Physical environment

Study finds link between neighborhood disadvantage and COVID-19 disparities

New research has found a strong link between COVID-19 and neighborhood disadvantage, a finding that supports earlier contentions of the connection between social factors and coronavirus disparities (Source: “How Neighborhood Disadvantage Drove COVID Health Disparities,” Patient Engagement HIT, July 21).

The study examined the connection between COVID-19 inequity and subway ridership in New York City. Neighborhoods that ranked higher on a COVID-19 inequity index — meaning that the neighborhood saw more factors that could put inhabitants at risk — also had higher subway ridership even after COVID-19 forced city-wide shutdowns.

Daniel Carrión, a researcher from Mount Sinai, said needing to ride the subway — or work an essential job — had a strong link to the unequal infection rates seen during the height of the coronavirus pandemic, largely because it limits the ability to socially distance.

“For us, subway utilization was a proxy measure for the capacity to socially distance,” Carrión, a postdoctoral researcher in the Department of Environmental Medicine and Public Health at the Icahn School of Medicine, told PatientEngagementHIT in an interview.

Although public health experts have made the link between the social determinants of health leading to actual infection, not just poor outcomes, Carrión and his colleagues put some data behind that. Social disadvantage was linked with higher subway utilization, and ultimately to higher infection rates and starker disparities.

“Folks like me were able to stay home for the majority of the pandemic and work from home. I didn't need to use public transit whereas others did. What we found was that areas that had higher COVID inequity indices were also riding the subways more after the stay-at-home orders compared to folks that were low in the COVID inequity index.”


Study: Americans with lower incomes more likely to have respiratory illnesses

Despite improvements in air quality and other advances, Americans with low incomes more often have asthma, lung disease and related illnesses, a new study has found (Source: “Poor Americans More Likely to Have Respiratory Problems, Study Finds,” New York Times, May 28).

In recent decades, air quality has improved in the United States, smoking rates have plummeted and government safety regulations have reduced exposure to workplace pollutants. But rich and poor Americans have not benefited equally, scientists reported in a paper on Friday.

While wealthier Americans have quit smoking in droves, tobacco use remains frequent among the poor. Asthma has become more prevalent among all children, but it has increased more drastically in low-income communities. And Americans with lower incomes continue to have more chronic lung disease than the wealthy.

The analysis, which was published in JAMA Internal Medicine, included data from national health surveys conducted by the Centers for Disease Control and Prevention periodically from 1959 to 2018. The study did not examine disparities in respiratory health by race or ethnicity, though it assessed both income-based and education-based differences in lung health.

Before the 1980s, smoking rates did not vary much by income, and they only slightly varied by education level: 62% of the wealthiest adults and 56% of the poorest were either current or former smokers. But that has changed drastically. By the survey period 2017-18, current and former smoking rates among the wealthiest dropped by nearly half to 34% — while rates among the poorest inched up to 57.9%.


Study links air pollution to reduced cognitive ability

New research suggests that even short-term exposure to polluted air, at levels generally considered “acceptable,” may impair mental ability in the elderly (Source: “Air Pollution Takes a Toll on the Brain,” New York Times, May 17).

The study of 954 men, average age 69, living in the greater Boston area found that higher levels of PM 2.5, particles of soot and other fine particulate matter with a diameter of up to 2.5 microns, were consistently associated with lower cognitive test scores. The study, in Nature Aging, adjusted for age, BMI, coronary heart disease, diabetes, alcohol consumption, smoking, high blood pressure and other factors.

Dr. Andrea A. Baccarelli, the senior author and a professor of environmental science at the Columbia Mailman School of Public Health, said that these short-term effects may be reversible. “When air pollution goes down,” he said, “the brain reboots and goes back to normal. However, if repeated, these episodes produce long-term damage to the brain.”

“Some of these particles come from natural sources — sea salt, for example, soil and pollen,” Dr. Baccarelli added. “We’ll never be completely free of them. But the ones generated by humans are much worse. The good news is that we’re at a point where we have the technology to reduce air pollution even further.”


Study finds widespread racial disparities in air quality

A new national study has found racial and ethnic disparities in the quality of air that Americans breathe (Source: “People of Color Breathe More Hazardous Air. The Sources Are Everywhere.,” New York Times, April 28).

According to the study, Black Americans are exposed to more pollution from every type of source, including industry, agriculture, all manner of vehicles, construction, residential sources and even emissions from restaurants. People of color more broadly, including Black and Hispanic people and Asian Americans, are exposed to more pollution from nearly every source.

The findings, which were published Wednesday in the journal Science Advances, came as a surprise to the study’s researchers, who had not anticipated that the inequalities spanned so many types of pollution.

The study builds on a wealth of research that has shown that people of color in America live with more pollution than their white neighbors. Fine particulate matter air pollution, known as PM 2.5, is harmful to human health and is responsible for 85,000 to 200,000 excess deaths a year in the United States.


Study: 4 in 10 Americans live in cities with unhealthy air

More than 40% of Americans live with unhealthy air, with certain cities and types of Americans far more prone to be affected, according to a new national study (Source: “More than 40% in U.S. live in cities with unhealthy air, study says,” United Press International, April 21).

The American Lung Association's annual "State of the Air" report, which was released this week, found that people of color are 61% more likely to live in a county with unhealthy air than are white people and three times more likely to live in a county with failing air-quality grades across the board.

Moreover, the report says climate change continues to worsen air pollution in much of the country. Research also shows that air pollution can make COVID-19 worse, the authors pointed out.


Ohio ranks near bottom in latest HPIO Health Value Dashboard

Ohio ranks 47 in the nation in health value compared to other states and D.C. according to the latest edition of the Health Value Dashboard, which was released earlier this week by the Health Policy Institute of Ohio.

“Ohioans live less healthy lives and spend more on health care than people in most other states,” according to the Dashboard.

Ohio has consistently ranked near the bottom on health value in each of the four editions of the Dashboard. Ohio’s overall health value ranking was 47 in 2014, 46 in 2017 and 46 in 2019. 

The Dashboard found that Ohio’s healthcare spending is mostly on costly downstream care to treat health problems. This is largely because of a lack of attention and effective action in the following areas:

  • Children. Childhood adversity and trauma have long-term consequences
  • Equity. Ohioans with the worst outcomes face systemic disadvantages
  • Prevention. Sparse public health workforce leads to missed opportunities for prevention

The Dashboard is a tool to track Ohio’s progress toward health value — a composite measure of Ohio’s performance on population health and healthcare spending. In ranked profiles, the Dashboard examines Ohio’s rank and trend performance relative to other states across seven domains. In addition, through a series of equity profiles, the Dashboard highlights gaps in outcomes between groups for some of Ohio’s most systematically disadvantaged populations.

The Dashboard includes examples of nine evidence-informed policies that could be adopted by Ohio policymakers and private-sector partners to make Ohio a leader in health value.


HPIO fact sheet highlights connection between affordable housing, health equity

The Health Policy Institute of Ohio released a new fact sheet titled “Housing Affordability and Health Equity,” which explores the connection between affordable and safe housing and health.

According to the fact sheet, “Quality, affordable housing is vital for Ohio families to maintain stable employment and long-term health. Low wages, a lack of safe and affordable housing and the impacts of racism and housing discrimination result in many Ohioans spending a significant portion of their income on poor quality housing in neighborhoods that are disconnected from necessary resources, including high-quality health care and high paying jobs.”

The fact sheet notes:

  • About one-fifth of white Ohio renters (21%) spent over 50% of their income on housing in 2017. This housing cost burden was even higher for Latino and Black Ohioans.
  • Many workers were not paid enough to afford a 2-bedroom apartment at fair market rent (FMR) in Ohio in 2020.
  • There were only 42 affordable rental units for every 100 renter households with incomes at or below the poverty line or 30% area median income in Ohio in 2019.

The fact sheet also includes links to existing state plans and resources that include evidence-based strategies policymakers can focus on to improve housing affordability in Ohio.


Pandemic could cause more childhood lead poisoning, CDC says

Lead screenings for children plummeted last spring, and stay-at-home orders may have increased household exposure to the toxic metal (Source: “More Childhood Lead Poisoning Is a Side Effect of Covid Lockdowns,” New York Times, March 11).

Over the past half-century, public health officials have made enormous progress in protecting American children from lead poisoning and the irreversible neurological damage it can cause. Since the 1970s, the percentage of children with high levels of lead in their blood has plummeted.

But in 2020, when Covid-19 cases spiked, lockdowns and day care closures confined young children to their homes, where lead exposure can be particularly high. The growing national emergency also delayed lead-removal efforts and disrupted routine childhood lead screenings, leaving health officials unable to identify and treat many children living in lead-laden homes.

Last month, the Centers for Disease Control and Prevention estimated that in the early months of the pandemic, roughly 10,000 children with elevated levels of lead in their blood may have gone undetected.

There is no safe level of exposure to lead, which can disrupt neurological and cognitive development, causing learning disabilities, behavioral problems and developmental delays.


Study finds link between neighborhood noise levels, dementia risk

Long-term exposure to noise may be linked to an increased risk for Alzheimer’s disease and other forms of dementia, a new study found (Source: “Living in Noisy Neighborhoods May Raise Your Dementia Risk,” New York Times, Oct. 28).

After controlling for education, race, smoking, alcohol consumption, neighborhood air pollution levels and other factors, researchers found that each 10 decibel increase in community noise level was associated with a 36% higher likelihood of mild cognitive impairment, and a 29 percent increased risk for Alzheimer’s disease. The associations were strongest in poorer neighborhoods, which also had higher noise levels, according to the study published in the journal Alzheimer’s & Dementia.

The reasons for the connection are unknown, but the lead author, Jennifer Weuve, an associate professor of epidemiology at Boston University, suggested that excessive noise can cause sleep deprivation, hearing loss, increased heart rate, constriction of the blood vessels and elevated blood pressure, all of which are associated with an increased risk for dementia.


Fighting climate change could avoid 4.5 million early deaths in U.S., study finds

The U.S. stands to avoid 4.5 million premature deaths if it works to keep global temperatures from rising by more than 2 degree Celsius, according to new research from Duke University (Source: “U.S. could avoid 4.5M early deaths by fighting climate change, study finds,” The Hill, Aug. 5).

The same study found working to limit climate change could prevent about 3.5 million hospitalizations and emergency room visits and approximately 300 million lost workdays in America.

Drew Shindell, a professor at Duke University, informed lawmakers during testimony Wednesday that action to limit climate change would amount to “over $700 billion per year in benefits to the U.S. from improved health and labor alone, far more than the cost of the energy transition.”

Shindell, who conducted the study alongside researchers at NASA, unveiled the findings during a House Oversight Committee hearing on the economic and health consequences of climate change.