This study uses data from Philadelphia, Chicago, and New York City and the Centers for Disease Control and Prevention Social Vulnerability Index to explore inequities in COVID-19 testing, positivity, confirmed cases, and mortality during the first 6 months of the COVID-19 pandemic.

Worse neighborhood economic and social conditions may contribute to increased risk of CVD among African American women. Policies directly addressing these issues may alleviate the burden of CVD in this group.

a b s t r a c tResidential segregation is the spatial manifestation of entrenched socioeconomic and racial inequities and is considered a fundamental cause of racial inequalities in health. Despite the well-documented racialized spatial inequalities that exist in urban areas throughout Brazil, few empirical investigations have examined the link between residential segregation and health and considered its implications for racial health inequalities in this setting. In the present study, we used data from the Brazilian Longitudinal Study of Adult Health (2008e2010) to examine the association between economic residential segregation and two major cardio-metabolic risk factorsdhypertension and diabetes. We also examined whether associations were stronger for historically marginalized racial groups in Brazil. Residential segregation was calculated for study-defined neighborhoods using the Getis-Ord Local G i * statistic and was based on household income data from the 2010 IBGE demographic census. Multivariable logistic regression models were used to examine associations. In our sample, Blacks and Browns were more likely to live in economically segregated neighborhoods. After taking into account income, education, and other demographic characteristics we found that individuals living in the most economically segregated neighborhoods were 26% more likely to have hypertension and 50% more likely to have diabetes than individuals living in more affluent areas. Although Blacks and Browns living in highly segregated neighborhoods had higher prevalence of hypertension and diabetes compared to Whites, we observed no statistically significant racial differences in the associations with residential segregation. Our findings suggest that residential segregation may be an important structural determinant of cardio-metabolic risk factors in Brazil. Moreover, the systematic and disproportionate exposure of Blacks and Browns to highly segregated neighborhoods may implicate these settings as potential drivers of racial inequalities in cardio-metabolic risk factors in urban settings in Brazil.

Objectives Neighborhoods characterized by disadvantage influence multiple risk factors for chronic disease and are considered potential drivers of racial and ethnic health inequities in the United States. The objective of the present study was to examine the relationship between neighborhood disadvantage and cumulative biological risk (CBR) and the extent to which the association differs by individual income and education among a large, socio-economically diverse sample of African American adults. Methods Data from the baseline examination of the Jackson Heart Study (2000-2004) were used for the analyses. The sample consisted of African American adults ages 21-85 with complete, geocoded data on CBR biomarkers and behavioral covariates (n=4,410). Neighborhood disadvantage was measured using a composite score of socioeconomic indicators from the 2000 US Census. Eight biomarkers representing cardiovascular, metabolic, inflammatory, and neuroendocrine systems were used to create a CBR score. We fit two-level linear regression models with random intercepts and included cross-level interaction terms between neighborhood disadvantage and individual SES. Results Living in a disadvantaged neighborhood was associated with greater CBR after covariate adjustment (B=0.18, SE: 0.07, p<0.05). Interactions showed a weaker association for individuals with ≤ high school education, but were not statistically significant. Conclusion Disadvantaged neighborhoods contribute to poor health among African American adults via cumulative biological risk. Policies directly addressing the socioeconomic conditions of these environments should be considered as viable options to reduce disease risk in this group and mitigate racial/ethnic health inequities.

Objectives Few studies have examined the joint impact of neighborhood disadvantage and low social cohesion on health. Moreover, no study has considered the joint impact of these factors on a cumulative disease risk profile among a large sample of African American adults. Using data from the Jackson Heart Study, we examined the extent to which social cohesion modifies the relationship between neighborhood disadvantage and cumulative biological risk (CBR)—a measure of accumulated risk across multiple physiological systems. Methods Our analysis included 4,408 African American women and men ages 21–85 residing in the Jackson, MS Metropolitan Area. We measured neighborhood disadvantage using a composite score of socioeconomic indicators from the 2000 US Census and social cohesion was assessed using a 5-item validated scale. Standardized z-scores of biomarkers representing cardiovascular, metabolic, inflammatory, and neuroendocrine systems were combined to create a CBR score. We used two-level linear regression models with random intercepts adjusting for socio-demographic and behavioral covariates in the analysis. A three-way interaction term was included to examine whether the relationship between neighborhood disadvantage and CBR differed by levels of social cohesion and gender. Results The interaction between neighborhood disadvantage, social cohesion and gender was statistically significant (p=0.05) such that the association between living in a disadvantaged neighborhood and CBR was strongest for men living in neighborhoods with low levels of social cohesion (B=0.63, SE: 0.32). In gender-specific models, we found a statistically significant interaction between neighborhood disadvantage and social cohesion for men (p=0.05) but not for women (p=0.50). Conclusion Neighborhoods characterized by high levels of economic disadvantage and low levels of social cohesion contribute to higher cumulative risk of disease among African American men. This suggests that they may face a unique set of challenges that put them at greater risk in these settings.

Background: Preliminary evidence has shown wide inequities in COVID-19 related deaths in the US. We explored the emergence of spatial inequities in COVID-19 testing, positivity, and incidence in New York City, Philadelphia, and Chicago. Methods: We used zip code-level data on cumulative tests and confirmed cases by date for each city and computed testing, positivity, and incidence indicators. We linked these to 2014-2018 American Community Survey data on income, education, race/ethnicity, occupation, health insurance, and overcrowding, and computed a summary index. We computed associations between using Poisson models. We also examined clusters of high and low incidence using the G* statistic. Results: Through May 18th, there were wide inequities in positivity and incidence, with less advantaged neighborhoods having a higher incidence (RR=1.36 [95% CrI 1.18;1.57], 1.17 [1.11;1.23], and 1.10 [0.98;1.23], per 1 SD increase in the summary index in Chicago, NYC and Philadelphia, respectively). In all three cities inequities in incidence increased as the pandemic advanced, while inequities in positivity remained stable. In contrast the social patterning of testing changed over time: testing was inversely associated with disadvantage early in the pandemic but was either not associated or positively associated with disadvantage later in the pandemic. We also found clusters of high and low incidence, co-located with areas of high and low disadvantage. Conclusions: We found wide spatial inequities in COVID-19 positivity and incidence in three large metropolitan areas of the US. In health crises health inequities become magnified and reflect a longstanding history of racial and economic injustice.

Background Few studies have focused on the impact of neighborhood social environment on changes in smoking and alcohol use over time among African Americans. Method Jackson Heart Study participants were recruited from the Jackson, MS metropolitan area from 2000–2004. Neighborhood social environment was characterized using census-based neighborhood socio-economic status (NSES) and survey-derived perceptions of neighborhood social cohesion, disorder, and violence. Multinomial logistic regression was used to estimate the associations of neighborhood social environment with prevalence of smoking and alcohol use and with changes in these behaviors over time adjusted for individual sociodemographic characteristics. Results Participants (N=3166) resided in 108 census tracts. All neighborhood social environment variables were consistently associated with prevalence of current smoking at baseline (11%) and with persistence of smoking over a median of 8-years follow-up (8%). The odds of being a consistent smoker relative to never smoking was about 30% higher per 1 SD higher neighborhood violence (aOR: 1.30, 95% CI: 1.16–1.46) and disorder aOR: 1.26, 95% CI: 1.08 – 1.47) and at least 16% lower per 1 SD higher in neighborhood social cohesion (aOR: 0.84, 95% CI: 0.74–0.95) and NSES (aOR: 0.79, 95% CI: 0.67–0.95). Heavy alcohol use at baseline (17%) and consistent heavy use over the study period (8%) were negatively associated with higher NSES (aOR: 0.85, 95% CI: 0.73–0.99 per 1 SD increase in NSES). Conclusion Favorable neighborhood social environments may reduce unhealthy behaviors among African Americans.

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