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.

Adverse childhood experiences among black sexually minoritized men and Black transgender women in Chicago.

BACKGROUND: Adverse childhood experiences (ACE) are important predictors of mental health outcomes in adulthood. However, commonly used ACE measures such as the Behavioural Risk Factor Surveillance System (BRFSS) have not been validated among Black sexually minoritized men (SMM) nor transgender women (TW), whom are known to have higher rates of ACE and poorer mental health outcomes. Assessing the psychometric properties of the measure is important for health equity research, as measurements that are not valid for some populations will render uninterpretable results. METHODS: Data are drawn from the Neighborhoods and Networks (N2) study, a longitudinal cohort of Black SMM and TW living in Southern Chicago. We conducted confirmatory factor analysis, correlation analysis and a two-parameter Item Response Theory (IRT) on the BRFSS ACE measure, an 11-item measure with 8 domains of ACE. RESULTS: One hundred forty seven participants (85% cisgender male) completed the BRFSS ACE measurement in the N2 study with age ranges from 16-34. The cohort were from a low socioeconomic background: about 40% of the cohort were housing insecure and made than $10,000 or less annually. They also have a high number of ACEs; 34% had endorsed 4 or more ACE domains. The three-factor structure fit the BRFSS ACE measure best; the measurement consisted of three subscales: of "Household Dysfunction", "Emotional / Physical", and "Sexual Abuse" (CFI = 0.975, TLI = 0.967, and RMSEA = 0.051). When the 8 domains of ACE were summed to one score, the total score was is correlated with depressive symptoms and anxiety scores, establishing concurrent validity. Item Response Theory model indicated that the "parental separation" domain had a low discrimination (slope) parameter, suggesting that this domain does not distinguish well between those with and without high ACE. CONCLUSIONS: The BRFFS ACE measure had adequate reliability, a well-replicated structure and some moderate evidence of concurrent validity among Black SMM and TW. The parental separation domain does not discriminate between those with high and low ACE experiences in this population. With changing population demographics and trends in marriage, further examination of this item beyond the current study is warranted to improve health equity research for all.

Neighborhood Safety and Neighborhood Police Violence Are Associated with Psychological Distress among English- and Spanish-Speaking Transgender Women of Color in New York City: Finding from the TURNNT Cohort Study.

Transgender women of color (TWOC) experience high rates of police violence and victimization compared to other sexual and gender minority groups, as well as compared to other White transgender and cisgender women. While past studies have demonstrated how frequent police harassment is associated with higher psychological distress, the effect of neighborhood safety and neighborhood police violence on TWOC's mental health is rarely studied. In this study, we examine the association between neighborhood safety and neighborhood police violence with psychological distress among TWOC. Baseline self-reported data are from the TURNNT ("Trying to Understand Relationships, Networks and Neighborhoods among Transgender Woman of Color") Cohort Study (analytic n = 303). Recruitment for the study began September 2020 and ended November 2022. Eligibility criteria included being a TWOC, age 18-55, English- or Spanish-speaking, and planning to reside in the New York City metropolitan area for at least 1 year. In multivariable analyses, neighborhood safety and neighborhood police violence were associated with psychological distress. For example, individuals who reported medium levels of neighborhood police violence had 1.15 [1.03, 1.28] times the odds of experiencing psychological distress compared to those who experienced low levels of neighborhood police violence. Our data suggest that neighborhood safety and neighborhood police violence were associated with increased psychological distress among TWOC. Policies and programs to address neighborhood police violence (such as body cameras and legal consequences for abusive officers) may improve mental health among TWOC.

The burden of Cardiovascular diseases in Jordan: a longitudinal analysis from the global burden of disease study, 1990-2019.

BACKGROUND: Cardiovascular Disease (CVD) is the leading cause of mortality worldwide. While countries in the Arab world continue to lack public health data and be severely understudied in health research, previous research has shown that compared to 1990, CVDs had a higher burden of disease in the Arab World in 2010. Jordan, a middle-income Arab country, is profiled with unique attributes such as a dual-sector healthcare system, political stability, and its role as a haven for refugees and migrants. These distinctive factors emphasize Jordan's suitability as a case study. This investigation aims to quantify CVD burden in Jordan and identify risk factors, contributing to a broader understanding of health challenges in the Arab region and beyond. METHODS: The Global Burden of Disease (GBD) dataset was used to estimate prevalence, death, and disability-adjusted life-years (DALYs) as age-standardized rates from 1990 to 2019. We calculated percentage change for nine specific CVDs and reported trends by gender and age groups. Additionally, data on twelve a priori selected behavioral, clinical, and environmental risk factors attributing to overall age-standardized CVDs DALY were reported per 100,00 population. RESULTS: In 2019, the age-standardized CVD prevalence, death, and DALYs rates in Jordan were 7980 (95% uncertainty interval [UI] 7629, 8360), 248 (95% UI 211, 288), and 4647 (95% UI 4028, 5388), respectively. Despite an increase in the absolute number of mortality and prevalence, between 1990 and 2019, the age-standardized prevalence, death, and DALYs rates all decreased by 5.5%, 45.1%, and 46.7%, respectively. In 2019, the leading risk factors contributing to overall age-standardized CVDs DALY per 100,000 population were high systolic blood pressure, high BMI, dietary risks, and high LDL cholesterol. CONCLUSION: Despite decreasing burden rate of CVDs in Jordan between 1990 and 2019, CVDs remain the leading cause of mortality in Jordan, with an increase in the total number of prevalence and mortality. Overall, this contributes to increased healthcare costs. Further research is required to quantify the burden of CVDs and understand it better. Intervention measures and policies tailored to specific CVDs should be designed to reduce the burden of CVDs in Jordan.

A Network Science Approach to Sex-Polydrug Use Among Black Sexually Minoritized Men and Transgender Women: The N2 Cohort Study.

Black sexually minoritized men (SMM) and transgender women (TW) are subgroups with lower rates of substance use and comparable rates of condom use relative to White SMM and TW yet experience heightened vulnerability to HIV. This study sought to explore associations of substance use, including sex-drug use (i.e., drug or alcohol use during sex to enhance sex), and condomless sex among Black SMM and TW. Data were collected from Black SMM and TW living in Chicago, Illinois, enrolled in the Neighborhoods and Networks (N2) cohort study, from November 2018 to April 2019. We used bivariate analyses followed by a multilevel egocentric network analysis to identify factors associated with condomless sex. We conducted Spearman correlation coefficients to examine correlations between pairs of sex-drugs to enhance sex. We used a bipartite network analysis to identify correlates of sex-drug use and condomless sex. A total of 352 Black SMM and TW (egos) provided information about 933 sexual partners (alters). Of respondents, 45% reported condomless sex and 61% reported sex-drug use. In unadjusted analyses, marijuana (34%) and cocaine/crack (5%) sex-drug use were associated with condomless sex (p < 0.05). Condomless sex was positively associated with sex-polydrug use, or the use of 2+ drugs or 1 drug and alcohol (OR = 1.48; 95% CI: 1.02-2.14; p = 0.039), and negatively associated with sharing an HIV-negative serostatus with a sexual partner (OR = 0.57; 95% CI: 0.33-0.98; p = 0.041), having a different HIV serostatus with a sexual partner (OR = 0.37; 95% CI: 0.21-0.64; p < 0.001) or not knowing the HIV serostatus of a sexual partner (OR = 0.47; 95% CI: 0.26-0.84; p = 0.011). The following pairs of sex-polydrug use had Spearman correlation coefficients higher than 0.3: marijuana and alcohol, ecstasy and alcohol, cocaine/crack and ecstasy, and methamphetamine and poppers (p < 0.05). HIV prevention interventions for Black SMM and TW designed to reduce HIV transmission through egocentric sexual networks could address sex-drug use through sex-positive and pleasure-centered harm reduction strategies and provide and promote biomedical prevention and care options at supraoptimal levels.

Neighborhood violent crime exposure is associated with preexposure prophylaxis nonuse among black sexually minoritized men and transgender women.

OBJECTIVE: The objective of this study is to use GPS technology to determine if violent and property crime exposure to participants activity spaces affect outcomes of the HIV prevention and care continuum (PCC) among Young black sexually minoritized men (YBSMM) and transgender women (TGW), a subgroup at high vulnerability for new HIV diagnoses. Exposure to violent and property crime adversely affects a variety of acute and chronic medical conditions; however, the relationship between exposure to violent and property crime and HIV risk [e.g. preexposure prophylaxis (PrEP) nonuse] is unknown. Spatial analytic analysis using dynamic Global Position Systems (GPS) technology can accurately detect geospatial associations between the crime exposure and objective HIV-related outcomes. METHODS: With the Neighborhoods and Networks (N2) Cohort Study, GPS technology to identify the activity space of 286 [123 people with HIV (PWH) and 163 people without HIV (PWoH)] YBSMM and TGW living in Chicago, Illinois, to identified spatial associations between violent and property crime exposures with HIV PCC outcomes. RESULTS: We found that YBSMM and TGW with higher exposure areas with higher levels of violent crime were less likely to use HIV PrEP therapy [adjusted odds ratio (aOR) 0.76, 95% confidence interval (CI) 0.63-0.91, P  = 0.03]. CONCLUSION: This study demonstrates the importance of clinical providers to consider violent crime as a potential sociostructural barrier that may impact medication adherence and healthcare outcomes among vulnerable populations. Additionally, GPS technology offers an alternative data analytic process that may be used in future studies to assist in identifying barriers to ending the HIV epidemic.

Examination of multidimensional geographic mobility and sexual behaviour among Black cisgender sexually minoritized men in Chicago.

Black sexually minoritized men (BSMM) are the most likely to acquire HIV in Chicago- a racially segregated city where their daily travel may confer different HIV-related risks. From survey and GPS data among participants of the Neighbourhoods and Networks Cohort Study, we examined spatial (proportion of total activity space away from home), temporal (proportion of total GPS points away from home), and motivation-specific (discordance between residential and frequented sex or socializing neighbourhoods) dimensions of mobility. To identify potential drivers of BSMM's risk, we then examined associations between mobility and sexual behaviours known to cause HIV transmission: condomless anal sex, condomless anal sex with a casual partner, transactional sex, group sex, and sex-drug use. Multivariable logistic regression models assessed associations. Of 269 cisgender BSMM, most were 20-29 years old, identified as gay, and lowincome. On average, 96.9% (Standard Deviation: 3.7%) of participants' activity space and 53.9% (Standard Deviation: 38.1%) of participants' GPS points occurred outside their 800m home network buffer. After covariate adjustment, those who reported sex away from home were twice as likely to report condomless sex (Odds Ratio: 2.02, [95% Confidence Interval (CI): 1.08, 3.78]). Those who reported socializing away from home were four times more likely to have condomless sex with a casual partner (Odds Ratio: 4.16 [CI: 0.99, 29.0]). BSMM are on the move in Chicago, but only motivation-specific mobility may increase HIV transmission risk. Multidimensional investigations of mobility can inform place-based strategies for HIV service delivery.

Rest-Activity Rhythms Are Associated With Prevalent Cardiovascular Disease, Hypertension, Obesity, and Central Adiposity in a Nationally Representative Sample of US Adults.

BACKGROUND: Rest-activity rhythms (RARs), a measure of circadian rhythmicity in the free-living setting, are related to mortality risk, but evidence is limited on associations with cardiovascular disease (CVD) and its risk factors. METHODS AND RESULTS: Participants included 4521 adults from the 2013 to 2014 National Health and Nutrition Examination Survey physical activity monitoring examination. Wrist-worn ActiGraph GT3X+ data were used to estimate RARs. Multivariable logistic models evaluated associations of RARs with prevalent CVD, hypertension, obesity, and central adiposity. Participants (mean age, 49 years) in the highest versus lowest tertile of relative amplitude (greater circadian rhythmicity) had 39% to 62% lower odds of prevalent CVD, hypertension, obesity, and central adiposity. A more active wake period was associated with 19% to 72% lower CVD, hypertension, obesity, and central adiposity odds. Higher interdaily stability (regular sleep-wake and rest-activity patterns) was related to 52% and 23% lower CVD and obesity odds, respectively. In contrast, participants in the highest versus lowest tertile of intradaily variability (fragmented RAR and inefficient sleep) had >3-fold and 24% higher CVD and obesity odds, respectively. A later and less restful sleep period was associated with 36% to 2-fold higher CVD, hypertension, obesity, and central adiposity odds. A statistically significant linear trend was observed for all associations (P-trend<0.05). CONCLUSIONS: A robust, stable, and less fragmented RAR, an active wake period, and an earlier and more restful sleep period are associated with lower prevalent CVD, hypertension, obesity, and central adiposity, with evidence of a dose-response relationship. The magnitude, timing, and regularity of sleep-wake and rest-activity patterns may be important targets for reducing cardiovascular risk.

Neighborhood Factors as Correlates of Alcohol Use in the N2 Cohort Study of Black Sexual Minority Men and Transgender Women.

Sexually minoritized men (SMM), transgender women (TW), and particularly Black SMM and Black TW may be disproportionately impacted by alcohol-related problems. Few studies have empirically examined neighborhood factors that may contribute to alcohol use, specifically among these populations. Using data from the N2 longitudinal cohort study in Chicago, IL, survey data from the second wave of longitudinal assessment (n = 126), and GPS mobility data collected during study enrollment were used to evaluate neighborhood alcohol outlet availability, neighborhood disorder, and neighborhood poverty as correlates for individual alcohol use. Neighborhood exposures were measured using 200-m derived activity space areas, created from GPS data, and with publicly accessible geospatial contextual data. Separate multi-variable quasi-poison regression models tested for association between neighborhood alcohol outlet density (AOD), measured separately for on-premise (e.g. bars) and off-premise consumption outlets (e.g. liquor stores), neighborhood poverty (defined as the percentage of neighborhood areas at 150% or greater of the U.S. poverty line), exposure to vacant buildings, and neighborhood violent crime density. Separate analytical models found no significant effect between alcohol use and on-premise neighborhood AOD (IRR = 0.99, p = 0.35), off-premise consumption AOD (IRR = 0.92, p = 0.33), or neighborhood violent crime (IRR = 1.00, p = 0.65). Vacant buildings (IRR = 1.03, p = 0.05) and levels of neighborhood poverty (1.05, p = 0.01) were found to be significantly associated with increased alcohol use. Among this population, opposed to geospatial access, neighborhood measurements indicative of disorder and poverty may have greater influence on shaping alcohol use.

Neighborhood-level characteristics as effect modifiers on the efficacy of the MyPEEPS mobile intervention in same-sex attracted adolescent men.

To estimate the effect of neighborhood-level modification on the efficacy of the MyPEEPS Mobile intervention on the reduction of condomless anal sex acts among same-sex attracted adolescent men. A series of generalized linear mixed model was used to examine if the effect of the MyPEEPS Mobile intervention on condomless anal sex acts was moderated by neighborhood-level factors using data from the 2019 American Community Survey US Census Bureau. "The magnitudes of intervention were significantly smaller at both 6- and 9-month follow-up among adolescents living in neighborhood with high proportions of Hispanic or Latino residents (IRR6M = 1.02, 95 % CI: 1.01, 1.02; IRR9M = 1.03, 95 % CI: 1.01, 1.05) and high proportions of families with income below the poverty level (IRR6M = 1.07, 95 % CI: 1.01, 1.12; IRR9M = 1.05, 95 % CI: 1.01, 1.10), which indicated that living in communities with a higher concentration of residents living under poverty or of Hispanic/and Latino ethnicity significantly modified the effective of program intervention on condomless sex among adolescent MSM. Understanding how neighborhood characteristics modify the effect of HIV prevention interventions may be useful in better targeting delivery and tailoring content of interventions based on neighborhood level characteristics such as the ones identified in this study.

Using GPS-defined venue-based affiliation networks among Black sexually minoritized men and transgender women to identify locations for HIV prevention interventions.

PURPOSE: HIV biomedical intervention uptake is suboptimal among Black sexually minoritized men (SMM) and transgender women (TW). Venues where people meet and interact shape HIV-related risk and prevention behaviors. We aimed to construct GPS-defined venue-based affiliation networks and identify the unique set of venues that could maximize reach of HIV biomedical interventions among Black SMM and TW. METHODS: We used baseline survey and GPS data from 272 Black SMM and TW in the Neighborhoods and Networks (N2) Cohort Study in Chicago, Illinois (2018-2019). We mapped participants' GPS data to the nearest pre-identified SMM- and TW-friendly venue (n = 222) to construct affiliation networks. Network analyses were performed to identify influential venues that can yield high reach to intervention candidates. RESULTS: Participants were affiliated with 75.5 % of all pre-identified venues based on GPS data. Two influential venues were identified in the non-PrEP use network, which when combined, could reach 52.5 % of participants not taking PrEP. Participants that could be reached through these two influential venues reported more non-main sex partners than participants not affiliated with either venue (p = 0.049). CONCLUSION: We demonstrate a potential for GPS-defined venue-based affiliation networks to identify unique combinations of venues that could maximize the impact of HIV prevention interventions.

Hair Dye and Relaxer Use among Cisgender Women in Embu and Nakuru Counties, Kenya: Associations with Perceived Risk of Breast Cancer and Other Health Effects.

Despite widespread use of hair products globally, little is known about the prevalence and patterns of use in populations outside the United States. As some hair products contain endocrine-disrupting chemicals (EDCs) and EDCs have been linked to breast cancer, which is increasing globally, in this study, we addressed key knowledge gaps about hair product use and practices, and perceptions of use among women in two counties in Kenya. Using community-engaged approaches in Embu and Nakuru, Kenya, we recruited women aged 15-50 years to complete a questionnaire that ascertained hair product use in the last 7-14 days, ever using hair dyes and chemical relaxers, and participants' perceptions or harm around hair product use. In multivariable-adjusted regression models, we evaluated associations between participants' sociodemographic characteristics and perceptions of hair product use in relation to if they have ever used hair dyes and relaxers. In our sample of 746 women (mean age, 30.4 ± 8.1 years), approximately one-third of participants reported ever using permanent and/or semi-permanent hair dyes, with approximately one-fifth reporting current use. Almost 60% reported ever using chemical relaxers, with a little over one-third reporting current use. Increasing age and having an occupation in the sales and service industry were statistically significant predictors of hair dye use (OR 1.04, 95% CI: 1.02-1.06 and OR 2.05, 95% CI: 1.38-3.03, respectively) and relaxer use (OR 1.03, 95% CI: 1.01-1.06 and OR 1.93, 95% CI: 1.30-2.87). On average, participants reported moderate-to-high levels of concern about exposures and general health effects from using hair products, and relatively high levels of perceived risk of breast cancer related to hair product use. However, in contrast to our hypotheses, we observed mixed evidence regarding whether higher levels of perceived risk were associated with lower odds of ever using hair dyes and relaxers. These findings add new knowledge to the extant literature on hair product use among women in Kenya, where breast cancer incidence rates are increasing. Improving the understanding of patterns of use of specific products and their chemical ingredients-which may be hormone disruptors or carcinogens-and exploring the role of environmental health literacy are critical for developing interventions to reduce potentially harmful exposures found in these products.

Police Harassment and Psychiatric, Sexual, and Substance Use Risk Among Black Sexual Minority Men and Black Transgender Women in the HIV Prevention Trials 061 Cohort.

BACKGROUND: Black sexual minority men and Black transgender women (BSMM/BTW) experience disproportionate levels of HIV/STI-related risk factors as well as police harassment (PH). PH is linked to psychiatric risk and could play a role in substance use, sexual risk behavior, and HIV/STI risk. METHODS: We used data from the HIV Prevention Trials Network 061(HPTN 061) study to examine associations between PH and HIV/STI-related outcomes. Using PH exposure measured at baseline and 6-month study visits, we examined an ordinal exposure (PH reported at both visits, PH reported at either visit, versus PH reported at neither baseline nor 6 months) and a binary exposure of persistent PH reported at both visits (yes versus no). We estimate risk ratios (RR) for associations between PH and depression, use of alcohol and methamphetamine, multiple partnerships, condomless sex, and syphilis. RESULTS: Persistent PH (binary) was associated with a 20% or greater increase in the risk of depression (RR, 1.26 (1.07, 1.47)) and multiple partnerships (RR, 1.20 (1.05, 1.39)). There was evidence that ordinal PH was associated with elevated risk of alcohol use (RR, 1.17 (1.00, 1.36)); the point estimate for the association between persistent PH and alcohol use was similar but the imprecision was greater (RR, 1.16 (0.95, 1.42)). CONCLUSION: PH may influence not only mental health but also behavioral risks that contribute to HIV/STI among BSMM/BTW, highlighting the potential wide-ranging and downstream effects of PH on health. Further research is required to confirm associations and elucidate pathways through which PH may influence HIV/STI among BSMM/BTW.

Neighborhood social environment and disability among Mexican older adults: a cohort-based analysis / O ambiente social da vizinhança e a incapacidade nos idosos mexicanos: uma análise de coorte / Ambiente social del vecindario y discapacidad entre adultos mayores mejicanos: un análisis basado en cohortes

Considering that the world population is rapidly aging and disability is a very frequent event in older adults, there is an increasing interest in studying their determinants, such as the neighborhood characteristics. Thus, this study aimed to explore the association between the social environment of the neighborhood and disability in older adults. A cohort study was assembled using waves 1 and 2 from the Study of Global Ageing and Adults Health (SAGE) in Mexico, which included adults with 55+ years old. Neighborhood characteristics - such as social participation, trust and safety - and individual covariates were measured only in wave 1 (baseline), while disability was measured in both waves to adjust for the score of wave 1. Multilevel negative binomial models with random intercepts at the municipality level were constructed for the disability score in wave 2, using each of the social environment variables as the main exposure and adjusting for the sociodemographic and health-related variables. Finally, interaction terms with sex, age, and socioeconomic quintiles were tested. Results showed that neighborhoods with a medium (IRR: 0.68; 95%CI: 0.53-0.87) or high (IRR: 0.67; 95%CI: 0.52-0.86) safety level were associated with a significant reduction in the disability score of adults older than 75 years, although there was no association between other characteristics of the social environment and disability in the general sample. Consequently, actions to improve safety in the neighborhoods should be carried out to help reduce the disability score in vulnerable older adults, especially in a context where safety is a critical issue, as in Mexico.

Considerando que la población mundial está envejeciendo rápidamente y la discapacidad es un hecho muy frecuente entre la tercera edad, existe un creciente interés por estudiar los determinantes de esta última, así como las características del vecindario. Por lo tanto, el objetivo de este estudio fue investigar la asociación entre el ambiente social del vecindario y la discapacidad en adultos mayores. La cohorte de estudio se formó usando las curvas 1 y 2, procedentes del Estudio Global sobre el Envejecimiento y la Salud del Adulto (SAGE por sus siglas en inglés) en México, que incluyó adultos de 55+ años. Características del vecindario como: participación social, confianza y seguridad, así como las covariables individuales se midieron sólo en la curva 1 (base de referencia), mientras que la discapacidad se midió en ambas curvas para ajustarla a la puntuación de la curva 1. Se realizaron modelos binomiales negativos multinivel con intercepciones aleatorias en el nivel municipal para el marcador de discapacidad en la curva 2, usando cada una de las variables socioambientales como las de principal exposición y ajustándolas a las variables sociodemográficas, así como a las relacionadas con la salud. Finalmente, se probaron los términos de interacción con sexo, edad, así como quintiles socioeconómicos. Los resultados mostraron que los vecindarios con una media (IRR: 0,68; IC95%: 0,53-0,87) o alto (IRR: 0,67; IC95%: 0,52-0,86) nivel de seguridad estuvieron asociados con una significativa reducción en el marcador de discapacidad de adultos 75+ años, pese a que no hubo asociación entre otras características del ambiente social y discapacidad en la muestra general. Consecuentemente, las acciones para mejorar la seguridad en los vecindarios deberían haber ayudado a reducir la puntuación en discapacidad en ancianos vulnerables, especialmente, en un contexto donde la seguridad es un asunto crítico, como en México.

Considerando o envelhecimento rápido da população mundial e o fato de a incapacidade ser um evento muito frequente nos idosos, há um interesse cada vez maior no estudo dos determinantes da incapacidade, que incluem as características da vizinhança. Portanto, o estudo procurou explorar a associação entre o ambiente social da vizinhança e a incapacidade nos idosos. Foi organizado um estudo de coorte com as ondas 1 e 2 do Estudo sobre Envelhecimento Global e Saúde do Adulto (SAGE) no México, que incluiu adultos com 55 anos ou mais. As características da vizinhança, tais como a participação social, confiança e segurança, e as covariáveis individuais foram medidas apenas na onda 1 (linha de base), enquanto a incapacidade era medida em ambas as ondas para ajustar para a pontuação da onda 1. Foram construídos modelos binomiais negativos multiníveis com interceptos no nível municipal para a pontuação da incapacidade na onda 2, usando cada uma das variáveis ambientais como a principal variável de exposição, e ajustando para as variáveis sociodemográficas e sanitárias. Finalmente, foram testados termos de interação com sexo, idade e quintis socioeconômicos. Os resultados mostraram que os bairros com nível de segurança médio (RTI: 0,68; IC95%: 0,53-0,87) ou alto (RTI: 0,67; IC95%: 0,52-0,86) estavam associados com uma redução significativa na escala de incapacidade nos idosos com 75 anos ou mais, embora não houvesse associação entre outras características do entorno e a incapacidade na amostra geral. Portanto, são necessárias medidas para melhorar a segurança dos bairros para ajudar a reduzir a escala da incapacidade nos idosos vulneráveis, principalmente em um contexto onde a segurança é uma questão crítica, como no México.