Widespread prostate-specific antigen (PSA) screening detects many cancers that would have otherwise gone undiagnosed. To estimate the prevalence of unsuspected prostate cancer, we reviewed 19 studies of prostate cancer discovered at autopsy among 6024 men. Among men aged 70-79, tumor was found in 36% of Caucasians and 51% of African-Americans. This enormous prevalence, coupled with the high sensitivity of PSA screening, has led to the marked increase in the apparent incidence of prostate cancer. The impact of PSA screening on clinical practice is well-recognized, but its effect on epidemiologic research is less appreciated. Before screening, a larger proportion of incident prostate cancers had lethal potential and were diagnosed at advanced stage. However, in the PSA era, overall incident prostate cancer mainly is indolent disease, and often reflects the propensity to be screened and biopsied. Studies must therefore focus on cancers with lethal potential, and include long follow-up to accommodate the lead time induced by screening. Moreover, risk factor patterns differ markedly for potentially lethal and indolent disease, suggesting separate etiologies and distinct disease entities. Studies of total incident or indolent prostate cancer are of limited clinical utility, and the main focus of research should be on prostate cancers of lethal potential.
Despite a proliferation of research on neighborhood effects on health, how neighborhood economic development, in the form of gentrification, affects health and well-being in the U.S. is poorly understood, and no systematic assessment of the potential health impacts has been conducted. Further, we know little about whether health impacts differ for residents of neighborhoods undergoing gentrification versus urban development, or other forms of neighborhood socioeconomic ascent. We followed current guidelines for systematic reviews and present data on the study characteristics of the twenty-two empirical articles that met our inclusion criteria and were published on associations between gentrification, and similar but differently termed processes (e.g., urban regeneration, urban development, neighborhood upgrading), and health published between 2000 and 2018. Our results show that impacts on health vary by outcome assessed, exposure measurement, the larger context specific determinants of neighborhood change, and analysis decisions including which reference and treatment groups to examine. Studies of the health impacts of gentrification, urban development, and urban regeneration describe similar processes, and synthesis and comparison of their results helps bridge differing theoretical approaches to this emerging research. Our article helps to inform the debate on the impacts of gentrification and urban development for health and suggests that these neighborhood change processes likely have both detrimental and beneficial effects on health. Given the influence of place on health and the trend of increasing gentrification and urban development in many American cities, we discuss how future research can approach understanding and researching the impacts of these processes for population health.
Background & methods Recent social movements have highlighted fatal police violence as an enduring public health problem in the United States. To solve it, the public requires basic information, such as understanding where rates of fatal police violence are particularly high, and for which groups. Existing mapping efforts, though critically important, often use inappropriate statistical methods and can produce misleading, unstable rates when denominators are small. To fill this gap, we use inverse-variance-weighted multilevel models to estimate overall and race-stratified rates of fatal police violence for all Metropolitan Statistical Areas (MSAs) in the U.S. (2013-2017), as well as racial inequities in these rates. We analyzed the most recent, reliable data from Fatal Encounters, a citizen science initiative that aggregates and verifies media reports. Results Rates of police-related fatalities varied dramatically, with the deadliest MSAs exhibiting rates nine times those of the least deadly. Overall rates in Southwestern MSAs were highest, with lower rates in the northern Midwest and Northeast. Yet this pattern was reversed for Black-White inequities, with Northeast and Midwest MSAs exhibiting the highest inequities nationwide. Our main results excluded deaths that could be considered accidents (e.g., vehicular collisions), but sensitivity analyses demonstrated that doing so may underestimate the rate of fatal police violence in some MSAs by 60%. Black-White and Latinx-White inequities were slightly underestimated nationally by excluding reportedly 'accidental' deaths, but MSA-specific inequities were sometimes severely under-or overestimated. Conclusions Preventing fatal police violence in different areas of the country will likely require unique solutions. Estimates of the severity of these problems (overall rates, racial inequities, specific causes of death) in any given MSA are quite sensitive to which types of deaths are analyzed, and whether race and cause of death are attributed correctly. Monitoring and
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