Exploring the use of experimental small area estimates to examine the relationship between individual-level and area-level community belonging and self-rated health.

Background: Small area estimation refers to statistical modelling procedures that leverage information or "borrow strength" from other sources or variables. This is done to enhance the reliability of estimates of characteristics or outcomes for areas that do not contain sufficient sample sizes to provide disaggregated estimates of adequate precision and reliability. There is growing interest in secondary research applications for small area estimates (SAEs). However, it is crucial to assess the analytic value of these estimates when used as proxies for individual-level characteristics or as distinct measures that offer insights at the area level. This study assessed novel area-level community belonging measures derived using small area estimation and examined associations with individual-level measures of community belonging and self-rated health. Data and methods: SAEs of community belonging within census tracts produced from the 2016-2019 cycles of the Canadian Community Health Survey (CCHS) were merged with respondent data from the 2020 CCHS. Multinomial logistic regression models were run between area-level SAEs, individual-level sense of community belonging, and self-rated health on the study sample of people aged 18 years and older. Results: Area-level community belonging was associated with individual-level community belonging, even after adjusting for individual-level sociodemographic characteristics, despite limited agreement between individual- and area-level measures. Living in a neighbourhood with low community belonging was associated with higher odds of reporting being in fair or poor health, versus being in very good or excellent health (odds ratio: 1.53; 95% confidence interval: 1.22, 1.91), even after adjusting for other factors such as individual-level sense of community belonging, which was also associated with self-rated health. Interpretation: Area-level and individual-level sense of community belonging were independently associated with self-rated health. The novel SAEs of community belonging can be used as distinct measures of neighbourhood-level community belonging and should be understood as complementary to, rather than proxies for, individual-level measures of community belonging.

Assessing the role of criminality in neighbourhood safety feelings and self-reported health: results from a cross-sectional study in a Dutch municipality.

BACKGROUND: Neighbourhood safety has repeatedly been shown to be associated with the health and well-being of the residents. Criminality is often seen as one of the key factors affecting neighbourhood safety. However, the relationship between crime, fear of crime and feelings of safety remains underexplored. METHODS: Data on socio-demographic, health and safety perceptions was extracted from the Maastricht municipality survey (the Netherlands) (n = 9656 adults) and merged with data on official neighbourhood crime rates from the Police Registry. Pearson correlation coefficients and multilevel logistic regression models were computed to assess the association between aspects of objective and perceived criminality, individuals' feelings of safety and health. RESULTS: The correlation between the police recorded crime and residents' perceptions of the neighbourhood crime rates was weak (0.14-0.38), with the exception of violent crime (0.59), which indicates that other factors contribute to the perceptions of safety. In turn, the perception of higher rates of violent crime and more nuisance (on the scale 0-10) but not other types of crime or nuisance was positively associated with feeling unsafe (OR 1.27 [1.22;1.32] and 1.39 [1.33;1.46], respectively). Lower general feelings of safety at both the individual and neighbourhood level were consistently associated with worse self-rated health. Among different indicators of safety, the general feelings of safety had the most pronounced association with health, while subjective or objective measures of crime showed limited to no direct relationship with health. CONCLUSIONS: Public health policies targeting safety as a social determinant of health should consider prioritizing areas of violent crime and nuisance to improve general feelings of safety. Further research is needed to understand which factors aside from criminality are driving residents' feelings of safety.

COVID-19 case rates, spatial mobility, and neighbourhood socioeconomic characteristics in Toronto: a spatial-temporal analysis.

OBJECTIVES: This study has two primary research objectives: (1) to investigate the spatial clustering pattern of mobility reductions and COVID-19 cases in Toronto and their relationships with marginalized populations, and (2) to identify the most relevant socioeconomic characteristics that relate to human mobility and COVID-19 case rates in Toronto's neighbourhoods during five distinct time periods of the pandemic. METHODS: Using a spatial-quantitative approach, we combined hot spot analyses, Pearson correlation analyses, and Wilcoxon two-sample tests to analyze datasets including COVID-19 cases, a mobile device-derived indicator measuring neighbourhood-level time away from home (i.e., mobility), and socioeconomic data from 2016 census and Ontario Marginalization Index. Temporal variations among pandemic phases were examined as well. RESULTS: The paper identified important spatial clustering patterns of mobility reductions and COVID-19 cases in Toronto, as well as their relationships with marginalized populations. COVID-19 hot spots were in more materially deprived neighbourhood clusters that had more essential workers and people who spent more time away from home. While the spatial pattern of clusters of COVID-19 cases and mobility shifted slightly over time, the group socioeconomic characteristics that clusters shared remained similar in all but the first time period. A series of maps and visualizations were created to highlight the dynamic spatiotemporal patterns. CONCLUSION: Toronto's neighbourhoods have experienced the COVID-19 pandemic in significantly different ways, with hot spots of COVID-19 cases occurring in more materially and racially marginalized communities that are less likely to reduce their mobility. The study provides solid evidence in a Canadian context to enhance policy making and provide a deeper understanding of the social determinants of health in Toronto during the COVID-19 pandemic.

RéSUMé: OBJECTIFS: Cette étude a deux grands objectifs de recherche : 1) examiner les schémas d'agrégation spatiale des baisses de mobilité et des cas de COVID-19 à Toronto et leurs liens avec les populations marginalisées; et 2) cerner les caractéristiques socioéconomiques les plus pertinentes liées à la mobilité humaine et aux taux de cas de COVID-19 dans les quartiers de Toronto au cours de cinq périodes distinctes de la pandémie. MéTHODE: À l'aide d'une approche spatio-quantitative, nous avons combiné des analyses de points chauds, des analyses de corrélation de Pearson et des tests de Wilcoxon à deux échantillons pour analyser des ensembles de données incluant : les cas de COVID-19, un indicateur dérivé d'appareils mobiles pour mesurer le temps passé à l'extérieur du domicile au niveau du quartier (c.-à-d. la mobilité), ainsi que les données socioéconomiques du recensement de 2016 et de l'indice de marginalisation ontarien. Nous avons aussi examiné les variations temporelles entre les phases de la pandémie. RéSULTATS: Nous avons repéré d'importants schémas d'agrégation spatiale des baisses de mobilité et des cas de COVID-19 à Toronto, ainsi que leurs liens avec les populations marginalisées. Les points chauds de la COVID-19 se trouvaient dans des grappes de quartiers plus défavorisés sur le plan matériel, où il y avait davantage de travailleurs essentiels et de personnes passant du temps à l'extérieur de leur domicile. La structure spatiale des grappes de cas de COVID-19 et de la mobilité a légèrement changé au fil du temps, mais les caractéristiques des groupes socioéconomiques communes à toutes les grappes sont restées semblables durant toutes les périodes sauf la première. Nous avons créé une série de cartes et de visualisations pour faire ressortir les schémas spatio-temporels dynamiques. CONCLUSION: Les quartiers de Toronto ont vécu la pandémie de COVID-19 de façons très différentes : les points chauds des cas de COVID-19 sont survenus dans des communautés plus marginalisées sur le plan matériel et racial et moins susceptibles de réduire leur mobilité. L'étude fournit des preuves solides dans un contexte canadien pour améliorer l'élaboration des politiques et approfondir la compréhension des déterminants sociaux de la santé à Toronto pendant la pandémie de COVID-19.