National Healthcare Quality and Disparities Report
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- Access to Care (1)
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- Human Immunodeficiency Virus (HIV) (2)
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- Racial and Ethnic Minorities (7)
- Research Methodologies (1)
- Risk (7)
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- Screening (4)
- Shared Decision Making (1)
- (-) Social Determinants of Health (35)
- Social Stigma (1)
- Surgery (1)
- Trauma (2)
- Urban Health (2)
- Vulnerable Populations (1)
- Women (3)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 35 Research Studies DisplayedNeerland C, Slaughter-Acey J, Behrens K
An evidence map for social and structural determinants for maternal morbidity and mortality: a systematic review.
The study aimed to identify social and structural determinants of maternal morbidity and mortality during prenatal and postpartum periods in the U.S. Out of 8,378 references screened, 118 studies were included, covering domains like identity, socioeconomic factors, violence, and trauma. Findings revealed mixed patterns between risk factors and outcomes, with notable attention to depression and mental health. Advancing the field long-term should involve developing comprehensive datasets to thoroughly investigate intersections with biological and medical risk factors.
AHRQ-funded; 75Q80120D00008.
Citation: Neerland C, Slaughter-Acey J, Behrens K .
An evidence map for social and structural determinants for maternal morbidity and mortality: a systematic review.
Obstet Gynecol 2024 Mar; 143(3):383-92. doi: 10.1097/aog.0000000000005489.
Keywords: Social Determinants of Health, Maternal Care, Mortality, Evidence-Based Practice, Risk, Women, Outcomes
Hogg-Graham R, Benitez JA, Lacy ME
Association between community social vulnerability and preventable hospitalizations.
The purpose of this study was to explore the relationship between variations in social vulnerability and preventable hospitalization rates. The researchers analyzed county-level preventable hospitalization rates for 33 states linked with data from the 2020 Social Vulnerability Index (SVI). The study found that preventable hospitalizations were 40% greater in the most vulnerable counties compared with the least vulnerable. Adjusted regression results confirm the strong relationship between social vulnerability and preventable hospitalizations.
AHRQ-funded; HS025494.
Citation: Hogg-Graham R, Benitez JA, Lacy ME .
Association between community social vulnerability and preventable hospitalizations.
Med Care Res Rev 2024 Feb; 81(1):31-38. doi: 10.1177/10775587231197248..
Keywords: Hospitalization, Social Determinants of Health
Carroll AR, Hall M, Noelke C
Association of neighborhood opportunity and pediatric hospitalization rates in the United States.
This study examined associations between a validated, multidimensional measure of social determinants of health and population-based hospitalization rates among children <18 years across 18 states from the 2017 Healthcare Cost and Utilization Project State Inpatient Databases and the US Census. Exposure was ZIP code-level Child Opportunity Index (COI), a composite measure of neighborhood resources and conditions that matter for children's health. The cohort included 614,823 hospitalizations among a population of 29,244,065 children, which measures at 21.02 hospitalizations per 1000. Adjusted hospitalization rates decreased significantly and in a stepwise fashion as COI increased, from 26.56 per 1000 in very low COI areas to 14.76 per 1000 in very high COI areas (incidence rate ratio 1.8). Decreasing neighborhood opportunity was associated with increasing hospitalization rates among children in the study.
AHRQ-funded; HS026122.
Citation: Carroll AR, Hall M, Noelke C .
Association of neighborhood opportunity and pediatric hospitalization rates in the United States.
J Hosp Med 2024 Feb; 19(2):120-25. doi: 10.1002/jhm.13252..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Hospitalization, Social Determinants of Health
Fleming MD, Safaeinili N, Knox M
Organizational and community resilience for COVID-19 and beyond: leveraging a system for health and social services integration.
This case study paper examined how a preexisting initiative to align health care, public health, and social services influenced COVID-19 pandemic response. In-depth interviews were conducted with administrators and frontline staff in health care, public health, and social services in Contra Costa County, California from October 2020 to May 2021. The authors interviewed 31 informants including 14 managers in public health, health care, or social services and 17 social needs case managers who coordinated services across these sectors on behalf of patients. They identified four distinct components of the county's system alignment capabilities that supported COVID-19 response, including (1) an organizational culture of adaptability fostered through earlier system alignment efforts, which included the ability and willingness to rapidly implement new organizational processes, (2) trusting relationships among organizations based on prior, positive experiences of cross-sector collaboration, (3) capacity to monitor population health of historically marginalized community members, including information infrastructures, data analytics, and population monitoring and outreach, and (4) frontline staff with flexible skills to support health and social care who had built relationships with the highest risk community members.
AHRQ-funded; HS027648.
Citation: Fleming MD, Safaeinili N, Knox M .
Organizational and community resilience for COVID-19 and beyond: leveraging a system for health and social services integration.
Health Serv Res 2024 Feb; 59(suppl 1):e14250. doi: 10.1111/1475-6773.14250..
Keywords: COVID-19, Social Determinants of Health
Danielson EC, Li W, Suleiman L
Social risk and patient-reported outcomes after total knee replacement: implications for Medicare policy.
The objective of this study was to determine if county- or patient-level social risk factors are associated with patient-reported outcomes after total knee replacement when added to the comprehensive joint replacement risk-adjustment model. Patient and outcomes data from the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement cohort were merged with the CDC Social Vulnerability Index. The findings indicated that patient-reported race, education, and income were associated with patient-reported pain or functional scores; pain improvement was negatively associated with Black race and positively associated with higher annual incomes. The authors concluded that these findings suggested that patient-level social factors warrant further investigation to promote health equity in patient-reported outcomes after total knee replacement.
Citation: Danielson EC, Li W, Suleiman L .
Social risk and patient-reported outcomes after total knee replacement: implications for Medicare policy.
Health Serv Res 2024 Feb; 59(1):e14215. doi: 10.1111/1475-6773.14215.
Keywords: Surgery, Orthopedics, Medicare, Outcomes, Patient-Centered Outcomes Research, Social Determinants of Health
Oates GR, Hamby BW, Bae S
Bikeshare use in urban communities: individual and neighborhood factors.
This study examined factors associated with bikeshare use in a metropolitan area in the southern United States. The study found that higher neighborhood socioeconomic disadvantage was associated with higher bikeshare use. Bikeshare was a viable transportation option in low-resource neighborhoods and may be an effective tool to improve the connectivity, livability, and health of urban communities.
AHRQ-funded; HS023009.
Citation: Oates GR, Hamby BW, Bae S .
Bikeshare use in urban communities: individual and neighborhood factors.
Ethn Dis 2017 Nov 9;27(Suppl 1):303-12. doi: 10.18865/ed.27.S1.303..
Keywords: Health Status, Social Determinants of Health, Urban Health
Tung EL, Johnson TA, O'Neal Y
Experiences of community violence among adults with chronic conditions: qualitative findings from Chicago.
The purpose of this study was to explore and characterize, using a qualitative study design, self-described experiences of community violence among adults with chronic health conditions. Investigators found that patients often struggled to balance the challenges imposed by community violence with the demands of living with and managing their chronic conditions.
AHRQ-funded; HS023007.
Citation: Tung EL, Johnson TA, O'Neal Y .
Experiences of community violence among adults with chronic conditions: qualitative findings from Chicago.
J Gen Intern Med 2018 Nov;33(11):1913-20. doi: 10.1007/s11606-018-4607-3..
Keywords: Chronic Conditions, Disparities, Social Determinants of Health
Masho SW, Rozario S, Walker D
Racial differences and the role of marital status in the association between intimate partner violence and unintended pregnancy.
This study examined the association between intimate partner violence (IPV) and unintended pregnancy across racial/ethnic and marital strata among U.S. women. Among other results, the investigators found that the odds of unintended pregnancy were increased for married non-Hispanic White women who reported IPV compared to their non-abused counterparts even after controlling for sociodemographic factors, health care access, and reproductive history.
AHRQ-funded; HS021504.
Citation: Masho SW, Rozario S, Walker D .
Racial differences and the role of marital status in the association between intimate partner violence and unintended pregnancy.
J Interpers Violence 2018 Oct;33(20):3162-85. doi: 10.1177/0886260516635317..
Keywords: Domestic Violence, Pregnancy, Racial and Ethnic Minorities, Social Determinants of Health
Washington DM, Curtis LM, Waite K
Sociodemographic factors mediate race and ethnicity-associated childhood asthma health disparities: a longitudinal analysis.
This study characterized the longitudinal effects associated with being African-American/Black or Hispanic/Latino on a range of asthma outcomes, and the extent to which sociodemographic factors, caregiver health literacy, education level, and asthma knowledge mediated these associations. The investigators concluded that African-American race and Hispanic/Latino ethnicity are significantly associated with worse asthma compared to Whites in longitudinal analyses.
AHRQ-funded; HS022242.
Citation: Washington DM, Curtis LM, Waite K .
Sociodemographic factors mediate race and ethnicity-associated childhood asthma health disparities: a longitudinal analysis.
J Racial Ethn Health Disparities 2018 Oct;5(5):928-38. doi: 10.1007/s40615-017-0441-2..
Keywords: Asthma, Children/Adolescents, Disparities, Racial and Ethnic Minorities, Social Determinants of Health
Zuckerman KE, Lindly OJ, Reyes NM
Parent perceptions of community autism spectrum disorder stigma: measure validation and associations in a multi-site sample.
In this study, the investigators developed a brief, English/Spanish bilingual parent-reported scale of perceived community autism spectrum disorder (ASD) stigma and tested it in a multi-site sample of Latino and non-Latino white parents of children with ASD.
AHRQ-funded; HS000063.
Citation: Zuckerman KE, Lindly OJ, Reyes NM .
Parent perceptions of community autism spectrum disorder stigma: measure validation and associations in a multi-site sample.
J Autism Dev Disord 2018 Sep;48(9):3199-209. doi: 10.1007/s10803-018-3586-x..
Keywords: Autism, Disabilities, Social Stigma, Social Determinants of Health, Behavioral Health
Nelson DB, Moniz MH, Davis MM
Population-level factors associated with maternal mortality in the United States, 1997-2012.
This study analyzed state-level maternal mortality for the years 1997-2012 using multilevel mixed-effects regression grouped by state, using publicly available data. The study concluded that, in addition to better case ascertainment of maternal deaths, adverse changes in chronic diseases, insufficient healthcare access, and social determinants of health represent identifiable risks for maternal mortality that merit prompt attention in population-directed interventions and health policies.
AHRQ-funded; HS025465.
Citation: Nelson DB, Moniz MH, Davis MM .
Population-level factors associated with maternal mortality in the United States, 1997-2012.
BMC Public Health 2018 Aug 13;18(1):1007. doi: 10.1186/s12889-018-5935-2..
Keywords: Health Services Research (HSR), Labor and Delivery, Mortality, Pregnancy, Social Determinants of Health
Sentell TL, Shen C, Landsittel D
Racial/ethnic differences in those accompanying Medicare patients to the doctor: insights from the 2013 Medicare current beneficiary's survey.
This study used multivariable models applied to Medicare Current Beneficiary's Survey Access to Care public use data in order to predict companion accompaniment to health care providers among Medicare beneficiaries; Chi square analyses compared, by race/ethnicity, who was accompanying patients and why. Black and Hispanic patients were more likely to be accompanied than whites. In all three groups, more than a third of patients brought someone with them to ‘take notes,’ ‘ask questions,’ and/or ‘explain things,’ but significantly more Hispanic patients brought a companion to ‘explain instructions,’ ‘translate,’ and/or to provide ‘moral support.’ The authors conclude that many Medicare beneficiaries are accompanied to doctors' appointments, particularly among minority racial/ethnic groups, and that this should be taken in consideration in healthcare policy and practice.
AHRQ-funded; HS023185.
Citation: Sentell TL, Shen C, Landsittel D .
Racial/ethnic differences in those accompanying Medicare patients to the doctor: insights from the 2013 Medicare current beneficiary's survey.
J Immigr Minor Health 2018 Aug;20(4):776-83. doi: 10.1007/s10903-017-0582-8..
Keywords: Caregiving, Elderly, Medicare, Racial and Ethnic Minorities, Social Determinants of Health
Cottrell EK, Gold R, Likumahuwa S
Using health information technology to bring social determinants of health into primary care: a conceptual framework to guide research.
The investigators recently proposed a conceptual framework to illustrate how health information technology can be used to bring social determinants of health information into primary care. In this paper, they describe how they are putting this conceptual model into practice within the OCHIN network of community health centers by highlighting examples of ongoing research, identifying knowledge gaps, and outlining a roadmap of future research to move the field forward.
Citation: Cottrell EK, Gold R, Likumahuwa S .
Using health information technology to bring social determinants of health into primary care: a conceptual framework to guide research.
AHRQ-funded; 233201500020I..
Keywords: Health Information Technology (HIT), Primary Care, Research Methodologies, Social Determinants of Health
Jarman MP, Haut ER, Curriero FC
Mapping areas with concentrated risk of trauma mortality: a first step toward mitigating geographic and socioeconomic disparities in trauma.
This study sought to classify injury event locations based on features of the built and social environment at the injury scene, and to examine patterns in individual patient demographics, injury characteristics, and mortality by location class. The investigators concluded identification of location classes may be useful for targeted primary prevention and treatment interventions, both by identifying geographic areas with the highest risk of injury mortality and by identifying patterns of individual risk within location classes.
AHRQ-funded; HS000029.
Citation: Jarman MP, Haut ER, Curriero FC .
Mapping areas with concentrated risk of trauma mortality: a first step toward mitigating geographic and socioeconomic disparities in trauma.
J Trauma Acute Care Surg 2018 Jul;85(1):54-61. doi: 10.1097/ta.0000000000001883..
Keywords: Disparities, Injuries and Wounds, Mortality, Social Determinants of Health, Trauma
Jarman MP, Curriero FC, Haut ER
Associations of distance to trauma care, community income, and neighborhood median age with rates of injury mortality.
The purpose of this study was to examine the association of injury scene characteristics with injury mortality. The study concluded that injury scene characteristics are associated with injury mortality. The authors found that odds of death are highest for patients injured in communities with higher median age or lower per capita income and at locations farthest from level 1 or 2 trauma centers.
AHRQ-funded; HS000029.
Citation: Jarman MP, Curriero FC, Haut ER .
Associations of distance to trauma care, community income, and neighborhood median age with rates of injury mortality.
JAMA Surg 2018 Jun;153(6):535-43. doi: 10.1001/jamasurg.2017.6133..
Keywords: Access to Care, Mortality, Social Determinants of Health, Trauma, Injuries and Wounds
Gorski Findling MT, Wolfson JA, Rimm EB
Differences in the neighborhood retail food environment and obesity among US children and adolescents by SNAP participation.
The authors sought to understand the association between children's neighborhood food access and overweight/obesity in a national sample of US households, and whether this association differs by Supplemental Nutrition Assistance Program (SNAP) participation or household purchases. Using data from the National Household Food Acquisition and Purchase Survey, 2012-2013, they found that the odds of childhood overweight/obesity were higher with greater access to combination grocery/other stores overall and for children in SNAP. Eligible non-SNAP children had higher odds of overweight/obesity with greater access to convenience stores. The average child lived in a household with 6.3% of total spending at food outlets on sugary beverages. They concluded that greater neighborhood access to combination grocery/other stores is associated with higher obesity prevalence for children overall and those in SNAP.
AHRQ-funded; HS000055.
Citation: Gorski Findling MT, Wolfson JA, Rimm EB .
Differences in the neighborhood retail food environment and obesity among US children and adolescents by SNAP participation.
Obesity 2018 Jun;26(6):1063-71. doi: 10.1002/oby.22184.
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Keywords: Children/Adolescents, Low-Income, Nutrition, Obesity, Social Determinants of Health
Goodman SM, Mandi LA, Mehta B
Does education level mitigate the effect of poverty on total knee arthroplasty outcomes?
The authors assessed the interaction between education and poverty on 2-year Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function. They found that having no college was associated with worse pain and function at baseline and 2 years and that living in a poor neighborhood was associated with worse 2-year pain and function. There was a strong interaction between individual education and community poverty with WOMAC scores at 2 years. Patients without college living in poor communities had pain scores that were ~10 points worse than those with some college; in wealthy communities, college was associated with a 1-point difference in pain. Function was similar. The authors recommended further study on how education protects those in impoverished communities.
AHRQ-funded; HS016075.
Citation: Goodman SM, Mandi LA, Mehta B .
Does education level mitigate the effect of poverty on total knee arthroplasty outcomes?
Arthritis Care Res 2018 Jun;70(6):884-91. doi: 10.1002/acr.23442..
Keywords: Arthritis, Education, Low-Income, Orthopedics, Outcomes, Patient-Centered Outcomes Research, Social Determinants of Health
Attanasio LB, Kozhimannil KB, Kjerulff KH
Factors influencing women's perceptions of shared decision making during labor and delivery: results from a large-scale cohort study of first childbirth.
The researchers examined correlates of shared decision making during labor and delivery. They found that women who were black and who did not have a college degree or private insurance were less likely to report high shared decision making, as well as women who underwent labor induction, instrumental vaginal or cesarean delivery.
AHRQ-funded; HS024215.
Citation: Attanasio LB, Kozhimannil KB, Kjerulff KH .
Factors influencing women's perceptions of shared decision making during labor and delivery: results from a large-scale cohort study of first childbirth.
Patient Educ Couns 2018 Jun;101(6):1130-36. doi: 10.1016/j.pec.2018.01.002.
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Keywords: Shared Decision Making, Disparities, Labor and Delivery, Patient-Centered Healthcare, Social Determinants of Health
Childers KK, Maggard-Gibbons M, Macinko J
National distribution of cancer genetic testing in the United States: evidence for a gender disparity in hereditary breast and ovarian cancer.
Identifying mutation carriers is critical for treatment decisions, cancer prevention, and early detection. This study analyzed the 2015 US National Health Interview Survey (NHIS), a cross-sectional in-person interview gathering self-reported health data for the US population. The study found that while cancer genetic testing seems to reach a broad geographic and sociodemographic population in the national survey, there remain underrepresented groups, including Hispanics, the uninsured, noncitizens, and those with less education.
AHRQ-funded; HS025079.
Citation: Childers KK, Maggard-Gibbons M, Macinko J .
National distribution of cancer genetic testing in the United States: evidence for a gender disparity in hereditary breast and ovarian cancer.
JAMA Oncol 2018 Jun;4(6):876-79. doi: 10.1001/jamaoncol.2018.0340..
Keywords: Cancer, Cancer: Breast Cancer, Cancer: Ovarian Cancer, Genetics, Racial and Ethnic Minorities, Screening, Social Determinants of Health, Women
Wong MS, Chan KS, Jones-Smith JC
The neighborhood environment and obesity: understanding variation by race/ethnicity.
The researchers examined the relationship between soda consumption and weight status with neighborhood sociodemographic, social, and built environments by race/ethnicity. Merging data on adults from the 2011-2013 California Health Interview Survey, U.S. Census data, and InfoUSA, they found that lower neighborhood educational attainment was associated with higher odds of obesity and soda consumption in all racial/ethnic groups. They found fewer associations between study outcomes and the neighborhood, especially the built environment, among non-Hispanic African Americans and non-Hispanic Asians. They concluded that, while improvements to neighborhood environment may be promising to reduce obesity, null associations among minority subgroups suggest that changes, particularly to the built environment, may alone be insufficient to address obesity in these groups.
AHRQ-funded; HS000029.
Citation: Wong MS, Chan KS, Jones-Smith JC .
The neighborhood environment and obesity: understanding variation by race/ethnicity.
Prev Med 2018 Jun;111:371-77. doi: 10.1016/j.ypmed.2017.11.029.
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Keywords: Disparities, Obesity, Racial and Ethnic Minorities, Social Determinants of Health
Roy B, Riley C, Herrin J
Identifying county characteristics associated with resident well-being: a population based study.
The authors aimed to identify county attributes that are independently associated with a comprehensive, multi-dimensional assessment of individual well-being. They identified twelve county-level factors that were independently associated with individual well-being scores. Collectively, these twelve factors explained 91% of the variance in individual well-being scores, and they represent four conceptually distinct categories: demographic; social and economic; clinical care; and physical environment.
AHRQ-funded; HS023000.
Citation: Roy B, Riley C, Herrin J .
Identifying county characteristics associated with resident well-being: a population based study.
PLoS One 2018 May 23;13(5):e0196720. doi: 10.1371/journal.pone.0196720.
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Keywords: Health Status, Quality of Life, Social Determinants of Health
Kato E, Borsky AE, Zuvekas SH
AHRQ Author: Kato E, Borsky AE, Zuvekas SH, Soni A, Ngo-Metzger Q
Missed opportunities for depression screening and treatment in the United States.
This study estimates the prevalence of depression assessment in adults age 35 and older and how prevalence varies by sociodemographic characteristics and depressive symptoms. It found that approximately 50 percent of US adults aged 35+ were being assessed for depression in 2014-2015. Certain populations were more likely to be missed, including men, people over 75 years old, minorities, and the uninsured.
AHRQ-authored.
Citation: Kato E, Borsky AE, Zuvekas SH .
Missed opportunities for depression screening and treatment in the United States.
J Am Board Fam Med 2018 May-Jun;31(3):389-97. doi: 10.3122/jabfm.2018.03.170406.
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Keywords: Depression, Medical Expenditure Panel Survey (MEPS), Prevention, Screening, Social Determinants of Health
Rising KL, Karp DN, Powell RE
Geography, not health system affiliations, determines patients' revisits to the emergency department.
This study sought to determine how frequently patients revisit the emergency department after an initial encounter, and to describe revisit capture rates for the same hospital, health system, and geographic region. Seventy percent of 30-day returns occurred to the same hospital. The 30-day return capture rates were highest within the same geographic area: county-level capture at 92 percent versus health system capture at 75 percent.
AHRQ-funded; HS023614.
Citation: Rising KL, Karp DN, Powell RE .
Geography, not health system affiliations, determines patients' revisits to the emergency department.
Health Serv Res 2018 Apr;53(2):1092-109. doi: 10.1111/1475-6773.12658.
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Keywords: Emergency Department, Healthcare Cost and Utilization Project (HCUP), Social Determinants of Health
Buys DR, Kennedy RE, Williams CP
Social and demographic predictors of nutritional risk: cross-sectional analyses from the UAB Study of Aging II.
Social factors may disparately affect access to food and nutritional risk among older adults by race and gender. This study assesses these associations using the Mini Nutritional Assessment among 414 community-dwelling persons 75+ years of age in Alabama. Multivariable analyses indicated that social factors affect nutritional risk differently by race and gender. Nutritional risk interventions are warranted for older adults.
AHRQ-funded; HS013852.
Citation: Buys DR, Kennedy RE, Williams CP .
Social and demographic predictors of nutritional risk: cross-sectional analyses from the UAB Study of Aging II.
Fam Community Health 2018 Apr/Jun;41 Suppl 2 Suppl, Food Insecurity and Obesity:S33-s45. doi: 10.1097/fch.0000000000000180.
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Keywords: Elderly, Nutrition, Obesity, Risk, Social Determinants of Health
Tung EL, Wroblewski KE, Boyd K
Police-recorded crime and disparities in obesity and blood pressure status in Chicago.
The purpose of this study was to examine associations between several types of police-recorded crime (violent, nonviolent, and homicide) and cardiometabolic health (obesity and elevated blood pressure [BP]), and to determine if associations were modified by age and sex. It concluded that in a densely populated, high-poverty region in Chicago, recurrent exposure to high rates of violent crime was consistently associated with obesity and elevated BP, but rare exposure to homicide was not.
AHRQ-funded; HS023007.
Citation: Tung EL, Wroblewski KE, Boyd K .
Police-recorded crime and disparities in obesity and blood pressure status in Chicago.
J Am Heart Assoc 2018 Mar 24;7(7). doi: 10.1161/jaha.117.008030.
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Keywords: Blood Pressure, Disparities, Risk, Social Determinants of Health, Urban Health