Staffing and Antipsychotic Medication Use in Nursing Homes and Neighborhood Deprivation.

Importance: Inappropriate use of antipsychotic medications in nursing homes is a growing public health concern. Residents exposed to higher levels of socioeconomic deprivation in the area around a nursing home may be currently exposed, or have a long history of exposure, to more noise pollution, higher crime rates, and have less opportunities to safely go outside the facility, which may contribute to psychological stress and increased risk of receiving antipsychotic medications inappropriately. However, it is unclear whether neighborhood deprivation is associated with use of inappropriate antipsychotic medications and whether this outcome is different by facility staffing levels. Objective: To evaluate whether reported inappropriate antipsychotic medication use differs in severely and less severely deprived neighborhoods, and whether these differences are modified by higher levels of total nurse staffing. Design, Setting, and Participants: This was a cross-sectional analysis of a national sample of nursing homes that linked across 3 national large-scale data sets for the year 2019. Analyses were conducted between April and June 2023. Exposure: Neighborhood deprivation status (severe vs less severe) and total staffing hours (registered nurse, licensed practical nurse, certified nursing assistant). Main Outcome and Measures: This study estimated the association between neighborhood deprivation and the percentage of long-stay residents who received an antipsychotic medication inappropriately in the nursing home at least once in the past week and how this varied by nursing home staffing through generalized estimating equations. Analyses were conducted on the facility level and adjusted for state fixed effects. Results: This study included 10 966 nursing homes (1867 [17.0%] in severely deprived neighborhoods and 9099 [83.0%] in less deprived neighborhoods). Unadjusted inappropriate antipsychotic medication use was greater in nursing homes located in severely deprived neighborhoods (mean [SD], 15.9% [10.7%] of residents) than in those in less deprived neighborhoods (mean [SD], 14.2% [8.8%] of residents). In adjusted models, inappropriate antipsychotic medication use was higher in severely deprived neighborhoods vs less deprived neighborhoods (19.2% vs 17.1%; adjusted mean difference, 2.0 [95% CI, 0.35 to 3.71] percentage points) in nursing homes that fell below critical levels of staffing (less than 3 hours of nurse staffing per resident-day). Conclusions and Relevance: These findings suggest that levels of staffing modify disparities seen in inappropriate antipsychotic medication use among nursing homes located in severely deprived neighborhoods compared with nursing homes in less deprived neighborhoods. These findings may have important implications for improving staffing in more severely deprived neighborhoods.

Sense of neighborhood belonging and health: geographic, racial, and socioeconomic variation in Wisconsin.

Background: Individuals' sense of belonging (SoB) to their neighborhood is an understudied psychosocial factor that may influence the association between neighborhood characteristics, health, and disparities across socio-demographic groups. Methods: Using 2014-2016 data from the Survey of the Health of Wisconsin (SHOW, N = 1,706), we conduct a detailed analysis of SoB and health in an American context. We construct OLS and logistic regressions estimating belonging's association with general, physical, and mental health. We explore geographic, racial, and socioeconomic variation to understand both the differential distribution of SoB and its heterogeneous relationship with health. Results: A higher SoB is positively associated with better physical, mental, and general health. White participants report higher SoB than Black participants, yet the association between SoB and mental health is strongest among participants of color and urban residents. Conclusion: Sense of belonging to neighborhood significantly predicts many facets of health, with place and individual characteristics appearing to moderate this relationship. Racial, geographic, and socioeconomic disparities in belonging-health associations raise important questions about who benefits from the social, economic, and physical aspects of local communities.

Health Care Access and Use Among U.S. Children Exposed to Neighborhood Violence.

INTRODUCTION: Neighborhood violence is an adverse childhood experience which impacts millions of U.S. children and is associated with poor health outcomes across the life course. These effects may be mitigated by access to care. Yet, the ways in which exposure to neighborhood violence shapes children's health care access have been understudied. METHODS: This is a cross-sectional analysis of 16,083 children (weighted N=67,214,201) ages 1 to <18 years from the 2019 and 2021 National Health Interview Survey. Guardians were asked about preventive care access, unmet health needs, and health care utilization in the last year. Changes associated with exposure to neighborhood violence were estimated using marginal effects from multivariable logistic regression models adjusted for year, age, sex, race/ethnicity, parental education, family structure, rurality, income, insurance type, insurance discontinuity, and overall reported health. RESULTS: Of 16,083 sample children, 863 (weighted 5.3% [95% CI 4.8-5.7]) reported exposure to neighborhood violence, representing a weighted population of ∼3.5 million. In adjusted analyses, exposure to violence was associated with forgone prescriptions (adjusted difference 1.2 percentage-points (pp) [95%CI 0.1-2.3]; weighted national population impact 42,833 children), trouble paying medical bills (7.7pp [4.4-11.0]; 271,735), delayed medical (1.5pp [0.2-2.9]; 54,063) and mental health care (2.8pp [1.1-4.6]; 98,627), and increased urgent care (4.5pp [0.9-8.1]; 158,246) and emergency department utilization (6.4pp [3.1-9.8]; 227,373). CONCLUSIONS: In this nationally representative study, neighborhood violence exposure among children was associated with unmet health needs and increased acute care utilization. Evidence-based interventions to improve access to care and reduce economic precarity in communities impacted by violence are needed to mitigate downstream physical and mental health consequences.

Location Matters: The Role of the Neighborhood Environment for Incident Cardiometabolic Disease in Adults Aging With Physical Disability.

PURPOSE: People aging with disability may be limited in their ability to engage in healthy behaviors to maintain cardiometabolic health. We investigated the role of health promoting features in the neighborhood environment for incident cardiometabolic disease in adults aging with physical disability in the United States. DESIGN: Retrospective cohort study. SETTING: Optum's Clinformatics® Data Mart Database (2007-2018) of administrative health claims. SUBJECTS: ICD-9-CM codes were used to identify 15 467 individuals with a diagnosis of Cerebral Palsy, Spina Bifida, Multiple Sclerosis, or Spinal Cord Injury. MEASURES: Cardiometabolic disease was identified using ICD-9-CM/ICD-10-CM codes over 3 years of follow-up. Measures of the neighborhood environment came from the National Neighborhood Data Archive and linked to individual residential ZIP codes over time. Covariates included age, sex, and comorbid health conditions. ANALYSIS: Cox regression models estimated hazard ratios (HR) for incident cardiometabolic disease. Using a 1-year lookback period, individuals with pre-existing cardiometabolic disease were excluded from the analysis. RESULTS: Net of individual risk factors, residing in neighborhoods with a greater density of broadband Internet connections (HR = .88, 95% CI: .81, .97), public transit stops (HR = .89, 95% CI: .83, .95), recreational establishments (HR = .89, 95% CI: .83, .96), and parks (HR = .88, 95% CI: .82, .94), was associated with reduced risk of 3-year incident cardiometabolic disease. CONCLUSION: Findings identify health-promoting resources that may mitigate health disparities in adults aging with disability.

Change in neighborhood socioeconomic status and childhood weight status and body composition from birth to adolescence.

BACKGROUND: We aim to assess the associations between the change in neighborhood socioeconomic score (SES) between birth and 6 years and childhood weight status and body composition from 6 to 13 years. METHODS: Data for 3909 children from the Generation R Study, a prospective population-based cohort in the Netherlands were analyzed. The change in neighborhood SES between birth and 6 years was defined as static-high, static-middle, static-low, upward, and downward mobility. Child body mass index (BMI), overweight and obesity (OWOB), fat mass index (FMI) and lean mass index (LMI) were measured at age 6, 10, and 13 years. The associations were explored using generalized estimating equations. The effect modification by child sex was examined. RESULTS: In total, 19.5% and 18.1% of children were allocated to the upward mobility and downward mobility neighborhood SES group. The associations between the change in neighborhood SES and child weight status and body composition were moderated by child sex (p < 0.05). Compared to girls in the static-high group, girls in the static-low group had relatively higher BMI-SDS (ß, 95% confidence interval (CI): 0.24, 0.09-0.40) and higher risk of OWOB (RR, 95% CI: 1.98, 1.35-2.91), together with higher FMI-SDS (ß, 95% CI: 0.27, 0.14-0.41) and LMI-SDS (ß, 95% CI: 0.18, 0.03-0.33). The associations in boys were not significant. CONCLUSIONS: An increased BMI and fat mass, and higher risk of OWOB from 6 to 13 years were evident in girls living in a low-SES neighborhood or moving downward from a high- to a low-SES neighborhood. Support for children and families from low-SES neighborhoods is warranted.

Neighborhood-level social determinants of health measures independently predict receipt of living donor liver transplantation in the United States.

Disparities exist in the access to living donor liver transplantation (LDLT) in the United States. However, the association of neighborhood-level social determinants of health (SDoH) on the receipt of LDLT is not well-established. This was a retrospective cohort study of adult liver transplant recipients between January 1, 2005 and December 31, 2021 at centers performing LDLT using the United Network for Organ Sharing database, which was linked through patients' ZIP code to a set of 24 neighborhood-level SDoH measures from different data sources. Temporal trends and center differences in neighborhood Social Deprivation Index (SDI), a validated scale of socioeconomic deprivation ranging from 0 to 100 (0=least disadvantaged), were assessed by transplant type. Multivariable logistic regression evaluated the association of increasing SDI on receipt of LDLT [vs. deceased donor liver transplantation (DDLT)]. There were 51,721 DDLT and 4026 LDLT recipients at 59 LDLT-performing centers during the study period. Of the 24 neighborhood-level SDoH measures studied, the SDI was most different between the 2 transplant types, with LDLT recipients having lower SDI (ie, less socioeconomic disadvantage) than DDLT recipients (median SDI 37 vs. 47; p < 0.001). The median difference in SDI between the LDLT and DDLT groups significantly decreased from 13 in 2005 to 3 in 2021 ( p = 0.003). In the final model, the SDI quintile was independently associated with transplant type ( p < 0.001) with a threshold SDI of ~40, above which increasing SDI was significantly associated with reduced odds of LDLT (vs. reference SDI 1-20). As a neighborhood-level SDoH measure, SDI is useful for evaluating disparities in the context of LDLT. Center outreach efforts that aim to reduce disparities in LDLT could preferentially target US ZIP codes with SDI > 40.

The relationship of single-family detached house prices with neighborhood walkability and disaster risk.

People's preferences regarding their neighborhood environment can vary depending on their socioeconomic status and the cities where they live. This study aims to discern the relationship between neighborhood environment factors and single-family detached house sales by sale price and by central and noncentral cities. We analyzed sale prices in the Tokyo Metropolitan Area from 2015 to 2020. The neighborhood environment was assessed using flood/sediment risk and neighborhood walkability measured by net residential density, intersection density, and facility density (walking opportunity). Flood and sediment risk is a major concern that restricts the available land and is included as a negative aspect of the neighborhood environment, taking the topographic features into consideration. A comparison of the results showed that the preference for neighborhood walkability varies by socioeconomic status as well as by target cities. For most facility types, the number of walking opportunities within walking distance from houses was found to be positively related to the sale price of single-family detached houses in all quantiles. The relationship of house price with population and intersection density was found to vary depending on the price level, with a negative relationship with the sale price of relatively more expensive houses being exhibited. People who considered buying houses with relatively higher sale prices were found to devalue houses located in flood/sediment-hazardous areas more. However, it was also found that the negative relationship was slightly mitigated in the highest quantile of sale prices for houses in areas with a moderate flood risk (maximum flooding depth: 3-5 m). Plains near rivers with amenities offer high walkability but pose a flood risk, resulting in a trade-off between flood risk and neighborhood walkability. The findings suggest the use of indices representing diverse preferences in accordance with the target socioeconomic status when policymakers assess the neighborhood environment.

Examining neighbourhood-level disparities in Black, Latina/o, Asian, and White physical health, mental health, chronic conditions, and social disadvantage in California.

Racial/ethnic minority individuals in the U.S. experience numerous health disparities versus Whites, often due to differences in social determinants. Yet, limited large-scale research has examined these differences at the neighbourhood level. We merged 2021 PLACES Project and 2020 American Community Survey data across 3,211 census tracts (neighbourhoods) defined as majority (>50%) Black, Latina/o, Asian or White. T-tests and hierarchical linear regressions were used to examine differences and associations between neighbourhoods on key health (general health, mental health, obesity, diabetes, cancer, coronary heart disease, chronic obstructive pulmonary disease, stroke), and social outcomes (income, unemployment, age, population density). Results indicated that minority neighbourhoods in California exhibited stark health and social disparities versus White neighbourhoods, displaying worse outcomes on nearly every social and health variable/condition examined; particularly for Black and Latina/o neighbourhoods. Moreover, regression findings revealed that, after considering income, unemployment, and population density, (1) fair/poor mental health and higher percentages of Black, Latina/o and Asian residents in neighbourhoods independently associated with greater neighbourhood fair/poor physical health, and (2) fair/poor mental health significantly associated with greater prevalence of obesity and COPD. This study thus underscores the need to address the profound health and social disparities experienced by minority neighbourhoods for more equitable neighbourhoods.

Neighborhood Unsafety, Discrimination, and Food Insecurity among Nigerians Aged 15-49.

We investigated the association between discrimination, neighborhood unsafety, and household food insecurity (FI) among Nigerian adults, as well as the gender-specific differences in these associations. Our analysis utilized data from the 2021 Multiple Indicator Cluster Survey (MICS), comprising 56,146 Nigerian adults aged 15-49 (17,346 males and 38,800 females). For bivariate analysis, we employed the Rao-Scott chi-square test to examine the relationship between predictors (discrimination, neighborhood unsafety, and a composite variable of both) and the outcome variable (FI). Food insecurity was assessed using both a dichotomous measure (food insecure vs. food secure) and a multinomial variable (food secure, mild FI, moderate FI, and severe FI). To model the association between predictors and FI while controlling for potential confounding factors, we utilized weighted binary and multinomial logistic regression. Among Nigerian adults, the prevalence of having ever experienced FI was 86.1%, with the prevalence of mild FI, moderate FI, and severe FI being 11.5%, 30.1%, and 44.5%, respectively. In the binary model, experiencing discrimination (OR = 1.36, 95% CI = 1.19-1.55), living in an unsafe neighborhood (OR = 1.33, 95% CI = 1.14-1.54), and facing both discrimination and unsafe neighborhood conditions (OR = 1.97, 95% CI = 1.57-2.48) were significantly associated with FI. In the multinomial model, discrimination, neighborhood unsafety, and experiencing both remained associated with moderate and severe FI. In the gender-specific models, discrimination and neighborhood unsafety were found to be significantly associated with FI in women but not in men. This study underscores the importance of implementing policies and programs that address the underlying causes of food insecurity, with specific attention to discrimination and neighborhood safety concerns, particularly for Nigerian women.

Individual and community level predictors of women's autonomy in health care decision-making among youth in East African countries: a multilevel analysis.

OBJECTIVE: The autonomy of young women in healthcare decision-making has been reported to be lower, particularly in low-income and middle-income countries. This study was conducted to estimate the magnitude and the factors associated with autonomy in healthcare decision-making among youth in East African countries. DESIGN AND SETTING: A population-based, cross-sectional study was conducted with data from the most recent Demographic and Health Surveys conducted in 11 East African countries (Burundi, Ethiopia, Kenya, Comoros, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia, Zimbabwe) conducted from 2011 to 2019. PARTICIPANTS: Weighted sample of 24 135 women aged 15-24 years. PRIMARY OUTCOMES: Healthcare decision-making autonomy. METHODS: A multi-level logistic regression model was used to identify factors associated with women's autonomy in making decisions about their healthcare. Statistical significance was determined using an adjusted OR with 95% CI at a p value less than 0.05. RESULTS: Healthcare decision-making autonomy among youth in East Africa was 68.37% (95% CI 68%, 70%). In a multivariable analysis older aged youths (20-24 years) (adjusted OR (AOR)=1.27; 95% CI 1.19, 1.36), youths having an occupation (AOR=1.34; 95% CI 1.25, 1.53), having employed husband (AOR=1.12 95% CI 1.00, 1.26), exposure to media (AOR=1.18 95% CI 1.08, 1.29), rich wealth index 1.18 (AOR=1.18 95% CI 1.08, 1.29), female household head, youths having secondary and higher education, youths whose husband had secondary and higher education, and country were significant predictors of healthcare decision making autonomy. CONCLUSION: Almost one-third of young women have no autonomy in healthcare decision-making. Older youth, being educated, having an educated husband, having an occupation, having an employed husband, exposure to media, female household head, rich wealth index and country are significant predictors for being autonomous in healthcare decision-making. Public health interventions should target uneducated and unemployed youth, poor families and those without media exposure to increase autonomy in health decisions.

Historical Redlining, Socioeconomic Distress, and Risk of Heart Failure Among Medicare Beneficiaries.

BACKGROUND: The association of historical redlining policies, a marker of structural racism, with contemporary heart failure (HF) risk among White and Black individuals is not well established. METHODS: We aimed to evaluate the association of redlining with the risk of HF among White and Black Medicare beneficiaries. Zip code-level redlining was determined by the proportion of historically redlined areas using the Mapping Inequality Project within each zip code. The association between higher zip code redlining proportion (quartile 4 versus quartiles 1-3) and HF risk were assessed separately among White and Black Medicare beneficiaries using generalized linear mixed models adjusted for potential confounders, including measures of the zip code-level Social Deprivation Index. RESULTS: A total of 2 388 955 Medicare beneficiaries (Black n=801 452; White n=1 587 503; mean age, 71 years; men, 44.6%) were included. Among Black beneficiaries, living in zip codes with higher redlining proportion (quartile 4 versus quartiles 1-3) was associated with increased risk of HF after adjusting for age, sex, and comorbidities (risk ratio, 1.08 [95% CI, 1.04-1.12]; P<0.001). This association remained significant after further adjustment for area-level Social Deprivation Index (risk ratio, 1.04 [95% CI, 1.002-1.08]; P=0.04). A significant interaction was observed between redlining proportion and Social Deprivation Index (Pinteraction<0.01) such that higher redlining proportion was significantly associated with HF risk only among socioeconomically distressed regions (above the median Social Deprivation Index). Among White beneficiaries, redlining was associated with a lower risk of HF after adjustment for age, sex, and comorbidities (risk ratio, 0.94 [95% CI, 0.89-0.99]; P=0.02). CONCLUSIONS: Historical redlining is associated with an increased risk of HF among Black patients. Contemporary zip code-level social determinants of health modify the relationship between redlining and HF risk, with the strongest relationship between redlining and HF observed in the most socioeconomically disadvantaged communities.

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.

Impact of COVID-19 on 'Living Well' with Mild-to-Moderate Dementia in the Community: Findings from the IDEAL Cohort.

BACKGROUND: Negative impacts of the COVID-19 pandemic on people with dementia have been widely-documented, but most studies have relied on carer reports and few have compared responses to information collected before the pandemic. OBJECTIVE: We aimed to explore the impact of the pandemic on community-dwelling individuals with mild-to-moderate dementia and compare responses with pre-pandemic data. METHODS: During the second wave of the pandemic, we conducted structured telephone interviews with 173 people with dementia and 242 carers acting as informants, all of whom had previously participated in the IDEAL cohort. Where possible, we benchmarked responses against pre-pandemic data. RESULTS: Significant perceived negative impacts were identified in cognitive and functional skills and ability to engage in self-care and manage everyday activities, along with increased levels of loneliness and discontinuity in sense of self and a decline in perceived capability to 'live well'. Compared to pre-pandemic data, there were lower levels of pain, depression, and anxiety, higher levels of optimism, and better satisfaction with family support. There was little impact on physical health, mood, social connections and relationships, or perceptions of neighborhood characteristics. CONCLUSION: Efforts to mitigate negative impacts of pandemic-related restrictions and restore quality of life could focus on reablement to address the effects on participation in everyday activities, creating opportunities for social contact to reduce loneliness, and personalized planning to reconnect people with their pre-COVID selves. Such efforts may build on the resilience demonstrated by people with dementia and carers in coping with the pandemic.

Active Aging through Volunteerism: A Longitudinal Assessment of Perceived Neighborhood Safety as a Predictor among Older Adults, 2008-2018.

Volunteering can play an important role in active aging. The resource theory of volunteering posits that volunteerism depends on human, social, and cultural capital. Benefits of volunteering have been documented at the micro-, meso-, and macrolevels, positively affecting individual older people as well as their local communities and society at large. Taking a process-oriented theoretical approach, this study focused on the mesolevel factor of the environment with the purpose of determining the relationship between perceived neighborhood safety and volunteerism over the course of a decade and the extent to which this relationship differs by gender and race. Longitudinal data from the Health and Retirement Study in the United States of America between 2008 and 2018 were used (N = 72,319 adults 60 years and older). Generalized estimating equations (GEE) with robust standard errors were employed while controlling for a number of covariates. A third of the sample volunteered in the past year (33%). The probability of volunteering among older adults who rated their perceived neighborhood safety as excellent was greater compared with those who rated their perceived neighborhood safety as fair/poor after controlling for all other model covariates (ME: 0.03, 95% CI: 0.02, 0.05). Among males rating their perceived neighborhood safety as excellent, the probability of volunteering was higher (ME: 0.04, 95% CI: 0.02, 0.07). Among females, the probability of volunteering was higher among those who perceived their neighborhood safety to be excellent (ME: 0.03, 95% CI: 0.01, 0.05) or very good (ME: 0.02, 95% CI: 0.00, 0.04). White respondents who rated their neighborhood safety as excellent (ME: 0.05, 95% CI: 0.03, 0.07) or very good (ME: 0.04, 95% CI: 0.02, 0.06) had a higher probability of volunteerism. Results were not significant among Black respondents and those who described their race as "other." This study's process-oriented theoretical approach indicates that initiatives aimed at improving neighborhood safety and older adults' perceptions of neighborhood safety could increase social capital and lead older adults to engage in more volunteering, providing benefits at micro-, meso-, and macrolevels-to older individuals, their local communities, and society at large.

A Mixed Methods Case Study of Food Shopping in a Community with High Infant Mortality.

In the U.S., preterm birth disproportionately impacts certain racial/ethnic groups, with Black women experiencing preterm birth at a rate 50% higher than other groups. Among the numerous factors that likely contribute to these increased rates are neighborhood characteristics, such as food environment. In this mixed-methods case study, we evaluated how pregnant women living in a predominately minority, lower income community with high preterm birth rates navigate and perceive their food environment. Qualitative interviews were performed to assess perceptions of food environment (n = 7) along with geographic and observational assessments of their food environment. Participants traveled an average of 2.10 miles (SD = 1.16) and shopped at an average of 3 stores. They emphasized the importance of pricing and convenience when considering where to shop and asserted that they sought out healthier foods they thought would enhance their pregnancy health. Observational assessments of stores' nutrition environment showed that stores with lower nutritional scores were in neighborhoods with greater poverty and a higher percent Black population. Future policies and programmatic efforts should focus on improving nutrition during pregnancy for women living in communities with high rates of poor birth outcomes. Availability, affordability, and accessibility are key aspects of the food environment to consider when attempting to achieve birth equity.

Association Between Genetic Risk for Psychiatric Disorders and the Probability of Living in Urban Settings.

Importance: Urban residence has been highlighted as an environmental risk factor for schizophrenia and, to a lesser extent, several other psychiatric disorders. However, few studies have explored genetic effects on the choice of residence. Objective: To investigate whether individuals with genetic predisposition to a range of psychiatric disorders have an increased likelihood to live in urban areas. Design, Setting, and Participants: A cross-sectional retrospective cohort study including genotypes, address history, and geographic distribution of population density in the UK based on census data from 1931-2011 was conducted. Polygenic risk score (PRS) analyses, genome-wide association studies, genetic correlation, and 2-sample mendelian randomization analyses were applied to 385 793 UK Biobank participants with self-reported or general practitioner registration-based address history. The study was conducted from February 2018 to May 2021, and data analysis was performed from April 2018 to May 2021. Main Outcomes and Measures: Population density of residence at different ages and movement during the life span between urban and rural environments. Results: In this cohort study of 385 793 unrelated UK Biobank participants (207 963 [54%] were women; age, 37-73 years; mean [SD], 56.7 [8] years), PRS analyses showed significant associations with higher population density across adult life (age 25 to >65 years) reaching highest significance at the 45- to 55-year age group for schizophrenia (88 people/km2; 95% CI, 65-98 people/km2), bipolar disorder (44 people/km2; 95% CI, 34-54 people/km2), anorexia nervosa (36 people/km2; 95% CI, 22-50 people/km2), and autism spectrum disorder (35 people/km2; 95% CI, 25-45 people/km2). The schizophrenia PRS was also significantly associated with higher birthplace population density (37 people/km2; 95% CI, 19-55 people/km2; P = 8 × 10-5). Attention-deficit/hyperactivity disorder PRS was significantly associated with reduced population density in adult life (-31 people/km2; 95% CI, -42 to -20 people/km2 at age 35-45 years). Individuals with higher PRS for schizophrenia, bipolar disorder, anorexia nervosa, and autism spectrum disorder and lower PRS for attention-deficit/hyperactivity disorder preferentially moved from rural environments to cities (difference in PRS with Tukey pairwise comparisons for schizophrenia: 0.05; 95% CI, 0.03 to 0.60; bipolar disorder: 0.10; 95% CI, 0.08 to 0.13; anorexia nervosa: 0.05; 95% CI, 0.03 to 0.07; autism spectrum disorder: 0.04; 95% CI 0.03 to 0.06; and attention-deficit/hyperactivity disorder: -0.09, 95% CI, -0.12 to -0.06). Genetic correlation results were largely consistent with PRS analyses, whereas mendelian randomization provided support for associations between schizophrenia and bipolar disorder and living in high population-density areas. Conclusions and Relevance: These findings suggest that a high genetic risk for a variety of psychiatric disorders may affect an individual's choice of residence. This result supports the hypothesis of genetic selection of an individual's environment, which intersects the traditional gene-environment dichotomy.

The association of socioeconomic disadvantage and remoteness with receipt of type 2 diabetes medications in Australia: a nationwide registry study.

AIMS/HYPOTHESIS: In recent years, several new medications for the treatment of type 2 diabetes have been released and some evidence indicates sociodemographic disparity in their utilisation. We sought to investigate sociodemographic disparities in receipt of diabetes medications across Australia. METHODS: This study included 1,203,317 people with type 2 diabetes registered on the Australian National Diabetes Services Scheme (NDSS) followed from 2007 to 2015. The NDSS was linked to the Australian pharmaceutical claims database. We investigated trends in diabetes medication dispensing and variation in dispensing by sociodemographic strata. RESULTS: Compared with individuals in the least disadvantaged areas, those in the most disadvantaged quintile were less likely to receive dipeptidyl peptidase-4 inhibitors (DPP4is), glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is) in the first year of availability (OR [95% CI] for most vs least disadvantaged: 0.78 [0.75, 0.82], 0.65 [0.60, 0.71] and 0.89 [0.84, 0.95], respectively). These disparities dissipated over time for DPP4is and SGLT2is but remained significant for GLP-1RAs. The OR (95% CI) of receiving DPP4is, GLP-1RAs and SGLT2is in the first year of availability for people in remote areas vs major cities was 0.46 (0.39, 0.54), 0.46 (0.35, 0.61) and 0.71 (0.59, 0.84), respectively. These disparities remained significant through to 2015. CONCLUSIONS/INTERPRETATION: People with diabetes in more disadvantaged areas are less likely to receive newer diabetes medications, although this effect decreased over time. However, there are considerable and persistent differences in receipt of newer diabetes medications between major cities and remote areas of Australia. Graphical abstract.