Histories of neighborhood socioeconomic status contribute to race differences in later-life cognition.

INTRODUCTION: Neighborhood characteristics are increasingly implicated in cognitive health disparities, but no research has investigated how the historical context of neighborhoods shapes these disparities. METHODS: Four hundred sixty-four Black (55%) and White older adults (Mage = 63.6) were drawn from the Michigan Cognitive Aging Project, a community-based, prospective study of older adults. Participants' addresses at baseline (2017-2020) were geocoded and linked to 2000-2017 measures of neighborhood socioeconomic status (NSES): disadvantage [NDis] and affluence [NAff]. Latent class growth analysis (LCGA) characterized 18 interpolated year trajectories of NSES across 1344 census tracts. Path analysis examined whether NSES trajectory classes mediated the association between race and a global cognition composite. RESULTS: LCGA identified three NDis and two NAff trajectory classes, which were associated with participant race. Only one NDis class was associated with cognition, and it mediated the association between the Black race and cognition. DISCUSSION: Disinvestment in neighborhoods may be particularly salient in race disparities in cognitive function. HIGHLIGHTS: Race is implicated in the likelihood of living in more disadvantaged neighborhoods. Historical trends in neighborhood disadvantage are associated with cognitive function in older adulthood. Identifying patterns of neighborhood change may inform neighborhood-level interventions.

Where I'm Livin' and How I'm Feelin': Associations among community stress, gender, and mental-emotional health among Black Americans.

RATIONALE: Structural racism is a primary avenue for the perpetuation of racial health disparities. For Black Americans, both historically and contemporarily, the neighborhood context serves as one of the most striking examples of structural racism, with stressful neighborhood contexts contributing to the well-documented inequalities in psychological functioning among this population. OBJECTIVE: Thus, in this study, we adapted an intersectional-ecological framework to investigate the links between community stress and multiple dimensions of mental-emotional health for Black men and women. METHODS: Drawing on cross-sectional data from 842 Black Americans from the Milwaukee area, we tested both objective (Area Deprivation Index; ADI) and subjective (perceived neighborhood disadvantage; PND) indicators of community stress as simultaneous predictors of negative and positive affect and the odds of psychological disorder (depression, anxiety) in multilevel models, examining gender differences in these linkages. RESULTS: Results showed greater objective community stress was related to lower levels of negative affect for both men and women and lower odds of psychological disorder for women specifically. Greater subjective community stress was related to higher levels of negative affect and lower levels of positive affect for both men and women and to higher odds of psychological disorder for women specifically. CONCLUSIONS: Findings highlight the complex intersectional nature of the links between community stress and Black Americans' mental-emotional health. Specifically, findings demonstrate the pernicious psychological effects of perceived community stress and allude to Black Americans', particularly women's, active resistance and resilience to objective disadvantage, potentially through investing in social relationships in their neighborhoods.

Tree-Based Machine Learning to Identify Predictors of Psoriasis Incidence at the Neighborhood Level: A Populational Study from Quebec, Canada.

BACKGROUND: Psoriasis is a major global health burden affecting ~ 60 million people worldwide. Existing studies on psoriasis focused on individual-level health behaviors (e.g. diet, alcohol consumption, smoking, exercise) and characteristics as drivers of psoriasis risk. However, it is increasingly recognized that health behavior arises in the context of larger social, cultural, economic and environmental determinants of health. We aimed to identify the top risk factors that significantly impact the incidence of psoriasis at the neighborhood level using populational data from the province of Quebec (Canada) and advanced tree-based machine learning (ML) techniques. METHODS: Adult psoriasis patients were identified using International Classification of Disease (ICD)-9/10 codes from Quebec (Canada) populational databases for years 1997-2015. Data on environmental and socioeconomic factors 1 year prior to psoriasis onset were obtained from the Canadian Urban Environment Health Consortium (CANUE) and Statistics Canada (StatCan) and were input as predictors into the gradient boosting ML. Model performance was evaluated using the area under the curve (AUC). Parsimonious models and partial dependence plots were determined to assess directionality of the relationship. RESULTS: The incidence of psoriasis varied geographically from 1.6 to 325.6/100,000 person-years in Quebec. The parsimonious model (top 9 predictors) had an AUC of 0.77 to predict high psoriasis incidence. Amongst top predictors, ultraviolet (UV) radiation, maximum daily temperature, proportion of females, soil moisture, urbanization, and distance to expressways had a negative association with psoriasis incidence. Nighttime light brightness had a positive association, whereas social and material deprivation indices suggested a higher psoriasis incidence in the middle socioeconomic class neighborhoods. CONCLUSION: This is the first study to highlight highly variable psoriasis incidence rates on a jurisdictional level and suggests that living environment, notably climate, vegetation, urbanization and neighborhood socioeconomic characteristics may have an association with psoriasis incidence.

Lifetime Upward Economic Mobility and US-Born Latina Women's Preterm Birth Rates.

OBJECTIVES: To determine whether Latina women's upward economic mobility from early-life residence in impoverished urban neighborhoods is associated with preterm birth (< 37 weeks, PTB) . METHODS: Multivariate logistic regression analyses were performed on the Illinois transgenerational birth-file with appended US census income information for Hispanic infants (born 1989-1991) and their mothers (born 1956-1976). RESULTS: In Chicago, modestly impoverished-born Latina women (n = 1,674) who experienced upward economic mobility had a PTB rate of 8.5% versus 13.1% for those (n = 3,760) with a lifelong residence in modestly impoverished neighborhoods; the unadjusted and adjusted (controlling for age, marital status, adequacy of prenatal care, and cigarette smoking) RR equaled 0.65 (0.47, 0.90) and 0.66 (0.47, 0.93), respectively. Extremely impoverished-born Latina women (n = 2,507) who experienced upward economic mobility across their life-course had a PTB rate of 12.7% versus 15.9% for those (n = 3,849) who had a lifelong residence in extremely impoverished neighborhoods, the unadjusted and adjusted RR equaled 0.8 (0.63. 1.01) and 0.95 (0.75, 1.22), respectively. CONCLUSIONS FOR PRACTICE: Latina women's upward economic mobility from early-life residence in modestly impoverished urban neighborhoods is associated with a decreased risk of PTB. A similar trend is absent among their peers with an early-life residence in extremely impoverished areas.

Gentrification Yields Racial And Ethnic Disparities In Exposure To Contextual Determinants Of Health.

This article examines racial and ethnic disparities in the relationship between gentrification and exposure to contextual determinants of health. In our study, we focused on changes in selected contextual determinants of health (health care access, social deprivation, air pollution, and walkability) and life expectancy during the period 2006-21 among residents of gentrifying census tracts in six large US cities that have experienced different gentrification patterns and have different levels of segregation: Chicago, Illinois; Los Angeles, California; New York, New York; Philadelphia, Pennsylvania; San Francisco, California; and Seattle, Washington. We found that gentrification was associated with overall improvements in the likelihood of living in Medically Underserved Areas across racial and ethnic groups, but it was also associated with increased social deprivation and reduced life expectancy among Black people, Hispanic people, and people of another or undetermined race or ethnicity. In contrast, we found that gentrification was related to better (or unchanged) contextual determinants of health for Asian people and White people. Our findings can inform policies that target communities identified to be particularly at risk for worsening contextual determinants of health as a result of gentrification.

Community-Level Factors are Predictors of Severe Maternal Morbidity Among American Indian and Alaska Native Pregnant People in the Pacific Northwest in a Multilevel Logistic Regression.

INTRODUCTION: American Indian/Alaska Native (AI/AN) pregnant people face barriers to health and healthcare that put them at risk of pregnancy complications. Rates of severe maternal morbidity (SMM) among Indigenous pregnant people are estimated to be twice that of non-Hispanic White (NHW) pregnant people. METHODS: Race-corrected Oregon Hospital Discharge and Washington Comprehensive Hospital Abstract Reporting System data were combined to create a joint dataset of births between 2012 and 2016. The analytic sample was composed of 12,535 AI/AN records and 313,046 NHW records. A multilevel logistic regression was used to assess the relationship between community-level, individual and pregnancy risk factors on SMM for AI/AN pregnant people. RESULTS: At the community level, AI/AN pregnant people were more likely than NHW to live in mostly or completely rural counties with low median household income and high uninsured rates. They were more likely to use Medicaid, be in a high-risk age category, and have diabetes or obesity. During pregnancy, AI/AN pregnant people were more likely to have insufficient prenatal care (PNC), gestational diabetes, and pre-eclampsia. In the multilevel model, county accounted for 6% of model variance. Hypertension pre-eclampsia, and county rurality were significant predictors of SMM among AI/AN pregnant people. High-risk age, insufficient PNC and a low county insured rate were near-significant at p < 0.10. DISCUSSION: Community-level factors are significant contributors to SMM risk for AI/AN pregnant people in addition to hypertension and pre-eclampsia. These findings demonstrate the need for targeted support in pregnancy to AI/AN pregnant people, particularly those who live in rural and underserved communities.

What is already known on this subject? American Indian and Alaska Native pregnant people face higher rates of severe maternal morbidity and mortality, and the risk is exacerbated for rural Indigenous pregnant people.What this study adds? This publication uses a multilevel model to assess the contribution of community-level factors in severe maternal morbidity risk for American Indian and Alaska Native pregnant people. This analysis highlights the important role that rurality, prenatal care adequacy and access to insurance play in maternal morbidity risk and discusses how those risks are disproportionately felt by American Indian and Alaska Native pregnant people in the Pacific Northwest.

Human mobility networks reveal increased segregation in large cities.

A long-standing expectation is that large, dense and cosmopolitan areas support socioeconomic mixing and exposure among diverse individuals1-6. Assessing this hypothesis has been difficult because previous measures of socioeconomic mixing have relied on static residential housing data rather than real-life exposures among people at work, in places of leisure and in home neighbourhoods7,8. Here we develop a measure of exposure segregation that captures the socioeconomic diversity of these everyday encounters. Using mobile phone mobility data to represent 1.6 billion real-world exposures among 9.6 million people in the United States, we measure exposure segregation across 382 metropolitan statistical areas (MSAs) and 2,829 counties. We find that exposure segregation is 67% higher in the ten largest MSAs than in small MSAs with fewer than 100,000 residents. This means that, contrary to expectations, residents of large cosmopolitan areas have less exposure to a socioeconomically diverse range of individuals. Second, we find that the increased socioeconomic segregation in large cities arises because they offer a greater choice of differentiated spaces targeted to specific socioeconomic groups. Third, we find that this segregation-increasing effect is countered when a city's hubs (such as shopping centres) are positioned to bridge diverse neighbourhoods and therefore attract people of all socioeconomic statuses. Our findings challenge a long-standing conjecture in human geography and highlight how urban design can both prevent and facilitate encounters among diverse individuals.

Diverging trajectories of neighborhood disadvantage by race and birth cohort from childhood through young adulthood.

Prior research has established the greater exposure of African Americans from all income groups to disadvantaged environments compared to whites, but the traditional focus in studies of neighborhood stratification obscures heterogeneity within racial/ethnic groups in residential attainment over time. Also obscured are the moderating influences of broader social changes on the life-course and the experiences of Latinos, a large and growing presence in American cities. We address these issues by examining group-based trajectory models of residential neighborhood disadvantage among white, Black, and Latino individuals in a multi-cohort longitudinal research design of over 1,000 children from Chicago as they transitioned to adulthood over the last quarter century. We find considerable temporal consistency among white individuals compared to dynamic heterogeneity among nonwhite individuals in exposure to residential disadvantage, especially Black individuals and those born in the 1980s compared to the 1990s. Racial and cohort differences are not accounted for by early-life characteristics that predict long-term attainment. Inequalities by race in trajectories of neighborhood disadvantage are thus at once more stable and more dynamic than previous research suggests, and they are modified by broader social changes. These findings offer insights on the changing pathways by which neighborhood racial inequality is produced.

Generating data to facilitate more equitable distribution of health resources: an illustration of how local health surveys can identify probable need in mixed socio-economic regions.

OBJECTIVES: This study aimed to (1) encourage allocation of governmental and grant funds to the administration of local area health surveys and (2) illustrate the predictive impact of socio-economic resources on adult health status at the local area level to provide an example of how health surveys can identify residents with the greatest health needs. STUDY DESIGN: Randomly sampled and weight-adjusted regional household health survey (7501 respondents) analyzed with categorical bivariate and multivariate statistics, combined with Census data. Survey sample consists of the lowest, highest, and near highest ranked counties in the County Health Rankings and Roadmaps for Pennsylvania. METHODS: Socio-economic status (SES) is measured regionally with Census data consisting of seven indicators and individually with Health Survey data consisting of five indicators based on poverty level, overall household income, and education. Both of these composite measures are examined jointly for their predictive effects on a validated health status measure using binary logistic regression. RESULTS: Once county-level measures of SES and health status are broken down into smaller areas, better identification of pockets of health need is possible. This was most strongly revealed in an urban county, Philadelphia, which is ranked lowest of 67 counties on health measures in the state of Pennsylvania, yet when broken down into 'neighborhood clusters' contained both the highest- and lowest-ranked local area in a five-county region. Overall, regardless of the SES level of the County subdivision one lives in, a low-SES adult has close to six times greater odds of reporting 'fair or poor health status' than does a high-SES adult. CONCLUSION: Local health survey analysis can lead to a more precise identification of health needs than surveys attempting to cover broad areas. Low-SES communities within counties, and low-SES individuals, regardless of the community they live in, are substantially more likely to experience fair to poor health. This adds urgency to the need to implement and investigate socio-economic interventions, which can hopefully improve health and save healthcare costs. Novel local area research can identify the impact of intervening variables such as race in addition to SES to add more specificity in identifying populations with the greatest health needs.

Barriers, Facilitators, and Sustainers in Tai Ji Quan Practice: A Mixed-Methods RE-AIM Assessment of College Students Versus the General Population.

BACKGROUND: Tai Ji Quan (TJQ) has broad appeal to people of all ages and backgrounds. This study aimed to examine a variety of individual and environmental factors in the dissemination of TJQ to diverse practicing communities in China. METHODS: A mixed-methods approach was utilized in the research design. Quantitative data were collected via an online survey using a national sample (N = 737), whereas qualitative data came from focus groups and in-depth interviews. Analysis was performed along the RE-AIM dimensions of reach, efficacy, adoption, implementation, and maintenance. RESULTS: We divided TJQ experience into 4 distinct categories (nonlearners, current learners, quitters, and retainers) and observed significant patterns of variation along lines of occupation groups and age cohorts. A significant male/female difference was detected in TJQ experience among college students but not the general public, and having practicing family members was an important predictor of personal TJQ history. Varied TJQ experience has a significant impact on perceptions of TJQ's miscellaneous values as well as level of satisfaction with its health outcomes. CONCLUSIONS: Both individual (personal) and environmental (settings) factors are important in shaping personal decisions in TJQ engagement. An ecological approach coordinating individual factors and settings resources is essential in promoting TJQ to the general population.

Remapping racial and ethnic inequities in severe maternal morbidity: The legacy of redlining in California.

BACKGROUND: Historical mortgage redlining, a racially discriminatory policy designed to uphold structural racism, may have played a role in producing the persistently elevated rate of severe maternal morbidity (SMM) among racialised birthing people. OBJECTIVE: This study examined associations between Home-Owner Loan Corporation (HOLC) redlining grades and SMM in a racially and ethnically diverse birth cohort in California. METHODS: We leveraged a population-based cohort of all live hospital births at ≥20 weeks of gestation between 1997 and 2017 in California. SMM was defined as having one of 21 procedures and diagnoses, per an index developed by Centers for Disease Control and Prevention. We characterised census tract-level redlining using HOLC's security maps for eight California cities. We assessed bivariate associations between HOLC grades and participant characteristics. Race and ethnicity-stratified mixed effects logistic regression models assessed the risk of SMM associated with HOLC grades within non-Hispanic Black, Asian/Pacific Islander, American Indian/Alaskan Native and Hispanic groups, adjusting for sociodemographic information, pregnancy-related factors, co-morbidities and neighbourhood deprivation index. RESULTS: The study sample included 2,020,194 births, with 24,579 cases of SMM (1.2%). Living in a census tract that was graded as "Hazardous," compared to census tracts graded "Best" and "Still Desirable," was associated with 1.15 (95% confidence interval [CI] 1.03, 1.29) and 1.17 (95% CI 1.09, 1.25) times the risk of SMM among Black and Hispanic birthing people, respectively, independent of sociodemographic factors. These associations persisted after adjusting for pregnancy-related factors and neighbourhood deprivation index. CONCLUSIONS: Historical redlining, a tool of structural racism that influenced the trajectory of neighbourhood social and material conditions, is associated with increased risk of experiencing SMM among Black and Hispanic birthing people in California. These findings demonstrate that addressing the enduring impact of macro-level and systemic mechanisms that uphold structural racism is a vital step in achieving racial and ethnic equity in birthing people's health.

Características actuales de la población pediátrica asistida en un centro de salud del primer nivel de atención en 2020-2021: Montevideo, Uruguay / Characteristics of the pediatric population assisted at primary care level in Montevideo, Uruguay / Características da população pediátrica assistida no nível de atenção primária em Montevidéu, Uruguai

Introducción: alrededor del 30% de las enfermedades infantiles responden a factores sociofamiliares y ambientales, asociados a condiciones de vida, dinámica familiar y exposición a sustancias tóxicas. Conocer las características de la población pediátrica que asiste este centro de salud nos ayudará a identificar factores que pueden estar influyendo en su salud. Objetivos: Describir las características clínico-epidemiológicas de la población menor de 15 años que recibió asistencia en el Centro de Salud Badano Repetto en el período 2020-2021. Conocer diferentes variables que pueden influir en la salud de esta población Identificar asociación de variables familiares y socioculturales con el desarrollo en las diferentes edades. Metodología: estudio descriptivo, retrospectivo, corte transversal. Se incluyó una muestra por conveniencia del 15% del total de los niños y adolescentes menores de 15 años asistidos en el centro de salud desde 1/10/2020 hasta 31/3/2021. Variables estudiadas: del niño: sexo, edad, antecedentes perinatales, crecimiento y desarrollo, controles en salud, inmunizaciones, escolarización, actividades extracurriculares. De los padres: edad, nivel educativo, consumo de sustancias psicoactivas, antecedentes patológicos, empleo, privación de libertad. Familia y vivienda: estado civil de los padres, antecedentes de violencia doméstica, convivientes, características de la vivienda, servicios básicos, transferencias directas de ayuda, intervención de equipos de territorio. Fuente de datos: historias clínicas y vía telefónica. Registro en planilla prediseñada. Los resultados se expresan en frecuencias absolutas, relativas y medidas de tendencia central con su rango. Se utilizó test de Chi cuadrado o exacto de Fisher. Nivel de significación: 0,05. Programa Epi Info™ versión 7.2. Consentimiento informado telefónico a padres y asentimiento a adolescentes. Aprobado por el Comité de Ética del CHPR. Resultados: consultaron 2.826 menores de 15 años, se incluyeron 426 (15%), pero solo 263 (62%) fueron analizados, dado que 163 (38%) no pudieron ser contactados telefónicamente. El 52% eran de sexo femenino. Media de edad: 4 años (5 días-14 años), 69% ≤5 años. 83% de los pacientes tenían adecuados controles de salud y 91% estaban al día con sus inmunizaciones. 12% tenían sobrepeso/obesidad. El desarrollo neurológico fue adecuado en 93% en los menores de 5 años y en 56% de los mayores de 5 años de edad. En el caso de aquellos con trastornos del neurodesarrollo mayores de 5 años, 46% tenían trastornos del aprendizaje, 39% trastorno de conducta, 32% trastornos del lenguaje, 10% déficit intelectual. 56% estaba escolarizado, todos en escuelas públicas. En el caso de aquellos que no asistían a la escuela, 4 estaban en edad de asistencia obligatoria (6, 7, 9 y 10 años de edad). 20% de los niños/adolescentes había repetido por lo menos un año en escuela o liceo. Datos perinatales: 14% de las madres consumieron drogas; las más frecuentes fueron tabaco y pasta base de cocaína (PBC). 85% fueron recién nacidos de término, 10% presentaron depresión neonatal. 15% de niños/ adolescentes estuvo expuesto a violencia doméstica y 32% de ellos (12/38) tenía por lo menos un padre con uso de drogas psicoactivas en el domicilio. 21% de los niños/adolescentes expuestos a violencia doméstica tenía una dificultad de aprendizaje. 8% de estos pacientes tenía por lo menos un padre que no había terminado educación primaria y 28% que no había terminado ciclo básico. Se encontró una relación significativa entre uso de drogas psicoactivas, declarada por uno o ambos padres, y violencia doméstica. No se encontró una relación significativa entre alteración del neurodesarrollo y violencia doméstica. Conclusiones: estos hallazgos muestran una población social y económicamente vulnerable, padres con baja escolaridad, uso de pasta base de cocaína durante el embarazo en un porcentaje mayor al reportado nacionalmente, y 15% de niños/adolescentes expuestos a violencia doméstica, pero con un buen número de controles de salud. La mayor fortaleza encontrada por este estudio es la importancia de mantener una buena conexión con estas familias, que mostraron un alto nivel de compromiso con el centro de salud. Esto nos desafía a priorizar la prevención y promoción en salud como herramientas valiosas para adquirir salud de calidad para estos niños/adolescentes. Nuevos estudios, con otras metodologías, serán necesarios para analizar estas variables encontradas.

Introduction: around 30% of childhood diseases are caused by social, environmental and family issues, as well as by life conditions, family dynamics and exposure to toxic substances. Understanding the characteristics of the pediatric population assisted at this Health Center, will help us identify health-threatening factors. Objectives: Describe the clinical and epidemiological characteristics of the population under 15 years of age assisted at Badano Repetto Health Center between 2020 and 2021. Understand the different variables that could influence this population´s health. Identify the link between family, social and cultural variables and neurological development at different ages. Methodology: descriptive, retrospective cross-sectional study. Convenience sampling of 15% of the total number of children and adolescents under 15 years of age, assisted at the Health Center from 10/01/2020 to 3/31/2021. Variables: children: sex, age, perinatal history, growth and neurological development, health checkups, vaccines, school attendance, extracurricular activities. Parents: age, education, psychoactive substance use, pathological background, job, prison. Family and household: parent`s marital status, domestic violence history, cohabitants, housing characteristics, basic household services, government aids, community interventions. Data source: medical records and telephone conversations. Data was recorded on template charts. We used results in absolute and relative frequencies, and their measures of central tendency measures and their range, Chi-square test or Fisher´s exact test. Significance level 0,05. Epi Info Program, version 7.2. Informed parent and adolescent consent. Approved by the CHPR Ethics Committee. Results: out of the 2826 patients under 15 years of age assisted at the clinic, we included 426 (15%), but only 263 (62%) were analyzed, since we were not able to reach 163 (38%) by phone. 52% were female. The average age was 4 years of age (5 days-14 years old). 69% of children were under 5 years old. 83% of patients had adequate number of checkups and 91% had an updated vaccination chart. 12% were overweight/obese. Neurodevelopment was adequate in 93% of those under 5 years of age, and 56% of those over 5 years of age. Regarding those with neurodevelopmental difficulties and over 5 years of age, 46% had learning disabilities, 39% had behavioral disorders, 32% language disorders, 10% intellectual deficit. 56% attended school, all of them public schools. For those who did not attend school, 4 of them were old enough to attend mandatory school (6, 7, 9 and 10 years of age). 20% of the children and adolescents had failed at least one year in school or high school. Perinatal findings: 14% of mothers had substance use during pregnancy, mainly tobacco and cocaine base paste. 85% of them had been born to term, 10% had neonatal depression 15% of children/adolescents had been exposed to domestic violence and 32% of them (12/38) had one parent with psychoactive drug use at home. 21% of children/adolescents exposed to domestic violence had a learning disability. 8% had at least one parent who did not finish primary school and 28% who did not finish middle school. Statistically, a significant link was found between psychoactive substance use, declared by one or both parents, and domestic violence. No statistically significant link was found between neurodevelopmental difficulties and domestic violence. Conclusions: these findings show a socially and economically vulnerable population, parents with little formal education, higher cocaine paste base use during pregnancy than the national statistics and 15% of children/adolescents exposed to domestic violence, even though they a high number of them had received their health checkups. The biggest strength shown by this study is the importance of maintaining a good bond with these families, who showed a high level of commitment with the health center. This leads us to prioritize health prevention and promotion as a valuable tool to achieve health quality standards for these children and adolescents. New studies, using other methodologies, will be necessary to analyze this data.

Introdução: cerca de 30% das doenças infantis são causadas por questões sociais, ambientais e familiares, bem como por condições de vida, dinâmica familiar e exposição a substâncias tóxicas. Compreender as características da população pediátrica atendida neste Centro de Saúde, nos ajudará a identificar fatores de risco à saúde. Objetivos: Descrever as características clínico-epidemiológicas da população menor de 15 anos de idade atendida no Centro de Saúde Badano Repetto no período 2020-2021. Compreender diferentes variáveis que podem influenciar a saúde dessa população. Identificar uma relação entre as variáveis familiares e socioculturais e o desenvolvimento em diferentes idades. Metodologia: estudo descritivo, retrospectivo, transversal. Foi incluída uma amostra por conveniência de 15% de todas as crianças e adolescentes menores de 15 anos atendidos no Centro de Saúde entre 01/10/2020 e 31/03/2021. Variáveis estudadas: da criança: sexo, idade, história perinatal, crescimento e desenvolvimento, controles de saúde, imunizações, escolaridade, atividades extracurriculares. Dos pais: idade, escolaridade, consumo de substâncias psicoativas, histórico médico, emprego, privação de liberdade. Família e habitação: estado civil dos pais, história de violência doméstica, coabitantes, características da moradia, serviços básicos, transferências de ajuda de custo, intervenção das equipes no território. Fonte de dados: prontuários e enquetes telefônicas. Cadastro em planilha padrão. Os resultados são expressos em frequências absolutas e relativas e medidas de tendência central com sua amplidão. Utilizou-se o teste do qui-quadrado ou exato de Fisher. Nível de significância 0,05. Programa Epi Info™ versão 7.2. Consentimento informado por telefone pais e consentimento dos adolescentes. Aprovado pelo Comitê de Ética do CHPR. Resultados: 2.826 crianças menores de 15 anos consultadas, 426 (15%) foram incluídas, mas 263 (62%) foram analisadas, pois 163 (38%) não puderam ser contatadas por telefone. 52% eram do sexo feminino. Idade média 4 anos (5 dias -14 anos), 69% ≤ 5 anos. 83% dos pacientes possuíam controles de saúde adequados e 91% estavam com suas imunizações em dia. 12% com sobrepeso/obesidade. O desenvolvimento neurológico foi adequado em 93% dos menores de 5 anos e em 56% dos maiores de 5 anos. No caso dos portadores de transtornos de neurodesenvolvimento com mais de 5 anos, 46% apresentavam transtorno de aprendizagem, 39% transtorno de conduta, 32% transtorno de linguagem, 10% déficit intelectual. 56% estavam na escola, todos em escolas públicas. No caso dos que não frequentaram a escola, 4 deles estavam em idade em idade escolar obrigatória (6, 7, 9 e 10 anos). 20% das crianças/adolescentes repetiram pelo menos um ano na escola ou no ensino médio. Dados perinatais: 14% das mães usavam drogas; pasta base de tabaco e maiormente pasta base de cocaína (PBC). 85% eram recém-nascidos a termo, 10% tinham depressão neonatal. 15% das crianças/adolescentes foram expostos à violência doméstica e 32% deles (12/38) tinham pelo menos um dos pais que usava drogas psicoativas em casa. 21% das crianças/adolescentes expostas à violência doméstica tinham dificuldade de aprendizagem. 8% desses pacientes possuíam pelo menos um dos pais com escola primária incompleta e 28% com ensino médio incompleto. Encontrou-se relação significativa entre o uso de drogas psicoativas, declarado por um ou ambos os pais, e a violência doméstica. Não foi encontrada relação significativa entre transtornos do neurodesenvolvimento e violência doméstica. Conclusões: esses achados mostram uma população social e economicamente vulnerável, pais com baixa escolaridade, uso de pasta base de cocaína durante a gravidez em porcentagem superior ao reportado a nível nacional, e 15% de crianças/adolescentes expostos à violência doméstica, mas com um alto número de controles de saúde. A maior fortaleza encontrada por este estudo é a importância de manter um bom vínculo com essas famílias, que demonstraram alto nível de comprometimento com o centro de saúde. Isso nos leva a priorizar a prevenção e promoção da saúde como ferramentas valiosas para a aquisição de saúde de qualidade para essas crianças/adolescentes. Novos estudos, com outras metodologias, serão necessários para poder analisar essas variáveis encontradas.

Assessment of a Crisis Standards of Care Scoring System for Resource Prioritization and Estimated Excess Mortality by Race, Ethnicity, and Socially Vulnerable Area During a Regional Surge in COVID-19.

Importance: Crisis standards of care (CSOC) scores designed to allocate scarce resources during the COVID-19 pandemic could exacerbate racial disparities in health care. Objective: To analyze the association of a CSOC scoring system with resource prioritization and estimated excess mortality by race, ethnicity, and residence in a socially vulnerable area. Design, Setting, and Participants: This retrospective cohort analysis included adult patients in the intensive care unit during a regional COVID-19 surge from April 13 to May 22, 2020, at 6 hospitals in a health care network in greater Boston, Massachusetts. Participants were scored by acute severity of illness using the Sequential Organ Failure Assessment score and chronic severity of illness using comorbidity and life expectancy scores, and only participants with complete scores were included. The score was ordinal, with cutoff points suggested by the Massachusetts guidelines. Exposures: Race, ethnicity, Social Vulnerability Index. Main Outcomes and Measures: The primary outcome was proportion of patients in the lowest priority score category stratified by self-reported race. Secondary outcomes were discrimination and calibration of the score overall and by race, ethnicity, and neighborhood Social Vulnerability Index. Projected excess deaths were modeled by race, using the priority scoring system and a random lottery. Results: Of 608 patients in the intensive care unit during the study period, 498 had complete data and were included in the analysis; this population had a median (IQR) age of 67 (56-75) years, 191 (38.4%) female participants, 79 (15.9%) Black participants, and 225 patients (45.7%) with COVID-19. The area under the receiver operating characteristic curve for the priority score was 0.79 and was similar across racial groups. Black patients were more likely than others to be in the lowest priority group (12 [15.2%] vs 34 [8.1%]; P = .046). In an exploratory simulation model using the score for ventilator allocation, with only those in the highest priority group receiving ventilators, there were 43.9% excess deaths among Black patients (18 of 41 patients) and 28.6% (58 of 203 patients among all others (P = .05); when the highest and intermediate priority groups received ventilators, there were 4.9% (2 of 41 patients) excess deaths among Black patients and 3.0% (6 of 203) among all others (P = .53). A random lottery resulted in more excess deaths than the score. Conclusions and Relevance: In this study, a CSOC priority score resulted in lower prioritization of Black patients to receive scarce resources. A model using a random lottery resulted in more estimated excess deaths overall without improving equity by race. CSOC policies must be evaluated for their potential association with racial disparities in health care.

Socioeconomic Disparities of Low-Cost Air Quality Sensors in California, 2017-2020.

Objectives. To (1) examine the disparity in availability of PurpleAir low-cost air quality sensors in California based on neighborhood socioeconomic status (SES) and exposure to fine particulate matter smaller than 2.5 micrometers (PM2.5), (2) investigate the temporal trend of sensor distribution and operation, and (3) identify priority communities for future sensor distribution. Methods. We obtained census tract-level SES variables and PM2.5 concentrations from the CalEnviroScreen4.0 data set. We obtained real-time PurpleAir sensor data (July 2017-September 2020) to examine sensor distribution and operation. We conducted spatial and temporal analyses at the census tract level to investigate neighborhood SES and PM2.5 concentrations in relation to sensor distribution and operation. Results. The spatial coverage and the number of PurpleAir sensors increased significantly in California. Fewer sensors were distributed in census tracts with lower SES, higher PM2.5, and higher proportions of racial/ethnic minority populations. Furthermore, a large proportion of existing sensors were not in operation at a given time, especially in disadvantaged communities. Conclusions. Disadvantaged communities should be given access to low-cost sensors to fill in spatial gaps of air quality monitoring and address environmental justice concerns. Sensor purchasing and deployment must be paired with regular maintenance to ensure their reliable performance. (Am J Public Health. 2022;112(3):434-442. https://doi.org/10.2105/AJPH.2021.306603).

Social Determinants of Health Among Non-Elderly Adults With Stroke in the United States.

OBJECTIVE: To examine the association of social determinants of health (SDOH) on prevalence of stroke in non-elderly adults (<65 years of age). METHODS: We used the National Health Interview Survey (2013-2017) database. The study population was stratified into younger (<45 years of age) and middle age (45 to 64 years of age) adults. For each individual, an SDOH aggregate score was calculated representing the cumulative number of individual unfavorable SDOH (present vs absent), identified from 39 subcomponents across five domains (economic stability, neighborhood, community and social context, food, education, and health care system access) and divided into quartiles (quartile 1, most favorable; quartile 4, most unfavorable). Multivariable models tested the association between SDOH score quartiles and stroke. RESULTS: The age-adjusted prevalence of stroke was 1.4% in the study population (n=123,631; 58.2% (n=71,956) in patients <45 years of age). Young adults reported approximately 20% of all strokes. Participants with stroke had unfavorable responses to 36 of 39 SDOH; nearly half (48%) of all strokes were reported by participants in the highest SDOH score quartile. A stepwise increase in age-adjusted stroke prevalence was observed across increasing quartiles of SDOH (first, 0.6%; second, 0.9%; third, 1.4%; and fourth, 2.9%). After accounting for demographics and cardiovascular disease risk factors, participants in the fourth vs first quartile had higher odds of stroke (odds ratio, 2.78; 95% CI, 2.25 to 3.45). CONCLUSION: Nearly half of all non-elderly individuals with stroke have an unfavorable SDOH profile. Standardized assessment of SDOH risk burden may inform targeted strategies to mitigate disparities in stroke burden and outcomes in this population.

Developing Dashboards to Address Children's Health Disparities in Ohio.

OBJECTIVES: Social determinants of health (SDoH) can be measured at the geographic level to convey information about neighborhood deprivation. The Ohio Children's Opportunity Index (OCOI) is a composite area-level opportunity index comprised of eight health domains. Our research team has documented the design, development, and use cases of a dashboard solution to visualize OCOI. METHODS: The OCOI is a multidomain index spanning the following eight domains: (1) family stability, (2) infant health, (3) children's health, (4) access, (5) education, (6) housing, (7) environment, and (8) criminal justice. Information on these eight domains is derived from the American Community Survey and other administrative datasets. Our team used the Tableau Desktop visualization software and applied a user-centered design approach to developing the two OCOI dashboards-main OCOI dashboard and OCOI-race dashboard. We also performed convergence analysis to visualize the census tracts where different health indicators simultaneously exist at their worst levels. RESULTS: The OCOI dashboard has multiple, interactive components as follows: a choropleth map of Ohio displaying OCOI scores for a specific census tract, graphs presenting OCOI or domain scores to compare relative positions for tracts, and a sortable table to visualize scores for specific county and census tracts. A case study using the two dashboards for convergence analysis revealed census tracts in neighborhoods with low infant health scores and a high proportion of minority population. CONCLUSION: The OCOI dashboards could assist health care leaders in making decisions that enhance health care delivery and policy decision-making regarding children's health particularly in areas where multiple health indicators exist at their worst levels.

Real-world pharmacological treatment patterns of patients with threatened miscarriage in China from 2014 to 2020: A cross-sectional analysis.

WHAT IS KNOWN AND OBJECTIVE: Approximately half of the patients with threatened miscarriage suffer an abortion, and consistent medication therapy to prevent threatened miscarriage is lacking. Our goal was to investigate the real-world pharmacological treatment patterns of patients with threatened miscarriage in China, with a focus on the trend and rationality of progestogen use over the last 7 years. METHODS: We performed a cross-sectional analysis of data from the Hospital Prescription Analysis Cooperation Project that is overseen by the Chinese Pharmaceutical Association. Information was extracted from prescriptions of outpatients with threatened miscarriage between January 2014 and December 2020. We quantified the types of medications using the first level anatomical therapeutic chemical (ATC) classification code and the frequency of use of medicines classified as category X by the United States Food and Drug Administration (FDA). We also calculated the prevalence of the most frequently used progestogens by assessing prescription rates, determined the sum of the defined daily doses (DDDs) and defined daily cost (DDC) and evaluated the rationality of progestogens according to drug labels and guidelines. RESULTS AND DISCUSSION: Of the 91,464 patients included in this study, 69.4% were from the eastern region, 92.5% were from tertiary hospitals, and 72.9% were between 25 and 34 years old. The average number of medications per patient was 1.4. The following types of medicines were the most prevalent: "genitourinary system and sex hormones" (90.7%), "alimentary tract and metabolism" (10.8%) and "blood and blood-forming organs" (9.9%). Progestogens were prescribed for 81,080 patients (88.6%), among which oral progesterone (39.7%) was the most commonly used, followed by oral dydrogesterone (34.4%), progesterone injection (26.0%), oral allylestrenol (0.7%) and progesterone gel (0.4%). In other words, 10,991 (12.0%) patients used more than one progestogen, and the top three combinations were oral dydrogesterone plus progesterone injection (5.6%), oral progesterone plus progesterone injection (4.7%) and oral dydrogesterone plus oral progesterone (1.1%). The prescription rate of dydrogesterone increased gradually, whereas that of progesterone, especially progesterone injection, obviously decreased. Among 34,760 prescriptions of progestogens with complete usage information, the primary errors of progestogen use were "low frequency" (18.4%), "high single dose" (15.9%) and "low single dose" (11.3%). In addition, 137 prescriptions were identified with drug-progestogen interactions, and 61 were identified with contraindications for progestogens. A total of 4.5% of prescriptions included FDA category X medicines. WHAT IS NEW AND CONCLUSION: Our findings are the first to provide information on medication use in patients with threatened miscarriage over the last seven years in China. Medicines targeting the "genitourinary system and sex hormones," especially progestogens, were the most commonly prescribed medications, among which dydrogesterone was the most prevalent. However, it is remarkable that the use of progestogens for the treatment of threatened abortion is still controversial; thus, high-quality large sample studies are still required, especially among Chinese patients. Since usage errors in progestogen records and exposure to category X medicines were common, more efforts are needed to guarantee the safety and rationality of medicines used in pregnant women.

Racial/ethnic disparities in wait-list outcomes are only partly explained by socioeconomic deprivation among children awaiting liver transplantation.

BACKGROUND AND AIMS: Racial/ethnic minority children have worse liver transplant (LT) outcomes. We evaluated whether neighborhood socioeconomic deprivation affected associations between race/ethnicity and wait-list mortality. APPROACH AND RESULTS: We included children (age <18) listed 2005-2015 in the Scientific Registry of Transplant Recipients. We categorized patients as non-Hispanic White, Black, Hispanic, and other. We matched patient ZIP codes to a neighborhood socioeconomic deprivation index (range, 0-1; higher values indicate worse deprivation). Primary outcomes were wait-list mortality, defined as death/delisting for too sick, and receipt of living donor liver transplant (LDLT). Competing risk analyses modeled the association between race/ethnicity and wait-list mortality, with deceased donor liver transplant (DDLT) and LDLT as competing risks, and race/ethnicity and LDLT, with wait-list mortality and DDLT as competing risks. Of 7716 children, 17% and 24% identified as Black and Hispanic, respectively. Compared to White children, Black and Hispanic children had increased unadjusted hazard of wait-list mortality (subhazard ratio [sHR], 1.44; 95% CI, 1.18, 1.75 and sHR, 1.48; 95% CI, 1.25, 1.76, respectively). After adjusting for neighborhood deprivation, insurance, and listing laboratory Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease, Black and Hispanic children did not have increased hazard of wait-list mortality (sHR, 1.12; 95% CI, 0.91, 1.39 and sHR, 1.21; 95% CI, 1.00, 1.47, respectively). Similarly, Black and Hispanic children had a decreased likelihood of LDLT (sHR, 0.58; 95% CI, 0.45, 0.75 and sHR, 0.61; 95% CI, 0.49, 0.75, respectively). Adjustment attenuated the effect of Black and Hispanic race/ethnicity on likelihood of LDLT (sHR, 0.79; 95% CI, 0.60, 1.02 and sHR, 0.89; 95% CI, 0.70, 1.11, respectively). CONCLUSIONS: Household and neighborhood socioeconomic factors and disease severity at wait-list entry help explain racial/ethnic disparities for children awaiting transplant. A nuanced understanding of how social adversity contributes to wait-list outcomes may inform strategies to improve outcomes.

Adherence to Urgent Eye Visits during the COVID-19 Pandemic: A Population Characteristics Study.

PURPOSE: To explore individual and community factors associated with adherence to physician recommended urgent eye visits via a tele-triage system during the COVID-19 pandemic. METHOD: We retrospectively reviewed acute visit requests and medical exam data between April 6, 2020 and June 6, 2020. Patient demographics and adherence to visit were examined. Census tract level community characteristics from the U.S. Census Bureau and zip code level COVID-19 related death data from the Cook County Medical Examiner's Office were appended to each geocoded patient address. Descriptive statistics, t-tests, and logistic regression analyses were performed to explore the effects of individual and community variables on adherence to visit. RESULTS: Of 229 patients recommended an urgent visit, 216 had matching criteria on chart review, and 192 (88.9%) adhered to their visit. No difference in adherence was found based on individual characteristics including: age (p = .24), gender (p = .94), race (p = .56), insurance (p = .28), nor new versus established patient status (p = .20). However, individuals who did not adhere were more likely to reside in neighborhoods with a greater proportion of Blacks (59.4% vs. 33.4%; p = .03), greater unemployment rates (17.5% vs. 10.7%; p < .01), and greater cumulative deaths from COVID-19 (56 vs. 31; p = .01). Unemployment rate continued to be statistically significant after controlling for race and cumulative deaths from COVID-19 (p = .04). CONCLUSION: We found that as community unemployment rate increases, adherence to urgent eye visits decreases, after controlling for relevant neighborhood characteristics. Unemployment rates were highest in predominantly Black neighborhoods early in the pandemic, which may have contributed to existing racial disparities in eye care.

Neighborhood Racial and Economic Segregation and Disparities in Violence During the COVID-19 Pandemic.

Objectives. To describe associations between neighborhood racial and economic segregation and violence during the COVID-19 pandemic. Methods. For 13 US cities, we obtained zip code-level data on 5 violence outcomes from March through July 2018 through 2020. Using negative binomial regressions and marginal contrasts, we estimated differences between quintiles of racial, economic, and racialized economic segregation using the Index of Concentration at the Extremes as a measure of neighborhood privilege (1) in 2020 and (2) relative to 2018 through 2019 (difference-in-differences). Results. In 2020, violence was higher in less-privileged neighborhoods than in the most privileged. For example, if all zip codes were in the least privileged versus most privileged quintile of racialized economic segregation, we estimated 146.2 additional aggravated assaults (95% confidence interval = 112.4, 205.8) per zip code on average across cities. Differences over time in less-privileged zip codes were greater than differences over time in the most privileged for firearm violence, aggravated assault, and homicide. Conclusions. Marginalized communities endure endemically high levels of violence. The events of 2020 exacerbated disparities in several forms of violence. Public Health Implications. To reduce violence and related disparities, immediate and long-term investments in low-income neighborhoods of color are warranted. (Am J Public Health. 2022;112(1):144-153. https://doi.org/10.2105/AJPH.2021.306540).