Development and validation of mortality prediction models based on the social determinants of health.

BACKGROUND: There is no standardised approach to screening adults for social risk factors. The goal of this study was to develop mortality risk prediction models based on the social determinants of health (SDoH) for clinical risk stratification. METHODS: Data were used from REasons for Geographic And Racial Differences in Stroke (REGARDS) study, a national, population-based, longitudinal cohort of black and white Americans aged ≥45 recruited between 2003 and 2007. Analysis was limited to participants with available SDoH and mortality data (n=20 843). All-cause mortality, available through 31 December 2018, was modelled using Cox proportional hazards with baseline individual, area-level and business-level SDoH as predictors. The area-level Social Vulnerability Index (SVI) was included for comparison. All models were adjusted for age, sex and sampling region and underwent internal split-sample validation. RESULTS: The baseline prediction model including only age, sex and REGARDS sampling region had a c-statistic of 0.699. An individual-level SDoH model (Model 1) had a higher c-statistic than the SVI (0.723 vs 0.708, p<0.001) in the testing set. Sequentially adding area-level SDoH (c-statistic 0.723) and business-level SDoH (c-statistics 0.723) to Model 1 had minimal improvement in model discrimination. Structural racism variables were associated with all-cause mortality for black participants but did not improve model discrimination compared with Model 1 (p=0.175). CONCLUSION: In conclusion, SDoH can improve mortality prediction over 10 years relative to a baseline model and have the potential to identify high-risk patients for further evaluation or intervention if validated externally.

Systematic Review of Longitudinal Evidence and Methodologies for Research on Neighborhood Characteristics and Brain Health.

Objective: Synthesize longitudinal research evaluating neighborhood environments and cognition to identify methodological approaches, findings, and gaps. Methods: Included studies evaluated associations between neighborhood and cognition longitudinally among adults >45 years (or mean age of 65 years) living in developed nations. We extracted data on sample characteristics, exposures, outcomes, methods, overall findings, and assessment of disparities. Results: Forty studies met our inclusion criteria. Most (65%) measured exposure only once and a majority focused on green space and/or blue space (water), neighborhood socioeconomic status, and recreation/physical activity facilities. Similarly, over half studied incident impairment, cognitive function or decline (70%), with one examining MRI (2.5%) or Alzheimer's disease (7.5%). While most studies used repeated measures analysis to evaluate changes in the brain health outcome (51%), many studies did not account for any type of correlation within neighborhoods (35%). Less than half evaluated effect modification by race/ethnicity, socioeconomic status, and/or sex/gender. Evidence was mixed and dependent on exposure or outcome assessed. Conclusion: Although longitudinal research evaluating neighborhood and cognitive decline has expanded, gaps remain in types of exposures, outcomes, analytic approaches, and sample diversity.

Spatial scale effects on associations between built environment and cognitive function: Multi-Ethnic Study of Atherosclerosis.

Built environments have the potential to favorably support cognitive function. Despite growing work on this topic, most of the work has ignored variation in the spatial scale of the effect. The issue with spatial scale effects is that the size and shape of the areal unit within which built environment characteristics are measured naturally influence the built environment exposure metric and thus the estimated associations with health. We used spatial distributed lag modeling (DLM) to estimate how associations between built environment exposures (walkable destinations [WD], social destinations [SD]) and change in cognition varied across distance of these destinations from participants' residences. Cognition was assessed as maintained/improved processing speed (PS) and global cognition (GC). Person-level data from Exam 5 (2010-2012) and Exam 6 (2016-2018) of the Multi-Ethnic Study of Atherosclerosis was used (N = 1380, mean age 67). Built environment data were derived from the National Establishment Time Series. Higher availability of walkable and social destinations at closer distance from participants' residence was associated with maintained/improved PS. The adjusted associations between maintained/improved PS and destinations waned with increasing distance from the residence; associations were evident until approximately 1.9-km for WD and 1.5-km for SD. Associations were most apparent for participants living in areas with high population density. We found little evidence for associations between change in GC and built environment at any distance. These results highlight the importance of identifying appropriate spatial scale to understand the mechanisms for built environment-cognition associations.

Features of the Physical and Social Neighborhood Environment and Neighborhood-Level Alzheimer's Disease and Related Dementia in South Carolina.

BACKGROUND: Studies are increasingly examining the relationship between the neighborhood environment and cognitive decline; yet, few have investigated associations between multiple neighborhood features and Alzheimer's disease and related dementias (ADRD). OBJECTIVE: We investigated the relationship between neighborhood features and ADRD cumulative incidence from 2010 to 2014 in the South Carolina Alzheimer's Disease Registry (SCADR). METHODS: Diagnosed ADRD cases ≥50 years of age were ascertained from the SCADR by ZIP code and census tract. Neighborhood features from multiple secondary sources included poverty, air pollution [particulate matter with a diameter of 2.5 micrometers or less (PM2.5)], and rurality at the census-tract level and access to healthy food, recreation facilities, and diabetes screening at the county level. In addition to using Poisson generalized linear regression to estimate ADRD incident rate ratios (IRR) with 95% confidence intervals (CIs), we applied integrated nested Laplace approximations and stochastic partial differential equations (INLA-SPDE) to address disparate spatial scales. We estimated associations between neighborhood features and ADRD cumulative incidence. RESULTS: The average annual ADRD cumulative incidence was 690 per 100,000 people per census tract (95% CI: 660, 710). The analysis was limited to 98% of census tracts with a population ≥50 years old (i.e., 1,081 of 1,103). The average percent of families living below the federal poverty line per census tract was 18.8%, and ∼20% of census tracts were considered rural. The average percent of households with limited access to healthy food was 6.4%. In adjusted models, every 5µg/m3) increase of PM2.5 was associated with 65% higher ADRD cumulative incidence (IRR=1.65; 95% CI: 1.30, 2.09), where PM2.5 at or below 12 µg/m3 is considered healthy. Compared to large urban census tracts, rural and small urban tracts had 10% (IRR=1.10; 95% CI: 1.00, 1.23) and 5% (IRR=1.05; 95% CI: 0.96, 1.16) higher ADRD, respectively. For every percent increase of the county population with limited access to healthy food, ADRD was 2% higher (IRR=1.02; 95% CI: 1.01, 1.04). CONCLUSIONS: Neighborhood environment features, such as higher air pollution levels, were associated with higher neighborhood ADRD incidence. The INLA-SPDE method could have broad applicability to data collected across disparate spatial scales. https://doi.org/10.1289/EHP13183.

A tale of many neighborhoods: Latent profile analysis to derive a national neighborhood typology for the US.

INTRODUCTION: Neighborhoods are complex and multi-faceted. Analytic strategies used to model neighborhoods should reflect this complexity, with the potential to better understand how neighborhood characteristics together impact health. We used latent profile analysis (LPA) to derive a residential neighborhood typology applicable for census tracts across the US. METHODS: From tract-level 2015-2019 American Community Survey (ACS) five-year estimates, we selected five indicators that represent four neighborhood domains: demographic composition, commuting, socioeconomic composition, and built environment. We compared model fit statistics for up to eight profiles to identify the optimal number of latent profiles of the selected neighborhood indicators for the entire US. We then examined differences in national tract-level 2019 prevalence estimates of physical and mental health derived from CDC's PLACES dataset between derived profiles using one-way analysis of variance (ANOVA). RESULTS: The 6-profile LPA model was the optimal categorization of neighborhood profiles based on model fit statistics and interpretability. Neighborhood types were distinguished most by demographic composition, followed by commuting and built environment domains. Neighborhood profiles were associated with meaningful differences in the prevalence of health outcomes. Specifically, tracts characterized as "Less educated non-immigrant racial and ethnic minority active transiters" (n = 3,132, 4%) had the highest poor health prevalence (Mean poor physical health: 18.6 %, SD: 4.30; Mean poor mental health: 19.6 %, SD: 3.85), whereas tracts characterized as "More educated metro/micropolitans" (n = 15, 250, 21%) had the lowest prevalence of poor mental and physical health (Mean poor physical health: 10.6 %, SD: 2.41; Mean poor mental health: 12.4 %, SD: 2.67; p < 0.001). CONCLUSION: LPA can be used to derive meaningful and standardized profiles of tracts sensitive to the spatial patterning of social and built conditions, with observed differences in mental and physical health by neighborhood type in the US.

A Segmented Regression Analysis of Household Income and Recurrent Falls Among Adults in a National Cohort Study.

Falls can have life-altering consequences for older adults, including extended recovery periods and compromised independence. Higher household income may mitigate the risk of falls by providing financial resources for mobility tools, remediation of environmental hazards, and needed supports, or it may buffer the impact of an initial fall on subsequent risk through improved assistance and care. Household income has not had a consistently observed association with falls in older adults; however, a segmented association may exist such that associations are attenuated above a certain income threshold. In this study, we utilized segmented negative binomial regression analysis to examine the association between household income and recurrent falls among 2,302 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study recruited between 2003 and 2007. Income-fall association segments separated by changes in slope were considered. Model results indicated a 2-segment association between household income and recurrent falls in the past year. In the range below the breakpoint, household income was negatively associated with the rate of recurrent falls across all age groups examined; in a higher income range (from $20,000-$49,999 to ≥$150,000), the association was attenuated (weaker negative trend) or reversed (positive trend). These findings point to potential benefits of ensuring that incomes for lower-income adults exceed the threshold needed to confer a reduced risk of recurrent falls.

Places for Healthy Play: A Multi-Pronged Evaluation of Context, Design, and Perceptions for Play Space Improvements.

Community design interventions have prioritized the creation of quality play space, especially in easy to access public places, to improve health outcomes and to reduce health inequities. Evaluations of health-relevant play interventions often fail to assess essential context, design, and perceptions. The Play Everywhere Philadelphia Challenge, led by KABOOM!, funded 16 play spaces to support child health and development and literacy skills for low-income neighborhoods across Philadelphia. In June-October 2022, our interdisciplinary team conducted a process evaluation of completed play space installations (k=9) to identify site aspects that facilitated greater use. We mapped neighborhood context (e.g., child amenities, sociodemographics, pedestrian and bike accessibility), and conducted direct and systematic observations of play space design (e.g., signage, shade), visitation (i.e., number of visitors/hour), and engagement. We summarized visitation and engagement across contextual and design data. While many visitors passed through sites, over half of the children we observed engaged with the installation. Installations with poor condition (i.e., cleanliness and maintenance) had the lowest visitation and engagement. More active/kinetic installations drew more children and engagement. This process evaluation comprehensively analyzed play space design elements and neighborhood context and provides evidence to inform recommendations to increase use of urban play spaces.

Neighborhood greenspace and neighborhood income associated with white matter grade worsening: Cardiovascular Health Study.

INTRODUCTION: We examined whether a combined measure of neighborhood greenspace and neighborhood median income was associated with white matter hyperintensity (WMH) and ventricle size changes. METHODS: The sample included 1260 cognitively normal ≥ 65-year-olds with two magnetic resonance images (MRI; ≈ 5 years apart). WMH and ventricular size were graded from 0 (least) to 9 (most) abnormal (worsening = increase of ≥1 grade from initial to follow-up MRI scans). The four-category neighborhood greenspace-income measure was based on median neighborhood greenspace and income values at initial MRI. Multivariable logistic regression tested associations between neighborhood greenspace-income and MRI measures (worsening vs. not). RESULTS: White matter grade worsening was more likely for those in lower greenspace-lower income neighborhoods than higher greenspace-higher income neighborhoods (odds ratio = 1.73; 95% confidence interval = 1.19-2.51). DISCUSSION: The combination of lower neighborhood income and lower greenspace may be a risk factor for worsening white matter grade on MRI. However, findings need to be replicated in more diverse cohorts. HIGHLIGHTS: Population-based cohort of older adults (≥ 65 years) with greenspace and MRI dataCombined measure of neighborhood greenspace and neighborhood income at initial MRIMRI outcomes included white matter hyperintensities (WMH) and ventricular sizeLongitudinal change in MRI outcomes measured approximately 5 years apartWorsening WMH over time more likely for lower greenspace-lower income neighborhoods.

Neighborhood gentrification, wealth, and co-ethnic density associations with acculturation stressors among Chinese immigrants.

Objective: This study examined the cross-sectional relationships between neighborhood social composition and gentrification, and acculturation stressors. Methods: Person-level data came from first-generation Chinese immigrants enrolled in the Immigrant Enclaves Study (Philadelphia, Pennsylvania, baseline 2018-2020, N = 512). A validated scale was used to assess 22 stressors associated with migration or acculturation. Neighborhood characteristics from the American Community Survey 2015-2019 and 2008-2012 included: tract proportion of foreign born Chinese, neighborhood wealth, and past decade gentrification. Most neighborhood exposures were modeled as continuous as well as binary variables (intended to represent highest level of neighborhood exposure). Multivariable negative binomial regression adjusted for age, gender, income, education, employment, language, years in the U.S., and neighborhood variables (proportion co-ethnic, and neighborhood per capita income). Results: The majority of participants spoke Mandarin (68% vs Cantonese 32%), mean participant age was 52.7 years old, years in the US was 18, and nearly one-half of the sample had less than 8 years of education. Mean number of stressors was 5.9 with nearly 20% of participants reporting 11 or more stressors. Multivariable results found the number of acculturation stressors was 18% lower for residents in the highest co-ethnic density neighborhoods and 13% lower for residents in the highest wealth areas, compared to other areas (expß 0.82, 95% CI [CI] 0.69, 0.98; expß 0.87, CI 0.75, 1.01, respectively). Stressors were no different whether participants lived in gentrified areas or not. Conclusions: Among middle-aged Chinese immigrants, acculturation stress was lower for residents in neighborhoods with higher proportion of Chinese immigrants and for residents in neighborhoods with higher wealth, whereas gentrification had no influence on acculturation stress. More work on this topic is needed with vulnerable populations such as this one, informed by local context.

Cumulative Experience of Neighborhood Walkability and Change in Weight and Waist Circumference in REGARDS.

Neighborhood walkability-features of the built environment that promote pedestrian activity-has been associated with greater physical activity and lower body mass index (BMI; calculated as weight (kg)/height (m)2) among neighborhood residents. However, much of the literature has been cross-sectional and only a few cohort studies have assessed neighborhood features throughout follow-up. Using data from the Reasons for Geographic and Racial Differences in Stroke Study (2003-2016) and a neighborhood walkability index (NWI) measured annually during follow-up, we assessed whether the cumulative experience of neighborhood walkability (NWI-years) predicted BMI and waist circumference after approximately 10 years of follow-up, controlling for these anthropometric measures at enrollment. Analyses were adjusted for individual-level sociodemographic covariates and the cumulative experience of neighborhood poverty rate and neighborhood greenspace coverage. Almost a third (29%) of participants changed address at least once during follow-up. The first change of residence, on average, brought the participants to neighborhoods with higher home values and lower NWI scores than their originating neighborhoods. Compared with those having experienced the lowest quartile of cumulative NWI-years, those who experienced the highest quartile had 0.83 lower BMI (95% confidence interval, -1.5, -0.16) and 1.07-cm smaller waist circumference (95% confidence interval, -1.96, -0.19) at follow-up. These analyses provide additional longitudinal evidence that residential neighborhood features that support pedestrian activity are associated with lower adiposity.

Residence in Hispanic/Latino Immigrant Neighborhoods, Away-From-Home Food Consumption, and Diet Quality: The Hispanic Community Health Study/Study of Latinos.

BACKGROUND: Hispanics/Latinos are disproportionately burdened by nutrition-related diseases but immigrants appear healthier than their US-born counterparts. Neighborhoods characterized by high Hispanic/Latino immigrant segregation may provide environments to support healthier diets. OBJECTIVE: To examine whether or not Hispanic/Latino immigrant segregation is associated with frequency of away-from-home food consumption and diet quality in a large, diverse sample of Hispanic/Latino adults. DESIGN: Cross-sectional baseline data from the Hispanic Community Health Study/Study of Latinos were analyzed (2008-2011). Residential addresses were geocoded and linked to census tract-level 2008-2012 American Community Survey data. Hispanic/Latino immigrant segregation was characterized using the local Getis-Ord Gi∗ statistic, a spatial clustering measure that quantifies the extent to which demographically similar neighborhoods group together. PARTICIPANTS/SETTING: Participants were 15,661 adults in the Hispanic Community Health Study/Study of Latinos, a population-based study of Hispanic/Latinos aged 18 to 74 years from 4 US regions (Bronx, NY; Chicago, IL; Miami, FL; and San Diego, CA). MAIN OUTCOME MEASURES: Away-from-home food consumption was assessed using a modified dietary behavior questionnaire. Diet quality was assessed using the Alternate Healthy Eating Index 2010 (range = 0 to 110) from two 24-hour recalls. STATISTICAL ANALYSIS: Multilevel linear and logistic regression with multilevel weights were used to estimate associations between Hispanic/Latino immigrant segregation (low, medium, or high) with Alternate Healthy Eating Index 2010 score, and away-from-home food consumption (≥3 vs <3 times/week) in separate models, respectively. The mediating role of neighborhood poverty and whether or not associations differed by nativity were also assessed. RESULTS: Higher levels of segregation were associated with higher adjusted mean Alternate Healthy Eating Index 2010 scores; estimates were further magnified after accounting for neighborhood poverty (low segregation: reference category; medium segregation: ß = 2.43, 95% CI 1.10 to 3.77; and high segregation: ß = 1.63, 95% CI .43 to 2.82). Associations were strongest among the foreign-born compared with the US-born. There was no association between segregation and away-from-home food consumption. CONCLUSIONS: These results highlight the potential role of Hispanic/Latino immigrant neighborhoods in supporting healthy diets among residents, especially immigrants.

Gentrification, perceptions of neighborhood change, and mental health in Montréal, Québec.

While census-defined measures of gentrification are often used in research on gentrification and health, surveys can be used to better understand how residents perceive neighborhood change, and the implications for mental health. Whether or not gentrification affects mental health may depend on the extent to which an individual perceives changes in their neighborhood. Using health and map-based survey data, collected from 2020 to 2021, from the Interventions, Research, and Action in Cities Team, we examined links between perceptions of neighborhood change, census-defined neighborhood gentrification at participant residential addresses, and mental health among 505 adults living in Montréal. After adjusting for age, gender, race, education, and duration at current residence, greater perceived affordability and more positive feelings about neighborhood changes were associated with better mental health, as measured by the mental health component of the short-form health survey. Residents who perceived more change to the social environment had lower mental health scores, after adjusting individual covariates. Census-defined gentrification was not significantly associated with mental health, and perceptions of neighborhood change did not significantly modify the effect of gentrification on mental health. Utilizing survey tools can help researchers understand the role that perceptions of neighborhood change play in the understanding how neighborhood change impacts mental health.

Time-Varying Food Retail and Incident Disease in the Cardiovascular Health Study.

INTRODUCTION: Natural experiments can strengthen evidence linking neighborhood food retail presence to dietary intake patterns and cardiometabolic health outcomes, yet sample size and follow-up duration are typically not extensive. To complement natural experiment evidence, longitudinal data were used to estimate the impacts of neighborhood food retail presence on incident disease. METHODS: The Cardiovascular Health Study recruited adults aged 65+ years in 1989-1993. Analyses conducted in 2021-2022 included those in good baseline health, with addresses updated annually through the year of death (restricted to 91% who died during >2 decades of cohort follow-up). Baseline and annually updated presence of 2 combined food retail categories (supermarkets/produce markets and convenience/snack focused) was characterized using establishment-level data for 1-km and 5-km Euclidean buffers. Cox proportional hazards models estimated associations with time to each incident outcome (cardiovascular disease, diabetes), adjusting for individual and area-based confounders. RESULTS: Among 2,939 participants, 36% with baseline supermarket/produce market presence within 1 km had excess incident cardiovascular disease (hazard ratio=1.12; 95% CI=1.01, 1.24); the association was attenuated and no longer statistically significant after adjustment for sociodemographic characteristics. Adjusted associations were robustly null for time-varying supermarket/produce market or convenience/fast food retail presence across analyses with outcomes of cardiovascular disease or diabetes incidence. CONCLUSIONS: Food environment changes continue to be studied to provide an evidence base for policy decisions, and null findings in this longitudinal analysis add literature that casts doubt on the sufficiency of strategies targeting food retail presence alone of an elderly cohort for curtailing incident events of clinical importance.

National trends and disparities in retail food environments in the USA between 1990 and 2014.

OBJECTIVE: To describe national disparities in retail food environments by neighbourhood composition (race/ethnicity and socio-economic status) across time and space. DESIGN: We examined built food environments (retail outlets) between 1990 and 2014 for census tracts in the contiguous USA (n 71 547). We measured retail food environment as counts of all food stores, all unhealthy food sources (including fast food, convenience stores, bakeries and ice cream) and healthy food stores (including supermarkets, fruit and vegetable markets) from National Establishment Time Series business data. Changes in food environment were mapped to display spatial patterns. Multi-level Poisson models, clustered by tract, estimated time trends in counts of food stores with a land area offset and independent variables population density, racial composition (categorised as predominantly one race/ethnicity (>60 %) or mixed), and inflation-adjusted income tertile. SETTING: The contiguous USA between 1990 and 2014. PARTICIPANTS: All census tracts (n 71 547). RESULTS: All food stores and unhealthy food sources increased, while the subcategory healthy food remained relatively stable. In models adjusting for population density, predominantly non-Hispanic Black, Hispanic, Asian and mixed tracts had significantly more destinations of all food categories than predominantly non-Hispanic White tracts. This disparity increased over time, predominantly driven by larger increases in unhealthy food sources for tracts which were not predominantly non-Hispanic White. Income and food store access were inversely related, although disparities narrowed over time. CONCLUSIONS: Our findings illustrate a national food landscape with both persistent and shifting spatial patterns in the availability of establishments across neighbourhoods with different racial/ethnic and socio-economic compositions.

Neighborhood greenspace and cognition: The cardiovascular health study.

OBJECTIVES: We examined whether greenspace measures (overall percent greenspace and forest, and number of greenspace types) were associated with clinically adjudicated dementia status. METHODS: In a sample of non-demented older adults (n = 2141, average age = 75.3 years) from the Cardiovascular Health and Cognition Study, Cox proportional hazard and logistic regression analyses were used to estimate associations of baseline greenspace with risks of incident dementia and MCI, respectively, while adjusting for demographics, co-morbidities, and other neighborhood factors. We derived quartiles of percent greenness (greenspace), forest (percent tree canopy cover), and tertiles of greenspace diversity (number of greenspace types) for 5-km radial buffers around participant's residences at study entry (1989-1990) from the 1992 National Land Cover Dataset. Dementia status and mild cognitive impairment (MCI) over 10 years was clinically adjudicated. RESULTS: We observed no significant association between overall percent greenspace and risk of mild cognitive impairment or dementia and mostly null results for forest and greenspace diversity. Forest greenspace was associated with lower odds of MCI (OR quartile 4 versus 1: 0.54, 95% CI: 0.29-0.98) and greenspace diversity was associated with lower hazard of incident dementia (HR tertile 2 versus 1: 0.70, 95% CI = 0.50-0.99). DISCUSSION: We found divergent results for different types of greenspace and mild cognitive impairment or dementia. Improved greenspace type and diversity measurement could better characterize the association between greenspace and cognition.

Healthy Community Design, Anti-displacement, and Equity Strategies in the USA: A Scoping Review.

Recent investments in built environment infrastructure to create healthy communities have highlighted the need for equity and environmental justice. Although the benefits of healthy community design (e.g., connecting transportation systems and land use changes) are well established, some reports suggest that these changes may increase property values. These increases can raise the risk of displacement for people with low incomes and/or who are from racial and ethnic minority groups, who would then miss out on benefits from changes in community design. This review scanned the literature for displacement mitigation and prevention measures, with the goal of providing a compilation of available strategies for a wide range of audiences including public health practitioners. A CDC librarian searched the Medline, EbscoHost, Scopus, and ProQuest Central databases, and we identified grey literature using Google and Google Scholar searches. The indexed literature search identified 6 articles, and the grey literature scan added 18 articles. From these 24 total articles, we identified 141 mitigation and prevention strategies for displacement and thematically characterized each by domain using an adapted existing typology. This work provides a well-categorized inventory for practitioners and sets the stage for future evaluation research on the implementation of strategies and practices to reduce displacement.

Uneven Growth in Social Capital Organizations After Disasters by Pre-Disaster Conditions in the United States 2000-2014.

INTRODUCTION: Community-level social capital organizations are critical pre-existing resources that can be leveraged in a disaster. AIM: The study aimed to test the hypothesis that communities with larger pre-disaster stocks of social capital organizations would maintain pre-disaster levels or experience growth. METHODOLOGY: An annual panel dataset of counties in the contiguous United States from 2000 to 2014 totaling 46620 county-years, including longitudinal data on disasters and social capital institutions was used to evaluate the effect of disaster on growth of social capital. RESULTS: When a county experienced more months of disasters, social capital organizations increased a year later. These findings varied based on the baseline level of social capital organizations. For counties experiencing minor disaster impacts, growth in social capital organizations tends to occur in counties with more social capital organizations in 2000; this effect is a countervailing finding to that of major disasters, and effect sizes are larger. CONCLUSION: Given the growing frequency of smaller-scale disasters and the considerable number of communities that experienced these disasters, the findings suggest that small scale events create the most common and potentially broadest impact opportunity for intervention to lessen disparities in organizational growth.

The Association between Changes in Built Environment and Changes in Walking among Older Women in Portland, Oregon.

Some cross-sectional evidence suggests that the objectively measured built environment can encourage walking among older adults. We examined the associations between objectively measured built environment with change in self-reported walking among older women by using data from the Study of Osteoporotic Fractures (SOF). We evaluated the longitudinal associations between built environment characteristics and walking among 1253 older women (median age = 71 years) in Portland, Oregon using generalized estimating equation models. Built environment characteristics included baseline values and longitudinal changes in distance to the closest bus stop, light rail station, commercial area, and park. A difference of 1 km in the baseline distance to the closest bus stop was associated with a 12% decrease in the total number of blocks walked per week during follow-up (eß = 0.88, 95% CI: 0.78, 0.99). Our study provided limited support for an association between neighborhood transportation and changes in walking among older women. Future studies should consider examining both objective measures and perceptions of the built environment.

Association between Gentrification and Health and Healthcare Utilization.

There is tremendous interest in understanding how neighborhoods impact health by linking extant social and environmental drivers of health (SDOH) data with electronic health record (EHR) data. Studies quantifying such associations often use static neighborhood measures. Little research examines the impact of gentrification-a measure of neighborhood change-on the health of long-term neighborhood residents using EHR data, which may have a more generalizable population than traditional approaches. We quantified associations between gentrification and health and healthcare utilization by linking longitudinal socioeconomic data from the American Community Survey with EHR data across two health systems accessed by long-term residents of Durham County, NC, from 2007 to 2017. Census block group-level neighborhoods were eligible to be gentrified if they had low socioeconomic status relative to the county average. Gentrification was defined using socioeconomic data from 2006 to 2010 and 2011-2015, with the Steinmetz-Wood definition. Multivariable logistic and Poisson regression models estimated associations between gentrification and development of health indicators (cardiovascular disease, hypertension, diabetes, obesity, asthma, depression) or healthcare encounters (emergency department [ED], inpatient, or outpatient). Sensitivity analyses examined two alternative gentrification measures. Of the 99 block groups within the city of Durham, 28 were eligible (N = 10,807; median age = 42; 83% Black; 55% female) and 5 gentrified. Individuals in gentrifying neighborhoods had lower odds of obesity (odds ratio [OR] = 0.89; 95% confidence interval [CI]: 0.81-0.99), higher odds of an ED encounter (OR = 1.10; 95% CI: 1.01-1.20), and lower risk for outpatient encounters (incidence rate ratio = 0.93; 95% CI: 0.87-1.00) compared with non-gentrifying neighborhoods. The association between gentrification and health and healthcare utilization was sensitive to gentrification definition.

Longitudinal neighbourhood determinants with cognitive health and dementia disparities: protocol of the Multi-Ethnic Study of Atherosclerosis Neighborhoods and Aging prospective cohort study.

INTRODUCTION: The burden of Alzheimer's disease (AD) and AD-related dementias (ADRD) is increasing nationally and globally, with disproportionate impacts on lower-income, lower education and systematically marginalised older adults. Presence of inequalities in neighbourhood factors (eg, social context, physical and built environments) may affect risk of cognitive decline and be key for intervening on AD/ADRD disparities at the population level. However, existing studies are limited by a dearth of longitudinal, detailed neighbourhood measures linked to rich, prospective cohort data. Our main objective is to identify patterns of neighbourhood change related to prevalence of-and disparities in-cognitive decline and dementia. METHODS AND ANALYSES: We describe the process of collecting, processing and linking extensive neighbourhood data to the Multi-Ethnic Study of Atherosclerosis (MESA), creating a 25+ years dataset. Within the MESA parent study, the MESA Neighborhoods and Aging cohort study will characterise dynamic, longitudinal neighbourhood social and built environment variables relevant to cognition for residential addresses of MESA participants. This includes administering new surveys, expanding residential address histories, calculating new measures derived from spatial data and implementing novel deep learning algorithms on street-level imagery. Applying novel statistical techniques, we will examine associations of neighbourhood environmental characteristics with cognition and clinically relevant AD/ADRD outcomes. We will investigate determinants of disparities in outcomes by socioeconomic position and race/ethnicity and assess the contribution of neighbourhood environments to these disparities. This project will provide new evidence about pathways between neighbourhood environments and cognitive outcomes, with implications for policies to support healthy ageing. ETHICS AND DISSEMINATION: This project was approved by the University of Washington and Drexel University Institutional Review Boards (protocols #00009029 and #00014523, and #180900605). Data will be distributed through the MESA Coordinating Center. Findings will be disseminated in peer-reviewed scientific journals, briefs, presentations and on the participant website.