Session
Assessing Health Equity Using Geospatial Techniques
APHA 2022 Annual Meeting and Expo
Abstract
The cultural context index: A geospatial measure of the United States
APHA 2022 Annual Meeting and Expo
Background: Spatial concentration is a distinguishing characteristic of ethnic enclave communities, and evidence suggests that health disparities in these communities are driven by the growth and uneven settlement of racial and ethnic groups across the United States (US). Current geospatial indices assess social determinants of health (SDoH), but none of them highlight ethnic enclaves, or geographic areas with high ethnic concentration. We propose a novel composite index built on this foundation for measuring neighborhood contexts.
Objectives: The purpose of this study is to present the Cultural Context Index (CCI), a new spatial measure that not only captures all five SDoH domains of Healthy People 2030, but further expands on the ethno-linguistic vulnerabilities tied to the social and community context domain.
Methods: We chose geographic information systems data for CCI inclusion based on the relationship between population and community characteristics and the association with disparities in care among ethnic enclaves. We calculated index values at census tract level using the sampled value of the first principal component extracted from a principal component analysis. We ranked all US census tracts using quintiles of CCI values.
Results: The tracts with the greatest need for culturally-framed care are mostly located in metropolitan areas (84.8%) and have a large presence in the Southern census region (41.5%) of the US. Areas with a greater need for cultural context consideration had, on average, larger populations per square mile (mean=12,611 census tract residents; Standard Deviation [SD]=22,244). High CCI tracts had higher Black and Hispanic representation than White and Asian. High CCI tract residents are, on average, younger (mean=34 years; SD=7 years)).
Conclusions: Cultural contexts and population health inequity are linked. The CCI ties the geographic variability of culturally-unified communities with those known risk factors for population health disparities. The CCI can pinpoint census tracts with a need for culturally-sensitive, patient-centered care delivery through interdisciplinary partnerships. Regionally, the CCI can inform policy plans to increase the geographic accessibility of providers to populations in need.
Public Health Implications: Minority populations will continue to grow in the US. Healthcare providers and social service workers will inevitably come in contact with more and more consumers who come from backgrounds different than theirs. The CCI’s utility is in measuring diversity as tool to identify persistent differences in health status between enclave and non-enclave residents.
Abstract
Novel Geocoding-based Method for Measuring Inequity in Access to Trauma Informed Care in an Urban Community during the COVID-19 Pandemic
APHA 2022 Annual Meeting and Expo
Background
Communities in Baltimore City have endured generations of trauma, including chronic exposure to violence and poverty. One approach to addressing community trauma is community targeted trauma-informed care training (TICT). Although community based organizations, academic institutions, and government agencies offer a variety of trainings, limited transportation and digital access pose accessibility barriers. While previous studies have examined accessibility to in-person healthcare services, there is limited understanding of the accessibility of the diverse TIC services.
Objectives
1) Develop a novel measure of accessibility of TICT across various modes of services within the context of the COVID-19 pandemic
2) Compare the distribution of violent crime and household poverty to TICTs in Baltimore.
Methods
Cross-sectional, secondary data analysis of TICTs collected between October and December 2021, and rates of violent crime and poverty in Baltimore City.
Data on TICTs were collected by the local non-profit, Healing City Baltimore.
Community trauma was defined as the rate of violent crime between 2017 and 2021 provided by the Baltimore City Police Department, and poverty was defined as the percentage of households living below the poverty line in each community statistical area, from the Baltimore Neighborhood Indicator Alliance.
Geographic accessibility of TICTs was multimodally estimated for various travel times in each community statistical area as follows:
[(Virtual TICTs Count)*(% of households with internet access)]
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[(In-Person TICTs Count in travel time radius )*(% of residents without access to a car)]
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[(In-Person TICTs Count in travel time radius)*(% of residents with access to a car)]
Spatial analysis was conducted using ArcGIS 2.9V. A Pearson correlation statistic was calculated to test the association of exposure to violent crime and poverty with the number of accessible TICTs in each CSA.
Results
A total of 149 TICTs were analyzed, half of which were provided by academic institutions and 45% by community-based organizations; 81.2% were virtual and 13.2% were in-person. The number of accessible TICT ranged from 79 - 149 across CSAs. There was a strong negative correlation between TICT access and violent crime & poverty across all travel times (minimum Pearson r(53)= -.42, p= .0011).
Conclusions
Communities with higher rates of violence and poverty tended to have lower accessibility to trauma informed care training, suggesting potentially reduced access of TICTs to historically at-risk residents.
Public Health Implications
Greater coordination is needed among diverse stakeholders to ensure access to trauma-informed training and care, particularly for residents and communities at greatest risk.
Abstract
Structural racism and COVID-19 vaccination in the state of Georgia
APHA 2022 Annual Meeting and Expo
Background
A plethora of emerging evidence suggests that the pandemic has a disproportionately larger impact on ethnic minorities including African Americans (AAs). Furthermore, vaccination rates among AAs trail behind other racial groups. Medical mistrust and misinformation are often tagged as associated factors, but more recent evidence suggests that the underlying lower rates may be due to reasons other than vaccine hesitancy.
Objective
In this study, we aimed to assess the association of vaccination among AAs with structural racism.
Methods
Data from the American Census Survey (2020) was used to calculate the racial segregation index at the census tract level. Data on the population proportion vaccinated for COVID-19 was obtained from the Georgia Department of Public Health (DPH) as of 3.18.2022. The racial segregation index was an average of two indices: the dissimilarity index and the isolation index, whose values ranged from 0 to 100, with 100 being the most spatially segregated by race. We used Poisson regression to model the proportion of AAs vaccinated as a function of the racial segregation index.
Results
Georgia had an average racial segregation index of 17.335 with 47.58% of its AA population being administered at least one dose of the COVID-19 vaccine. The racial segregation index was a significant predictor of the proportion of AAs getting vaccinated in Georgia [unadjusted β = -0.606; 95% CI: -0.836 - -0.376; p < 0.001].
Conclusion
These findings suggest that racial segregation is an important predictor of the Black-White disparity for COVID-19 vaccinations across Georgia.
Public Health Implications
The racial segregation raises the concern about further widening the existing health disparities and emphasizes policies to go beyond the traditionally associated factors and address the social structures to increase vaccinations among African Americans.
Abstract
Spatial analyses of TANF participation in response to the COVID-19 pandemic
APHA 2022 Annual Meeting and Expo
Background: Economic security and financial health are critical social determinants of health (SDOH) and undergird all other SDOH factors such as stable housing, social support, food security and access to healthcare. Research has shown that policies such as the Temporary Assistance for Needy Families (TANF) provide supplemental income or financial assistance play an important role in empowering low-income families to achieve self-sufficiency. The COVID-19 pandemic and associated job loss made several families eligible for TANF programs. However, little is known about changes in the utilization of TANF through the COVID pandemic, disparities in utilization between white and Black families, the spatial distribution of these disparities and the impact of COVID containment policies on TANF participation.
Objectives: The aim of this presentation is to investigate geographic and racial disparities in the impact of COVID on the economic security of low-income families. Our primary research questions are as follows: 1) How did TANF participation rates vary spatially and temporally with the advance of the COVID pandemic 2) How did these patterns differ for white and black families? 3) Did the COVID pandemic make a statistically significant change in TANF participation rates over time?
Methods: Using state-level, monthly TANF participation data we will use exploratory spatial data analysis to describe trends in reliance on financial assistance with the growth of the pandemic. Spatial statistics such as Moran’s I, LISA and time-space clustering will be used to describe general trends and the differences in these trends among racial groups. Our analysis will also control for state-based differences in TANF administration, strength and duration of COVID restrictions and other factors that might impact employment and poverty characteristics. We will also perform confirmatory data analysis using time-series modeling to determine if participation rates changed overall and between Black and white populations.
Public Health Implications: TANF Participation is correlated with several public health factors. A major economic downturn such as the 2008 Great Recession affected TANF caseloads, which in turn significantly reduced child neglect in many states (Albert, Lim, 2020). Other TANF related administrative policies such as restrictions and sanctioning have been associated with negative impacts on maternal and child health. The results of this study are intended to assist policymakers in evaluating the impact of COVID-19 on TANF participation and informing resource allocation during public health crises to better address disparities in financial and public health outcomes.