246863 Neighborhood-Level Characteristics Associated With Invasive Pneumococcal Disease-Related Mortality for New York City (NYC) Adults, 2007-2009

Sunday, October 30, 2011

Kathryn Lane, MA, MPH , Bureau of Communicable Diseaes, NYC DOHMH/Columbia University, New York, NY
Catherine Dentinger, FNP, MS , Bureau of Communicable Diseases, New York City Department of Health and Mental Hygiene, New York City, NY
Stanley Wang, MPH , Bureau of Communicable Diseases, New York City Department of Health and Mental Hygiene, New York, NY
Joseph Kennedy, MPH , Bureau of Vital Statistics, New York City Department of Health and Hygiene, New York City, NY
Susan Resnick, MA , GIS Center, NYC DOHMH, New York, NY
Denis Nash, PhD, MPH , Epidemiology and Biostatistics Program, CUNY School of Public Health - Hunter College, New York, NY
Background: Invasive pneumococcal disease (IPD), defined as Streptococcus pneumoniae isolated from normally sterile sites, is reportable by laboratories to the NYC Department of Health (DOH); case-specific data are not collected. We assessed IPD-related mortality in NYC neighborhoods and examined ecologic associations using neighborhood-level socioeconomic and health data.

Methods: For 2007-2009, we matched IPD surveillance data for cases aged ≥18 years with death certificate data; deaths occurring within 30 days of IPD diagnosis were defined as IPD-related. To examine associations with IPD-related mortality, we used neighborhood-level data, defined as United Hospital Fund area, including percent of residents living below the federal poverty level (U.S. Census Bureau), and NYC DOH surveillance and survey data for HIV infection, diabetes, and smoking prevalence, and coverage for vaccination with pneumococcal polysaccharide vaccine (PPV).

Results: Of 1,898 IPD cases with address data, 410 resulted in IPD-related death. Age-adjusted average annual IPD-related mortality rates ranged from 0.85-5.85/100,000 persons. Forty-three percent of deaths occurred in 33% of NYC neighborhoods with the lowest PPV coverage among adults ≥65 years. Controlling for variables except poverty, higher vaccination coverage among adults ≥65 within a neighborhood was protective (ARR=0.7, 95% CI: 0.54, 0.91). In a fully-adjusted model, only neighborhood poverty remained significantly associated with higher IPD-related mortality. For every 10 percentage-point increase in neighborhood poverty, there was a 23% increase in neighborhood IPD-related mortality rate (ARR=1.23, 95% CI: 1.1, 1.37).

Conclusion: Neighborhood poverty levels are associated with IPD-related mortality. Improving neighborhood pneumococcal vaccination coverage in impoverished NYC neighborhoods may help to decrease mortality rate disparities.

Learning Areas:
Protection of the public in relation to communicable diseases including prevention or control
Public health or related research

Learning Objectives:
List possible data sources a local health department could use to conduct an ecological study that can help to identify and explain health disparities. Describe how New York City conducted an ecological analysis to describe the burden and neighborhood-level determinants of mortality related to invasive pneumococcal disease (IPD), a laboratory-reportable disease for which the department does not collect case-specific data. Discuss the advantages and disadvantages of conducting this type of analysis for local public health departments.

Keywords: Health Disparities, Communicable Disease

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I graduated with an MPH in epidemiology from Columbia University in February 2011 and completed the Health Research Training Program at the New York City Department of Health and Hygiene (DOHMH).
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.