Unfavorable perceived neighborhood environment associates with less routine healthcare utilization: Data from the Dallas Heart Study

Abstract

Neighborhood environment perception (NEP) has been associated with health outcomes. However, little is known about how NEP relates to routine healthcare utilization. This study investigated the relationship between NEP and independent subfactors with healthcare utilization behavior, as measured by self-reported (1) usual source of healthcare and (2) time since last routine healthcare checkup. We used cross-sectional data from the Dallas Heart Study, which features a diverse, probability-based sample of Dallas County residents ages 18 to 65. We used logistic regression modeling to examine the association of self-reported NEP and routine healthcare utilization. NEP was assessed via a questionnaire exploring residents' neighborhood perceptions, including violence, the physical environment, and social cohesion. Routine healthcare utilization was assessed via self-reported responses regarding usual source of care and time since last routine healthcare checkup. The analytic sample (N = 1706) was 58% black, 27% white, 15% Hispanic, 42% male, and had a mean age of 51 (SD = 10.3). Analysis of NEP by tertile demonstrated that younger age, lower income, and lower education were associated with unfavorable overall NEP (p trend <0.05 for each). After adjustment for potential confounders, including neighborhood deprivation, health insurance, disease burden and psychosocial factors, we found that individuals with more unfavorable perception of their physical environment were more likely to report lack of a usual source of care (p = 0.013). Individuals with more unfavorable perception of the neighborhood physical environment or greater neighborhood violence reported longer time periods since last routine visit (p = 0.001, p = 0.034 respectively). There was no relationship between perceived social cohesion and healthcare utilization. Using a multi-ethnic cohort, we found that NEP significantly associates with report of a usual source of care and time since last routine checkup. Our findings suggest that public health professionals should prioritize improving NEP since it may act as barrier to routine preventive healthcare and ideal health outcomes.

Intersectional differences in serious violent victimization trajectories across the life course

“…Hispanic men and women have a lower risk of overall victimization than their Black counterparts, but arguably suffer from more persistent trajectories of violence. The cruel irony is that the health-enabling resources that can mitigate the trauma of repeated and chronic violent victimization – such as counseling and medical care – are in short supply and/or are underutilized in the communities most affected by violence ( Ceasar et al, 2020 , Tung et al, 2018 ). Proactive investment in communities and infrastructure that promotes health to prevent violent crime and victimization may be more productive than merely reacting to the health challenges that often emanate from repeated violence exposure ( Jackson and Vaughn, 2018 ).…”

Multi-Modality Imaging for Prevention of Coronary Artery Disease and Myocardial Infarction in the General Population: Ready for Prime Time?

“…CACS-based initiation of risk-modifying interventions, for instance by statins, was proven effective for the prevention of AMI at population level, even in low-risk individuals [ 53 , 54 , 55 ]. Individuals from lower socio-economic groups are known to be underrepresented in CAD preventive care and remain unrecognized until suddenly facing AMI or SCD [ 56 ]. To date, it remains unclear if screening the general population by CACS, CRPSs or other tests results in improved clinical outcomes, and, if proven beneficial, whether it would be cost-effective.…”

Neighborhood Social Cohesion and Mobility Limitations Among Community-dwelling Older Americans: The Mediating Roles of Depressive Symptoms and Mastery

“…A handful of studies have identified the important role of neighborhood social cohesion in the health of older residents. Specifically, neighborhood social cohesion has been associated with reduced physical symptoms (Robinette et al, 2013) and daily activity limitations (Qin et al, 2021), improved mental health (Elliott et al, 2014), and better routine health care utilization (Ceasar et al, 2020). However, limited studies have examined the impact of neighborhood social cohesion on mobility limitations.…”