background Life expectancy in southeastern North Carolina communities located in an area with multiple concentrated animal feeding operations (CAFOs) after adjusting for socioeconomic factors remains low. We hypothesized that poor health outcomes in this region may be due to converging demographic, socioeconomic, behavioral, and access-to-care factors and are influenced by the presence of hog CAFOs. methods We studied mortality, hospital admissions, and emergency department (ED) usage for health conditions potentially associated with hog CAFOs-anemia, kidney disease, infectious diseases, and low birth weight (LBW)-in North Carolina communities located in zip codes with hog CAFOs (Study group 1), in zip codes with > 215hogs/km 2 (Study group 2), and without hog CAFOs (Control group). We compared cause-specific age-adjusted rates, the odds ratios (ORs) of events in multivariable analyses (adjusted for 6 co-factors), and the changes of ORs relative to the distance to hog CAFOs. results Residents from Study groups 1 and 2 had higher rates of all-cause mortality, infant mortality, mortality of patients with multimorbidity, mortality from anemia, kidney disease, tuberculosis, and septicemia, and higher rates of ED visits and hospital admissions for LBW infants than the residents in the Control group. In zip codes with > 215hogs/km 2 , mortality ORs were 1.50 for anemia (P < 0.0001), 1.31 for kidney disease (P < 0.0001), 2.30 for septicemia (P < 0.0001), and 2.22 for tuberculosis (P = 0.0061). limitations This study included a lack of individual measurements on environmental contaminants, biomarkers of exposures and cofactors, and differences in residential and occupational locations. conclusion North Carolina communities located near hog CAFOs had higher all-cause and infant mortality, mortality due to anemia, kidney disease, tuberculosis, septicemia, and higher hospital admissions/ED visits of LBW infants. Although not establishing causality with exposures from hog CAFOs, our findings support the need for future studies to determine factors that influence these outcomes, as well as the need to improve screening and diagnostic strategies for these diseases in North Carolina communities adjacent to hog CAFOs.
Alzheimer’s disease (AD), non-AD dementia, and Parkinson’s disease (PD) are increasingly common in older adults, yet all risk factors for their onset are not fully understood. Consequently, environmental exposures, including air pollution, have been hypothesized to contribute to the etiology of neurodegeneration. Because persistently elevated rates of AD mortality in the southern Piedmont area of North Carolina (NC) have been documented, we studied mortality and hospital admissions for AD, non-AD dementia, and PD in residential populations aged 65+ with long-term exposures to elevated levels of ambient air particulate matter 2.5 (PM2.5) exceeding the World Health Organization (WHO) air quality standards (≥10μg/m3). Health data were obtained from the State Center for Health Statistics and the Healthcare Cost and Utilization Project. PM2.5 levels were obtained from the MODIS/MISR and SeaWiFS datafiles. Residents in the Study group of elevated air particulate matter (87 zip codes with PM2.5≥10μg/m3) were compared to the residents in the Control group with low levels of air particulate matter (81 zip codes with PM2.5≤7.61μg/m3), and were found to have higher age-adjusted rates of mortality and hospital admissions for AD, non-AD dementia, and PD, including a most pronounced increase in AD mortality (323/100,000 vs. 257/100,000, respectively). After adjustment for multiple co-factors, the risk of death (odds ratio, or OR) from AD in the Study group (OR = 1.35, 95%CI[1.24–1.48]) was significantly higher than ORs of non-AD dementia or PD (OR = 0.97, 95%CI[0.90–1.04] and OR = 1.13, 95%CI[0.92–1.31]). The OR of hospital admissions was significantly increased only for AD as a primary case of hospitalization (OR = 1.54, 95%CI[1.31–1.82]). Conclusion: NC residents aged 65+ with long-term exposures to ambient PM2.5 levels exceeding the WHO standard had significantly increased risks of death and hospital admissions for AD. The effects for non-AD dementia and PD were less pronounced.
Building upon the sizable literature on individual-level predictors of self-rated health, this study examined the impact of neighborhood characteristics, using older adult samples of four racial/ethnic groups. The considered neighborhood characteristics include (a) the proportion of individuals age 65 and older, (b) the proportion of individuals below poverty, and (c) the proportion of individuals from the same racial/ethnic background in the Census-block group. The samples were drawn from the 2004-2005 Survey of Older Floridians, which includes Whites (n = 488), Blacks (n = 345), Cubans (n = 319), and non-Cuban Latinos (n = 230). Using the reported residential address, each participant was linked to the 2000 Census at block-group level to retrieve the above-mentioned neighborhood characteristics. Multilevel analysis of self-rated health was estimated for each racial/ethnic group, considering individual-level variables (e.g., age, gender, marital status, education, financial strain, and chronic conditions) and each of the neighborhood characteristics. Regardless of racial/ethnic groups, those living in the neighborhood with a higher proportion of residents below poverty were likely to report poorer health. The proportion of older adults in the neighborhood was significant only in Cubans, and the proportion of residents with the same ethnic background was only in Whites. The findings show the overall importance of neighborhood context in the health of older adults and indicate different implications of neighborhood characteristics for diverse racial/ethnic groups.
This study explored how the physical and mental health of Korean American older adults were influenced by neighborhood characteristics (i.e., proportion of individuals living below the poverty level, proportion of individuals 65 years of age and older, and proportion of racial/ethnic minorities in the census block groups where each respondent lived). Health perceptions (i.e., the subjective appraisal of one’s own health) and depressive symptoms were used as indicators of physical and mental health. Multilevel analyses were performed with 567 individuals (at Level 1) nested within 233 census block groups (at Level 2). After controlling for individual demographic and health characteristics, we found that neighborhood poverty predicted health perceptions. The results add to the growing literature on the influence of the social environment and suggest that neighborhood characteristics should be taken into consideration in developing community-based policies for racially/ethnically diverse populations.
Purpose We visualized rural‐urban differences in inpatient hospitalization and emergency department (ED) health care utilization (HCU) for older adults with dementia to understand the HCU of rural versus urban older adults in Minnesota and to examine in greater detail the variability of HCU in rural areas. Methods For 3 older adult age groups, we utilized Healthcare Cost and Utilization Project (H‐CUP) datasets from 2016 to 2018 to profile hospital admission rates, and ED visit rates related to dementia stratified by rurality and regions. Rates were visualized by spatial interpolation method. We then used logistic regression analysis adjusted by multiple covariates to evaluate rural‐urban differences of the chance of having a dementia diagnosis in HCU. Findings Minnesota rural areas showed 17.6% lower age‐adjusted rate (AAR) of dementia mortality than urban areas. AARs of ED visits for dementia were 12.4% higher in rural ZIP codes, whereas AARs of hospitalization were 24.7% lower. After controlling for neighborhood‐level risk factors, such as income, education, health behaviors, and provider access, the odds ratios of having dementia diagnosis are 12% lower if an ED visit patient lives in rural as opposed to an urban area (OR = 0.88, P<.0001). Conclusions In comparison to AAR, the fully adjusted data showed larger rural‐urban predictors of having dementia diagnoses in hospitalizations and ED utilizations and demonstrated differences between AAR of ED visit and odds ratios of having dementia diagnosis. A regional comparison revealed that dementia ED visits were higher for Northeast MN compared to Minnesota's largest metropolitan region.
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