, which were assumed to be the reference standard, between January 1, 2015, and December 31, 2020. Cities included in the study (Philadelphia, Pennsylvania; New York, New York; Chicago, Illinois; and Cincinnati, Ohio) had a population of greater than 300 000 people according to the 2020 US Census and had publicly available shooting data from the city police department. A large city was defined as having a population greater than or equal to 500 000 (ie, Philadelphia, New York City, and Chicago). Data analysis was performed in December 2022. Main Outcomes and Measures: Events of community firearm violence from the Gun Violence Archive were matched to police department shootings by date and location. The sensitivity and positive predictive value of the data were calculated (0.9-1.0, excellent; 0.8-0.9, good; 0.7-0.8, fair; 0.6-0.7, poor; and <0.6, failed). Results: A total of 26 679 and 32 588 shooting events were documented in the Gun Violence Archive and the police department databases, respectively, during the study period. The overall sensitivity of the Gun Violence Archive over the 6-year period was 81.1%, and the positive predictive value was 99.0%. The sensitivity steadily improved over time. Shootings involving multiple individuals and those involving women and children were less likely to be missing from the Gun Violence Archive, suggesting a systematic missingness. Conclusions and Relevance: These findings support the use of the Gun Violence Archive in large cities for research requiring its unique advantages (ie, spatial resolution, timeliness, and geographic coverage), albeit with caution regarding a more granular examination of epidemiology given its apparent bias toward shootings involving multiple persons and those involving women and children.

Self-Report Survey Measures of Alcohol-Impaired Driving: A Systematic Review.

OBJECTIVE: Alcohol-impaired driving is a major contributor to motor vehicle crash deaths and injury. Many survey studies include self-report measures of alcohol-impaired driving, but no guidance is available to help researchers select from among available measures. The aims of this systematic review were to compile a list of measures that researchers have used previously, to compare performance between measures, and to identify the measures with highest validity and reliability. METHOD: Literature searches of PubMed, Scopus, and Web of Science identified studies that assessed alcohol-impaired driving behavior through self-report. The measures from each study and, if available, indices of reliability or validity were extracted. Using the measures' text, we developed 10 codes to group similar measures and compare them. For example, the "alcohol effects" code refers to driving while feeling dizzy or lightheaded after drinking, and the "drink count" code pertains to the number of drinks someone consumed before driving. For measures with multiple items, each item was categorized separately. RESULTS: After screening according to the eligibility criteria, 41 articles were included in the review. Thirteen articles reported on reliability. No articles reported on validity. The self-report measures with the highest reliability coefficients contained items from multiple codes, namely alcohol effects and drink count. CONCLUSIONS: Self-report alcohol-impaired driving measures with multiple items evaluating distinct aspects of alcohol-impaired driving show better reliability than measures using a single item. Future work investigating the validity of these measures is needed to determine the best approach for conducting self-report research in this area.

Optimizing sobriety checkpoints to maximize public health benefits and minimize operational costs.

BACKGROUND: Sobriety checkpoints are a highly effective strategy to reduce alcohol-impaired driving, but they are used infrequently in the USA. Recent evidence from observational studies suggests that using optimized sobriety checkpoints-operating for shorter duration with fewer officers-can minimize operational costs without reducing public health benefits. The aim of this research was to conduct a pilot study to test whether police can feasibly implement optimized sobriety checkpoints and whether researchers can examine optimized sobriety checkpoints compared to usual practice within a non-randomized controlled trial study design. METHODS: The study site was the Town of Apex, NC. We worked with Apex Police Department to develop a schedule of sobriety checkpoints during calendar year 2021 that comprised 2 control checkpoints (conducted according to routine practice) and 4 optimized checkpoints staffed by fewer officers. Our primary operations aim was to test whether police can feasibly implement optimized sobriety checkpoints. Our primary research aim was to identify barriers and facilitators for conducting an intervention study of optimized sobriety checkpoints compared to usual practice. A secondary aim was to assess motorist support for sobriety checkpoints and momentary stress while passing through checkpoints. RESULTS: Apex PD conducted 5 of the 6 checkpoints and reported similar operational capabilities and results during the optimized checkpoints compared to control checkpoints. For example, a mean of 4 drivers were investigated for possibly driving while impaired at the optimized checkpoints, compared to 2 drivers at control checkpoints. The field team conducted intercept surveys among 112 motorists at 4 of the 6 checkpoints in the trial schedule. The survey response rate was 11% from among 1,045 motorists who passed through these checkpoints. Over 90% of respondents supported sobriety checkpoints, and momentary stress during checkpoints was greater for motorists who reported consuming any alcohol in the last 90 days compared to nondrinkers (OR = 6.7, 95%CI: 1.6, 27.1). CONCLUSIONS: Results of this study indicate the sobriety checkpoints can feasibly be optimized by municipal police departments, but it will be very difficult to assess the impacts of optimized checkpoints compared to usual practice using an experimental study design.

Trends in alcohol-impaired crashes in California, 2016 to 2021: A time series analysis for alcohol involvement and crash distribution among demographic subgroups.

BACKGROUND: In 2020, the COVID-19 pandemic and control measures changed alcohol consumption in the United States (US) and globally. Before the pandemic, alcohol-impaired crashes contributed to approximately one-third of all road traffic crash injuries and fatalities nationally. We examined the impact of the COVID-19 pandemic on crashes and examined differences in alcohol-involved crashes across various subgroups. METHODS: The University of California Berkeley Transportation Injury Mapping Systems provided information on all crashes reported to the California Highway Patrol from January 1, 2016 through December 31, 2021. Using autoregressive integrated moving average (ARIMA) models applied to weekly time series data, we estimated the effect of California's first mandatory statewide shelter-in-place order (March 19, 2020) on crashes per 100,000 population. We also examined crash subgroups according to crash severity, sex, race/ethnicity, age, and alcohol involvement. RESULTS: In California, the mean crash rate per week before the pandemic (January 1, 2016-March 18, 2020) was 9.5 crashes per 100,000 population, and 10.3% of those were alcohol-involved. After the initiation of the COVID-19 stay-at-home order, the percentage of crashes that were alcohol-involved rose to 12.7%. Overall, the crash rate across California decreased significantly (-4.6 crashes per 100,000; 95% CI: -5.3, -3.9), including across all examined subgroups, with the greatest decrease among the least severe crashes. However, there was a 2.3% absolute increase in the proportion of crashes that were alcohol-involved (0.02 crashes per 100,000; 95% CI: 0.02, 0.03). CONCLUSIONS: The initiation of a COVID-19 stay-at-home ordinance in California was associated with a substantial decrease in overall crash rates. While crashes have returned to pre-pandemic levels, alcohol-involved crashes remain elevated. The initiation of the stay-at-home order significantly increased alcohol-impaired driving, which has remained elevated.

Ridesharing and alcohol-related assaults in NYC: A spatial ecological case-crossover study.

OBJECTIVE: Ridesharing has changed urban transportation and the distribution of some health outcomes, including alcohol consumption. Studies relating ridesharing to crime and violence at low space-time resolution (e.g., county-months) find mixed results. The aim of this study was to examine whether ridesharing was associated with increased incidence of alcohol-related assaults within highly resolved space-time units. METHODS: This spatial ecological case-crossover study used rideshare and taxi trip data from the New York City (NYC) Taxi and Limousine Commission for 2017-2018 and assault data from the NYC Police Department, aggregated within taxi zone-hours. Conditional logistic regression models estimated the odds of observing an assault for case taxi zone-hours in which an assault occurred compared to two control units of the same taxi zone-hour one week before (-168 h) and one week after (+168 h) relative to the number of rideshare trips. Separate analyses assessed assaults occurring at bars and restaurants. RESULTS: From 2017-2018, there were 47,124 nighttime assaults in the 262 taxi zones. There were 2482 taxi zone-hours at a bar and 693 taxi zone-hours at a restaurant that contained at least one nighttime assault. Ridesharing was positively associated with nighttime assaults at bars (OR: 1.050; 95% CI: 1.002-1.100) but not at restaurants (OR: 1.049; 95% CI: 0.943-1.168). CONCLUSIONS: Additional ridesharing trips are associated with increased incidence of assaults at on-premise alcohol outlets in NYC at the precise hour and taxi zone of trip origins.

Absolute versus relative socioeconomic disadvantage and homicide: a spatial ecological case-control study of US zip codes.

BACKGROUND: Homicide is a major cause of death and contributes to health disparities in the United States. This burden overwhelmingly affects people from racial and ethnic minority populations as homicide occurs more often in neighborhoods with high proportions of racial and ethnic minority residents. Research has identified that environmental factors contribute to variation in homicide rates between neighborhoods; however, it is not clear why some neighborhoods with high concentrations of racial and ethnic minority residents have high homicide rates while neighborhoods with similar demographic compositions do not. The aim of this study was to assess whether relative socioeconomic disadvantage, (i.e., income inequality), or absolute socioeconomic disadvantage (i.e., income) measured at the ZIP code- and state-levels, is associated with high homicide rates in US ZIP codes, independent of racial and ethnic composition. METHODS: This ecological case-control study compared median household income and income inequality in 250 ZIP codes with the highest homicide rate in our sample in 2017 (cases) to 250 ZIP codes that did not experience any homicide deaths in 2017 (controls). Cases were matched to controls 1:1 based on demographic composition. Variables were measured at both the ZIP code- and state-levels. RESULTS: Lower median household income at the ZIP code-level contributed most substantially to the homicide rate. Income inequality at the state-level, however, was additionally significant when controlling for both ZIP code- and state-level factors. CONCLUSIONS: Area-based interventions that improve absolute measures of ZIP code socioeconomic disadvantage may reduce gaps in homicide rates.