Racial, ethnic, and rural disparities in distance to physicians among decedents with Alzheimer's disease and related dementias in Washington State.

INTRODUCTION: Distance to physicians may explain some of the disparities in Alzheimer's disease and related dementia (AD/ADRD) outcomes. METHODS: We generated round trip distance between residences of decedents with AD/ADRD and the nearest neurologist and primary care physician in Washington State. RESULTS: The overall mean distance to the nearest neurologist and primary care physician was 17 and 4 miles, respectively. Non-Hispanic American Indian and/or Alaska Native and Hispanic decedents would have had to travel 1.12 and 1.07 times farther, respectively, to reach the nearest neurologist compared to non-Hispanic White people. Decedents in micropolitan, small town, and rural areas would have had to travel 2.12 to 4.01 times farther to reach the nearest neurologist and 1.14 to 3.32 times farther to reach the nearest primary care physician than those in metropolitan areas. DISCUSSION: These results underscore the critical need to identify strategies to improve access to specialists and primary care physicians to improve AD/ADRD outcomes. HIGHLIGHTS: Distance to neurologists and primary care physicians among decedents with AD/ADRD American Indian and/or Alaska Native decedents lived further away from neurologists Hispanic decedents lived further away from neurologists Non-metropolitan decedents lived further away from neurologists and primary care Decrease distance to physicians to improve dementia outcomes.

Sexual Orientation and Age-Related Patterns of Suicidal Ideation Among U.S. Adults.

Purpose: We aimed to explore whether and how suicidal ideation differs according to specific sexual orientations (i.e., heterosexual, gay/lesbian, bisexual orientation) and age groups in gender-stratified analyses. Methods: We identified state health departments from nine U.S. states that collected Behavioral Risk Factor Surveillance System data on both sexual orientation and suicidal ideation from 2011 to 2018 for adults aged 18 and older (n = 113,337). Logistic regression and average marginal effects (AME) were used to examine the likelihood of suicidal ideation by sexual orientation, gender, and age. Results: We found that after important sociodemographic and socioeconomic controls, sexual minority adult men and women experienced significantly higher odds of suicidal ideation than their same-gender heterosexual counterparts. After all adjustments, lesbian women had more than three times higher odds and bisexual women had almost four times higher odds than heterosexual women. Compared with heterosexual men, gay men reported twice higher odds and bisexual men exhibited 3.67 times higher odds of suicidal ideation. Analysis of the AME revealed age-specific disparities. The likelihood of suicidal ideation for bisexual men aged 18-24 years was significantly higher than that for gay and heterosexual men of the same age. Among women, bisexual women closer to middle age (35-44 years) experienced a higher likelihood of suicidal ideation than heterosexual or lesbian women of the same age. Conclusion: The elevated risk of suicidal ideation among sexual minority people throughout different stages of adulthood has important implications for policies and support services.

Race/ethnicity, sleep duration, and mortality risk in the United States.

Current evidence and professional guidance recommend sleeping between 7 and 9 h in a 24-h period for optimal health. The present study examines the association between sleep duration and mortality and assesses whether this association varies by racial/ethnic identity for a large and diverse sample of United States adults. We use data on 274,836 adults, aged 25 and older, from the 2004-2014 waves of the National Health Interview Survey (NHIS) linked to prospective mortality through 2015 (23,382 deaths). Cox proportional hazards models were used in multi-variable regressions to estimate hazard ratios for mortality by sleep duration and racial/ethnic identity, controlling for sociodemographic, socioeconomic, and psychological distress variables. We find elevated risks of mortality from any cause for adults who sleep less than 5 h or more than 9 h in a 24-h period after all adjustments. Further, we find evidence that these elevated risks for mortality are more pronounced for some racial/ethnic groups and less pronounced for others. Improved understanding of differences in sleep duration and sleep health can facilitate more effective and culturally-tailored interventions around sleep health, improving overall well-being and enhancing longevity.

A comprehensive examination of discrimination and the impact on health in young adults.

Research has begun to clarify links between discrimination and health, but important gaps remain. A more complete understanding may arise from data on both frequency of discrimination as well as the various forms of discrimination. Using unique Panel Study of Income Dynamics (PSID) Transition to Adulthood Supplement (TAS) data on a representative sample of young adults from the 2017 and 2019 waves, we consider frequency and forms of discrimination separately and in tandem. Using generalized estimating equations panel models, we find that the association between discrimination and health is more pronounced when the frequency of, and the number of reasons for, discriminatory experiences are considered together. For example, relative to experiencing no discrimination, perceiving frequent discrimination and for three or more reasons results in nearly three times higher odds of poor/fair self-rated health and 1.25 points lower on the languishing/flourishing scale. The impact of perceived discrimination on health is likely underestimated if frequency and rationale are not considered as a holistic experience.

All-cause mortality risk for men and women in the United States: the role of partner's education relative to own education.

This study examines the association between educational attainment, relative to that of an intimate partner, and all-cause mortality for men and women in different-sex relationships. Research suggests some health benefits for partnered adults that arise from economic benefits and improved access to health-promoting tools. One way these benefits could be gained is through the pairing of the highly educated. While high individual educational attainment lowers mortality risk, less is known about the risks of mortality associated with one's education, relative to their partner's education. Using National Health Interview Survey Linked Mortality Files (NHIS-LMF) for the years 1999-2014 with prospective mortality follow-up through December 2015 (N = 347,994), we document the association between relative educational attainment and mortality for men and women with different-sex partners in the United States. Fully adjusted Cox proportional hazard models revealed a higher risk of all-cause mortality for men and women who have more education than their partner, relative to those having the same education as their partner. For women only, having less education than their male partner was associated with a lower risk of all-cause mortality. A better understanding of relative status within different-sex partnerships provides insights into partnered adult's mortality risks.

Disparities in years of potential life lost among racial and ethnic groups in Washington state.

BACKGROUND: The disproportionate mortality burden racial and ethnic groups endure compared to their non-Hispanic white (NHW) counterparts is a widely known public health issue in the United States. METHODS: We examined disparities in premature mortality through a measure of years of potential life lost (YPLL) among racial and ethnic groups after accounting for individual and place-based risk factors. Data were nearly 400,000 geocoded death records from Washington state mortality records from 2011 to 2018. Decedent records included information on marital status and educational attainment at time of death. We linked these records to census tract indicators of rurality and area deprivation based on residential longitude and latitude coordinates at time of death. We conducted censored Poisson regression to test adjusted associations between racial and ethnic identity and YPLL. RESULTS: Relative to non-Hispanic whites, non-Hispanic blacks, American Indian and Alaska Natives, Asian or other Pacific Islanders, multiracial, and Hispanic decedents had significantly higher rates of YPLL. Controlling for sociodemographic factors reduced but did not eliminate the disparities in YPLL between non-Hispanic whites and other racial and ethnic groups. Controlling for place-based risk factors did not further attenuate differences. CONCLUSIONS: Racial and ethnic minorities suffer disproportionately from premature mortality. Researchers and policy makers must recognize the disproportionate risks to premature mortality and work together to alleviate them through the delivery of better and more accessible targeted services.

Community social environments and cigarette smoking.

Cigarette smoking remains a primary contributor to health disparities in the United States, and significant evidence suggests that smoking behavior is socially influenced. Though residential neighborhoods are important for health disparities, recent evidence suggests that people spend the majority of their waking time away from the residential neighborhood. We advance research on neighborhoods and smoking by using individual, neighborhood, and activity space data for adults in the Los Angeles Family and Neighborhood Survey (L.A.FANS). Moving beyond socioeconomic indicators of neighborhoods, we investigate the ways in which residential neighborhood social cohesion, neighborly exchange, and perceived danger impact smoking behavior after accounting for confounding factors in both the residential neighborhood and other activity spaces in which adults spend their days. We find that perceptions of danger in the residential neighborhood is robustly associated with the likelihood of smoking cigarettes. Further, measures of community social organization interact with perceived danger to influence smoking behavior. Adults with high levels of perceived danger are twice as likely to smoke if residing in communities with lower levels of social organization in the form of helpful, trusting, and supportive relationships. Understanding how the social organization of communities contributes to smoking disparities is important for curbing smoking's impact on population health.

Deaths associated with opioids, race and ethnicity, and years of potential life lost in Washington State.

INTRODUCTION: This study examined disparities in years of potential life lost (YPLL) related to opioid use among racial and ethnic groups adjusting for individual- and neighborhood-level characteristics. METHODS: The study obtained data on 5265 geocoded death records associated with opioid use from the Washington State Department of Health. Death certificates included information on race and ethnicity, sex, marital status, and educational attainment. We linked these records to neighborhood-level indicators of rurality, area deprivation, and access to opioid treatment programs. Generalized linear mixed models tested associations between racial and ethnic identity and YPLL controlling for other individual and neighborhood characteristics. RESULTS: Among all decedents from opioid-related causes, the study found that racial and ethnic minorities-including Black, American Indian/Alaska Native, Asian, Native Hawaiian or other Pacific Islander-multiracial, or Hispanic adults died at younger ages than did White adults (33 to 44 vs 45). In the fully adjusted models, the estimated mean for YPLL was higher for Asian or Native Hawaiian or other Pacific Islander, multiracial, and Hispanic adults compared to White adults. Accounting for educational attainment and marital status substantially reduced YPLL differences between groups, by as much as 40% in some cases. CONCLUSIONS: The study observed striking differences in YPLL related to opioid causes among racial and ethnic minorities. Accounting for social determinants of health greatly reduced YPLL across all groups but racial and ethnic disparities in YPLL remained significant. Understanding and alleviating additional causes of disparities in YPLL is warranted to abate the epidemic of opioid related deaths in the United States.

Disparities in Access to Radiation Therapy Facilities Among American Indians/Alaska Natives and Hispanics in Washington State.

PURPOSE: Racial and ethnic minorities in the state of Washington experience higher cancer mortality relative to whites. We sought to characterize differences in travel distance to radiation therapy (RT) facilities in Washington by race and ethnicity with a special focus on non-Hispanic American Indians and Alaska Natives as a contributor to limited access and cancer disparities. METHODS AND MATERIALS: Geocoded mortality data from Washington Department of Health (2011-2018) were used to identify decedents with mortality related to all-causes, all cancers, and cancers likely requiring access to RT. This was determined from optimal RT usage estimates by diagnosis. RT facility locations were ascertained from the Directory of Radiation Therapy Centers and confirmed. Distance from decedents' address listed on death certificates to nearest RT facility was calculated. Generalized mixed models were used for statistical analysis. RESULTS: We identified 418,754 deaths; 109,134 were cancer-related, 60,973 likely required RT. Among decedents with cancers likely requiring RT, non-Hispanic American Indians and Alaska Natives decedents would have had to travel 1.16 times (95% confidence interval [CI], 1.09-1.24) farther from their residences to reach the nearest treatment facility compared with non-Hispanic whites. This association existed in metro counties but was more pronounced in nonmetro counties (1.39 times farther; 95% CI, 1.22-1.58). In addition, Hispanics would have had to travel 1.11 times farther (95% CI, 1.06-1.16) to reach the nearest facility compared with non-Hispanic whites, primarily due to differences in urban counties. Decedents in nonmetro counties lived on average 35 miles (SD = 29) from RT centers and non-Hispanic American Indians and Alaska Natives in nonmetro counties 53 miles (SD = 38). Compared with non-Hispanic white decedents, those who were non-Hispanic black, non-Hispanic Asian, and non-Hispanic Native Hawaiian decedents lived closer to RT facilities. CONCLUSIONS: We observed significant disparities in access to RT facilities in Washington, specifically for non-Hispanic American Indians and Alaska Natives and rural decedents. The findings call for initiatives to improve access to critical cancer treatment services for these underserved populations with known disparities in cancer deaths.

Access to medication-assisted treatment in the United States: Comparison of travel time to opioid treatment programs and office-based buprenorphine treatment.

OBJECTIVES: Disparities in access to medication-assisted treatment are a major problem. This study estimated and compared drive time to the nearest opioid treatment program (OTP) and office-based buprenorphine treatment (OBBT) across the urban-rural continuum in the U.S. METHODS: Drive time was calculated between the longitude and latitude of population weighted block group centroids and the longitude and latitude of the nearest OTP and OBBT. Rural-Urban Commuting Area (RUCA) codes were used for defining rurality. The Integrated Nested Laplace Approximation approach was used for statistical analysis. RESULTS: The mean travel time to the nearest OBBT compared to OTP decreased by 7.18 min (95 % CI = 7.23-7.14) in metropolitan cores, 36.63 min (95 % CI = 37.12-36.15) in micropolitan cores, 38.84 min (95 % CI = 39.57-38.10) in small town cores, and 40.16 min (95 % CI = 40.81-39.50) in rural areas. Additionally, travel burden to the nearest OTP would be more than 60 min for 13,526,605 people and more than 90 min for 5,371,852 people. The travel burden to the nearest OBBT would be more than 60 min for 845,991 people and more than 90 min for 149,297 people. CONCLUSIONS: The mean drive time to the closest OBBT was significantly smaller than the mean drive time to the closest OTP. Analysis of barriers to access is necessary to devising creative initiatives to improve access to critical opioid use disorder treatment services.

Disparities in Access to Opioid Treatment Programs and Office-Based Buprenorphine Treatment Across the Rural-Urban and Area Deprivation Continua: A US Nationwide Small Area Analysis.

OBJECTIVES: To measure access to opioid treatment programs (OTPs) and office-based buprenorphine treatment (OBBTs) at the smallest geographic unit for which the Census Bureau publishes demographic and socioeconomic data (ie, block group) and to explore disparities in access to treatment across the rural-urban and area deprivation continua across the United States. METHODS: Access to OTPs and OBBTs at the block group in 2019 was quantified using an innovative 2-step floating catchment area technique that accounts for the supply of treatment facilities relative to the population size, proximity of facilities relative to the location of population in block groups, and time as a barrier within catchments. Block groups were stratified into tertiles based on the rural-urban continuum codes (metropolitan, micropolitan, small town, or rural) and area deprivation index (least-deprived, middle-deprived, most-deprived). The Integrated Nested Laplace Approximation approach was used for statistical analysis. RESULTS: Across the United States, 3329 block groups corresponding to 2 915 949 adults lacked access to OTPs within a 2-hour drive of their community and 130 block groups corresponding to 86 605 adults did not have access to OBBTs. Disparities in access to treatment were observed across the urban-rural and area deprivation continua including (1) lowest mean access score to OBBTs were found among most-deprived small towns, and (2) lower mean access score to OTPs were found among micropolitan and small towns. CONCLUSIONS: The results of this study revealed disparities in access to medication-assisted treatment. The findings call for creative initiatives and local and regional policies to develop to mitigate access problems.

Hearing Impairment, Household Composition, Marital Status, and Mortality Among U.S. Adults.

OBJECTIVES: This study investigates associations between hearing impairment, household composition, marital status, and all-cause mortality for a representative sample of United States adults aged 40 and older (N = 198,902). METHODS: We use data from 11 waves of the National Health Interview Survey (2004-2014) linked to prospective mortality status through 2015. The risk of mortality over the follow-up period is estimated using Cox proportional hazard models. RESULTS: Compared to those with good to excellent hearing, adults with moderate to severe hearing impairments and deaf adults had 11% and 21% higher risk of death from any cause over the follow-up period, respectively. Household composition and marital status, as indicators of household social support systems, associated independently with the risk of mortality but did not substantively change the association between hearing impairment and mortality. DISCUSSION: Hearing impairment represents an important contributor to the length of life for adults age 40 and older, independent of other important and established determinants of mortality.

Food insecurity in households with young children: A test of contextual congruence.

Household food insecurity, an inability to provide adequate nutrition for a healthy, active lifestyle, affects nearly 1 in 7 households with children in the United States. Though rates of food insecurity declined to pre-recession levels just prior to the COVID-19 pandemic, they are now once again increasing. As a result, in one of the wealthiest countries in the world, millions of young children continue to grow up in households that struggle daily with a problem that is often associated with the developing world. The result is both immediate and long-term health and development deficits for children. We propose that the degree of demographic and socioeconomic congruence between the households of young children and their neighborhood of residence lends unique insights to food insecurity. We examine this using the ECLS-K 2010-2011 for children in families with incomes below 400 percent of the federal poverty line (N = 8600). Results show that congruence between household and neighborhood education and race/ethnicity associates with the likelihood of experiencing food insecurity. For example, households with non-Hispanic black children living in neighborhoods with high proportions of non-Hispanic blacks have significantly lower probabilities of food insecurity than similar households living in neighborhoods with smaller black populations. Similarly, more highly educated families experience lower probability of food insecurity in high education neighborhoods than when they reside in low education neighborhoods. Focusing on neighborhood risk factors as absolute and independent contributors limits our understanding of how families experience food insecurity as well as any policy efforts to address it.

Area deprivation amplifies racial inequities in premature mortality: Analysis of 242,667 deaths in Washington State, USA 2011-15.

Racial and socioeconomic inequalities in health are consistently reported, but less is known about the interplay between racial and deprivation-related inequities. We used geographically-localized data on all deaths recorded in Washington state 2011 to 2015 (n = 242,667 decedents) and multi-level regression models to examine premature (<65 years) mortality by race and neighborhood deprivation separately and in combination. White versus non-white inequities in premature mortality did not vary substantially with increasing levels of deprivation. However, most non-white races from deprived neighborhoods had odds of premature mortality between three and eight times that of more-affluent whites. These findings may reflect the compounding of disadvantage stemming from social and environmental risk factors.

Racial disparities in health and health behaviors among gay, lesbian, bisexual and heterosexual men and women in the BRFSS-SOP.

Objectives: Research on sexual minority health lack examinations of how sexual orientation intersects with other identities, including racial/ethnic identity, to shape health outcomes among U.S. adults. This study examines how health status and health behavior varies for gay, lesbian, and bisexual men and women who identify as non-Hispanic white, non-Hispanic black, Latino, Asian/Pacific Islander, and American Indian/Alaskan Native. By examining health and health behaviors within and across sexual minority subgroups, our study reports on race/ethnic, gender, and sexual orientation specific health risks.Methods: We respond to shortcomings in current data by utilizing aggregated data from fourteen states from the Behavioral Risk Factor Surveillance System (BRFSS) collected between 2005 and 2010 (n = 557,773). We investigated the odds of reporting poorer health, current cigarette smoking, and obesity by sexual orientation within race/ethnic and gender subgroups; all statistical analyses were performed in 2016.Results: Results suggest persistent health and behavior disadvantages for lesbian and bisexual women of all racial and ethnic identities, relative to heterosexuals. Some of the heightened odds are extreme. Asian/Pacific Islander lesbian (OR = 3.92) and bisexual (OR = 4.61) women, for example, have 4.0 times higher odds of smoking than heterosexual A/PI women. Results for men are more variable. To illustrate, the odds of obesity for White and A/PI men are indistinguishable between bisexuals and heterosexuals, and Black and American Indian/Alaskan Native bisexuals have lower odds of obesity than their heterosexual counterparts.Conclusion: These findings highlight the need for policy efforts aimed at improving health and health behaviors among lesbian and bisexual women across groups, and more targeted efforts among sexual minority men.

Characteristics of place and the rural disadvantage in deaths from highly preventable causes.

Extensive research has documented higher mortality in rural parts of the United States compared to urban areas. Much of this work focuses on aggregate rates, documenting a rural mortality penalty that has been increasing over the last three decades. Advances in place-based analyses suggest the importance of community resources for individual mortality but have largely focused on urban spaces. We advance knowledge on rural-urban mortality disparities by focusing on differences for highly preventable causes of death. Using unique geocoded mortality records from Washington state, we match individual-level attributes with area-level measures of socioeconomic conditions to examine whether characteristics of place elucidate the rural mortality penalty. We find that rural decedents have greater odds of dying from highly preventable causes compared to their urban counterparts. Place-based socioeconomic measures, meanwhile, independently associate with the odds of dying from highly preventable causes. However, we find no evidence that the relationship between socioeconomic conditions and highly preventable death varies across geographic contexts.

Families in Context: Food Insecurity Among Hispanic Immigrant and Nonimmigrant Households With Children.

Using restricted, geo-coded Early Childhood Longitudinal Study, Kindergarten Class of 2010-2011 data (N = 2700) linked with 3 sources of contextual data, we examine whether a comprehensive set of individual, household, and county-level characteristics explains disparities in household food insecurity between Hispanic children of foreign- and US-born parents. Adjusting for individual, household, and county-level characteristics does not eliminate the higher odds of household food insecurity among Hispanic children in immigrant families, especially of Mexican origin. Moreover, growth in the noncitizen population at the county level is associated with food insecurity among Hispanic families, though the impact differs by parental nativity.

Estimated Residential Exposure to Agricultural Chemicals and Premature Mortality by Parkinson's Disease in Washington State.

The aim of this study was to examine the relationship between estimated residential exposure to agricultural chemical application and premature mortality from Parkinson's disease (PD) in Washington State. Washington State mortality records for 2011⁻2015 were geocoded using residential addresses, and classified as having exposure to agricultural land-use within 1000 meters. Generalized linear models were used to explore the association between land-use associated with agricultural chemical application and premature mortality from PD. Individuals exposed to land-use associated with glyphosate had 33% higher odds of premature mortality than those that were not exposed (Odds Ratio (OR) = 1.33, 95% Confidence Intervals (CI) = 1.06⁻1.67). Exposure to cropland associated with all pesticide application (OR = 1.19, 95% CI = 0.98⁻1.44) or Paraquat application (OR = 1.22, 95% CI = 0.99⁻1.51) was not significantly associated with premature mortality from PD, but the effect size was in the hypothesized direction. No significant associations were observed between exposure to Atrazine (OR = 1.21, 95% CI = 0.84⁻1.74) or Diazinon (OR = 1.07, 95% CI = 0.85⁻1.34), and premature mortality from PD. The relationship between pesticide exposure and premature mortality aligns with previous biological, toxicological, and epidemiological findings. Glyphosate, the world's most heavily applied herbicide, and an active ingredient in Roundup® and Paraquat, a toxic herbicide, has shown to be associated with the odds of premature mortality from PD.

Neighborhood and Social Environmental Influences on Child Chronic Disease Prevalence.

We investigate how distinct residential environments uniquely influence chronic child disease. Aggregating over 200,000 pediatric geocoded medical records to the census tract of residence and linking them to neighborhood-level measures, we use multiple data analysis techniques to assess how heterogeneous exposures of social and environmental neighborhood conditions influence an index of child chronic disease (CCD) prevalence for the neighborhood. We find there is a graded relationship between degree of overall neighborhood disadvantage and children's chronic disease such that the highest neighborhood CCD scores reside in communities with the highest concentrated disadvantage. Finally, results show that higher levels of neighborhood concentrated disadvantage and air pollution exposure associate with higher risks of having at least one chronic condition for children after also considering their individual- and family-level characteristics. Overall, our analysis serves as a comprehensive start for future researchers interested in assessing which neighborhood factors matter most for child chronic health conditions.

Does neighborhood social and environmental context impact race/ethnic disparities in childhood asthma?

Utilizing over 140,000 geocoded medical records for a diverse sample of children ages 2-12 living in Houston, Texas, we examine whether a comprehensive set of neighborhood social and environmental characteristics explain racial and ethnic disparities in childhood asthma. Adjusting for all individual risk factors, as well as neighborhood concentrated disadvantage, particulate matter, ozone concentration, and race/ethnic composition, reduced but did not fully attenuate the higher odds of asthma diagnosis among black (OR=2.59, 95% CI=2.39, 2.80), Hispanic (OR=1.22, 95% CI=1.14, 1.32) and Asian (OR=1.18, 95% CI=1.04, 1.33) children relative to whites.