Search

Objective. To develop a conceptual framework for investigating the role of racial/ ethnic residential segregation on health care disparities. Data Sources and Settings. Review of the MEDLINE and the Web of Science databases for articles published from 1998 to 2011. Study Design. The extant research was evaluated to describe mechanisms that shape health care access, utilization, and quality of preventive, diagnostic, therapeutic, and end-of-life services across the life course. Principal Findings. The framework describes the influence of racial/ethnic segregation operating through neighborhood-, health care system-, provider-, and individual-level factors. Conceptual and methodological issues arising from limitations of the research and complex relationships between various levels were identified. Conclusions. Increasing evidence indicates that racial/ethnic residential segregation is a key factor driving place-based health care inequalities. Closer attention to address research gaps has implications for advancing and strengthening the literature to better inform effective interventions and policy-based solutions. Key Words. Racial/ethnic residential segregation, health care disparities, health care access, social determinants of health, Despite a substantial literature documenting persistent disparities in health and health care utilization by race/ethnicity (Smedley, Stith, and Nelson 2002; AHRQ 2010), our understanding of the cause of these disparities [...]

Background: Herpes simplex virus type 2 (HSV-2) infection is associated with substantial morbidity and increased risk for human immunodeficiency virus acquisition. We describe HSV-2 seroprevalence in adult New Yorkers, and examine the relationship between select characteristics, infection, and diagnosis. Methods: HSV-2 seroprevalence and risk factors were measured using the 2004 New York City Health and Nutrition Examination Survey, a population-based cross-sectional survey of adults. HSV-2 seroprevalence and corresponding 95% confidence intervals were computed for select characteristics. Associations between proposed risk factors and HSV-2 infection and diagnosis were estimated using unadjusted and adjusted odds ratios. Results: Nearly 28% of adults were infected with HSV-2; 88.4% of HSV-2 positive persons were undiagnosed. Black women had the highest seroprevalence (59.7%) of any sex or race/ethnicity group. Women, non-Hispanic blacks, and Hispanics (vs. non-Hispanic whites), and men who have sex with men were at greater odds of HSV-2 infection. Among HSV-2 infected individuals, non-Hispanic blacks (vs. non-Hispanic whites), uncircumcised men, and those with no routine place of care were less likely to be diagnosed. Conclusions: HSV-2 is highly prevalent and largely undiagnosed in New York City; seroprevalence varies by subgroup. Targeted HSV-2 screening, counseling and treatment may help reduce transmission of HSV-2 and human immunodeficiency virus.

Introduction: Long-term risk for recurrent cardiovascular events among myocardial infarction (MI) patients in the acute versus chronic stable phase is not well characterized. This study was conducted to evaluate risk factors associated with all-cause mortality and cardiovascular (CVD) morbidity and to determine the transition period from the acute to chronic stable phase of disease. Methods: Administrative claims data from a managed care database (2007–2012) were linked to the Social Security Death Index. Kaplan–Meier curves were generated over a 3-year period. The association between risk factors and clinical endpoints was assessed using Cox proportional hazard models. Poisson models estimated the ‘transition time’ from acute to chronic phase of disease. Results: On average, recurrent cardiovascular event rates were higher among acute MI patients in comparison to the chronic MI patients during the first 3 months of follow-up. Over the 3-year follow-up period, survival curves became parallel and for some outcomes (i.e., acute myocardial infarction and bleeding events), were not statistically significantly different between the two groups. In both the acute and chronic MI cohorts, diabetes, heart failure, and renal disease were consistently statistically significant and positively associated with greater risk of death and ischemic events. PAD was consistently associated with increased risk among the chronic cohort and composite endpoints among the acute patients. Conclusions: Greater understanding of differences in the CVD risk profiles and the transition from acute to chronic stable phase may help identify high-risk patients and inform clinical risk stratification and long-term disease management in MI patients. Funding: Merck & Co., Inc., Kenilworth, NJ, USA.

Socially assigned race, the racial/ethnic categorization of individuals by others, may serve as the basis for differential or unfair treatment. Latinxs are commonly socially assigned to a race/ethnicity with which they do not self-identify. However, it is unclear the degree to which self-identified Latinxs who are socially assigned as white or Latinx may differentially predict health outcomes beyond general health status and healthcare utilization.We examine the association between socially assigned race and type 2 diabetes mellitus (T2DM). Data from the Arizona’s Behavioral Risk Factor Surveillance System (2013, 2014) was used in a cross-sectional analysis (restricted to Latinxs and non-Hispanic whites; N= 8370) to examine the association between self-identified (SI) and socially assigned (SA) race/ethnicity agreement and T2DM. Latinxs were categorized according to SI-SA race/ethnicity agreement: discordant (SI-SA, different) and concordant (SI-SA, same). T2DM was based on self-reported physician diagnosis. Data were analyzed using Poisson regression models to estimate prevalence ratios (PR) and 95% confidence intervals (CI). Latinxs comprised 28.5% of our sample, of which, 18.5% was discordant and 81.5% was concordant. In fully adjusted models, concordant Latinxs were more likely to have T2DM than whites (aPR 2.01, 95% CI 1.44, 2.82). There were no significant differences in T2DM between discordant Latinxs and whites. Our results suggest that socially assigned race is an understudied determinant of health and may further understanding of the impact of racial stratification on Latinx health inequities. Additional research examining socially assigned race and other health outcomes are warranted to gain further insight of the biological impact of racialized lived experiences.

Purpose: To assess the relationship between light-intensity physical activity (LIPA) and cardiometabolic risk factors among middle-aged and older adults with multiple chronic conditions.Design: Cross-sectional design utilizing data from the Health and Retirement Study (2010, 2012).Setting: Laboratory- and survey-based testing of a nationally representative sample of community-dwelling middle aged and older adults.Participants: Adults aged 50 years and older (N = 14 996).Measures: Weighted metabolic equivalent of tasks was calculated using self-reported frequency of light, moderate, and vigorous physical activity. Cardiometabolic risk factors (systolic and diastolic blood pressure, glycosylated hemoglobin [HbA1c], high-density lipoprotein cholesterol [HDL-C], total cholesterol, and non-HDL-C) were objectively measured. A multiple chronic condition index was based on 8 self-reported chronic conditions.Analysis: Weighted multivariate linear regression models.Results: Light-intensity physical activity was independently associated with favorable HDL-C (β = 1.25; 95% confidence interval [CI]: 0.46-2.05) and total cholesterol (β = 2.72; 95% CI: 0.53-4.90) after adjusting for relevant confounders. The HDL-C health benefit was apparent when stratified by number of chronic conditions, for individuals with 2 to 3 conditions (β = 1.73; 95% CI: 0.58-2.89). No significant associations were observed between LIPA and blood pressure, HbA1c, or non-HDL-C.Conclusions: Engaging in LIPA may be an important health promotion activity to manage HDL-C and total cholesterol. Additional longitudinal research is needed to determine the causal association between LIPA and cardiometabolic risk which can potentially inform physical activity guidelines targeting older adults with multiple chronic conditions.

With mounting evidence of how neighborhood socioeconomic context influences individual behavior, investigation of neighborhood social context and sex/drug use risk behavior could help explain and provide insight into solutions to solve persistent racial disparities in HIV. Interviewer-administered surveys and HIV testing among street-recruited individuals who reported illicit drug use in New York City were conducted from 2000 to 2004. Individuals were geocoded to census tracts, and generalized estimating equations were used to determine correlates of being newly diagnosed with HIV at study enrollment. Analyses were completed in 2014. Of the 920 participants, 10.5 % were HIV-positive, and among those, 45 % were diagnosed at study enrollment. After restricting the sample to those who self-reported negative HIV status (n= 867), 72 % were male, 65 % Latino, and 5.1 % tested HIV-positive. After adjustment, those testing HIV-positive were more likely to report male same-sex partnership (p< 0.01) and less likely to be homeless compared with those confirmed HIV-negative (p< 0.01). Neighborhood-adjusted models indicated those from neighborhoods with less deprivation (p< 0.05), and a higher proportion of owner-occupied homes (p< 0.01) were more likely to test HIV-positive. Additionally, Black individuals who used drugs and were from neighborhoods with a higher proportion of Black residents were more likely to be newly diagnosed compared to Latino individuals who used drugs and were from neighborhoods with lower proportions of Black residents (p< 0.05). These data suggest that HIV prevention and treatment efforts should continue widening its reach to those unaware of their HIV infection, namely men who have sex with men, heavy, drug-involved Black communities, and both Black and Latino communities from relatively less disadvantaged neighborhoods.

The racial/ethnic and income composition of neighborhoods often influences local amenities, including the potential spatial distribution of trees, which are important for population health and community wellbeing, particularly in urban areas. This ecological study used spatial analytical methods to assess the relationship between neighborhood socio-demographic characteristics (i.e. minority racial/ethnic composition and poverty) and tree density at the census tract level in Boston, Massachusetts (US). We examined spatial autocorrelation with the Global Moran’s Ifor all study variables and in the ordinary least squares (OLS) regression residuals as well as computed Spearman correlations non-adjusted and adjusted for spatial autocorrelation between socio-demographic characteristics and tree density. Next, we fit traditional regressions (i.e. OLS regression models) and spatial regressions (i.e. spatial simultaneous autoregressive models), as appropriate. We found significant positive spatial autocorrelation for all neighborhood socio-demographic characteristics (Global Moran’s Irange from 0.24 to 0.86, all P=0.001), for tree density (Global Moran’s I=0.452, P=0.001), and in the OLS regression residuals (Global Moran’s Irange from 0.32 to 0.38, all P<0.001). Therefore, we fit the spatial simultaneous autoregressive models. There was a negative correlation between neighborhood percent non-Hispanic Black and tree density (rS=−0.19; conventional P-value=0.016; spatially adjusted P-value=0.299) as well as a negative correlation between predominantly non-Hispanic Black (over 60% Black) neighborhoods and tree density (rS=−0.18; conventional P-value=0.019; spatially adjusted P-value=0.180). While the conventional OLS regression model found a marginally significant inverse relationship between Black neighborhoods and tree density, we found no statistically significant relationship between neighborhood socio-demographic composition and tree density in the spatial regression models. Methodologically, our study suggests the need to take into account spatial autocorrelation as findings/conclusions can change when the spatial autocorrelation is ignored. Substantively, our findings suggest no need for policy intervention vis-à-vis trees in Boston, though we hasten to add that replication studies, and more nuanced data on tree quality, age and diversity are needed.

It is plausible that features of the social environment combined with experiences of discrimination may help further explain experiences of depression among illicit drug users. We examined the influence of census tract-level characteristics and multiple forms of individual-level discrimination on lifetime depression among illicit drug users in New York City enrolled in the “Social Ties Associated With Risk of Transition” study. Population average models accounted for clustering of individuals within census tracts. Discrimination based on prior incarceration explained Hispanic/White differences in depression and was independently associated with depression after accounting for neighborhood characteristics. Neighborhood poverty was only marginally related to lifetime depression. These data provide evidence supporting the influence of discrimination on depression among drug users. Research is needed to confirm these findings and highlight specific mechanisms through which discrimination and neighborhood socioeconomic status may operate to influence mental health.

ObjectiveTo document disparities in health status, activity limitations, and disability in work and housework between Latinos and nonLatino whites with arthritis. We examined whether sociodemographic factors age, income, and education account for the disparities between the ethnic groups, and whether comorbid conditions, disease duration, health care utilization, and functional abilities predict health status, activity limitations, and work and housework disability after controlling for sociodemographic variables.MethodsWe analyzed data from the Condition file of the 1994 National Health Interview Survey on Disability, Phase I.ResultsThe risk of worse health, activity limitations, and work and housework disability was >2 times greater among Latinos compared with nonLatino whites. In the regression models accounting for potential confounders, Latino ethnicity remained significantly associated with poorer health status, but not activity limitations or disability in work or housekeeping. Of the socioeconomic status variables, education had a significant protective effect on work disability and health status. Comorbid conditions and health care utilization increased the likelihood of worse health, activity limitations, and work disability. Limitations in physical function were associated with poorer health and disability in work and homemaking.ConclusionSocial status differences between Latinos and nonLatinos may account for disparities in activity limitations and disability in work and housework. Education may provide various health benefits, including access to a range of occupations that do not require physical demands. The findings help to address the great gap in knowledge concerning factors related to the health and disability status of Latinos with arthritis.

To document disparities in health status, activity limitations, and disability in work and housework between Latinos and non‐Latino whites with arthritis. We examined whether sociodemographic factors (age, income, and education) account for the disparities between the ethnic groups, and whether comorbid conditions, disease duration, health care utilization, and functional abilities predict health status, activity limitations, and work and housework disability after controlling for sociodemographic variables.We analyzed data from the Condition file of the 1994 National Health Interview Survey on Disability, Phase I.The risk of worse health, activity limitations, and work and housework disability was >2 times greater among Latinos compared with non‐Latino whites. In the regression models accounting for potential confounders, Latino ethnicity remained significantly associated with poorer health status, but not activity limitations or disability in work or housekeeping. Of the socioeconomic status variables, education had a significant protective effect on work disability and health status. Comorbid conditions and health care utilization increased the likelihood of worse health, activity limitations, and work disability. Limitations in physical function were associated with poorer health and disability in work and homemaking.Social status differences between Latinos and non‐Latinos may account for disparities in activity limitations and disability in work and housework. Education may provide various health benefits, including access to a range of occupations that do not require physical demands. The findings help to address the great gap in knowledge concerning factors related to the health and disability status of Latinos with arthritis.

The article discusses the failure of fair housing initiatives in the U.S. that focus on dispersion to consider the social structures and processes that result in the inequitable distribution of resources necessary for health. Topics include the promise offered by increasing interest in fair-housing initiatives to improve health and promote health equity, and place-based community development programs that aim to transform neighborhoods through capacity building and economic development.