Objectives. We evaluated use of the Index of Concentration at the Extremes (ICE) for public health monitoring.Methods. We used New York City data centered around 2010 to assess cross-sectional associations at the census tract and community district levels, for (1) diverse ICE measures plus the US poverty rate, with (2) infant mortality, premature mortality (before age 65 years), and diabetes mortality.Results. Point estimates for rate ratios were consistently greatest for the novel ICE P ublic health monitoring data need to be informative about not only health outcomes, but also their societal distribution and determinants, so that the data can be useful for policies, programs, and advocacy focused on improving population health and advancing health equity.1-3 Both the global and US literature increasingly recognize the importance of assessing progress and setbacks in reducing health inequities (i.e., unfair, unnecessary, and preventable health differences between the groups at issue). [1][2][3][4][5][6][7][8][9][10][11] Adding to the urgency of using measures that illuminate inequitable health gaps is growing concern about 21st-century rising concentrations of income and wealth [12][13][14][15][16][17][18][19] and their implications for public health and health inequities. 12,20,21 Most public health monitoring systems, however, do not employ metrics that convey societal distributions of concentrations of privilege and deprivation.1,2 Instead, the typical practice is to present health data in relation to characteristics measured at the individual or household level, such as income, educational level, and also, chiefly in the United States, race/ethnicity. Health outcomes are then compared across groups defined in relation to the chosen characteristics, which may be modeled either continuously or categorically. 1-3,22-24Some analyses additionally employ variants of these measures aggregated to the neighborhood level (e.g., percentage of persons or households below poverty, percentage of persons with less than a highschool education, percentage of persons who are Black). [22][23][24] In either case, although gaps in health outcomes can be quantified by comparing groups with less versus more resources, distributional information on the extent to which the population is divided into the groups at issue is not part of the metric. The excess risk of societal groups that get the proverbial short end of the stick becomes the focus, and these groups effectively become characterized as the "problem"; by contrast, the societal groups holding the stick's other, longer end simply stand as a referent group, and the problematic economic, political, and social relationships that produce health inequities are hidden from view. 11,12,25,26 A troubling feature of our era, however, is not a property of individuals or households but instead pertains to increasing spatial social polarization, part and parcel of growing concentrations of extreme income and wealth. [12][13][14][15][16][17][18][19][20][21]26,27

Objectives. To assess if historical redlining, the US government’s 1930s racially discriminatory grading of neighborhoods’ mortgage credit-worthiness, implemented via the federally sponsored Home Owners’ Loan Corporation (HOLC) color-coded maps, is associated with contemporary risk of preterm birth (< 37 weeks gestation). Methods. We analyzed 2013–2017 birth certificate data for all singleton births in New York City (n = 528 096) linked by maternal residence at time of birth to (1) HOLC grade and (2) current census tract social characteristics. Results. The proportion of preterm births ranged from 5.0% in grade A (“best”—green) to 7.3% in grade D (“hazardous”—red). The odds ratio for HOLC grade D versus A equaled 1.6 and remained significant (1.2; P < .05) in multilevel models adjusted for maternal sociodemographic characteristics and current census tract poverty, but was 1.07 (95% confidence interval = 0.92, 1.20) after adjustment for current census tract racialized economic segregation. Conclusions. Historical redlining may be a structural determinant of present-day risk of preterm birth. Public Health Implications. Policies for fair housing, economic development, and health equity should consider historical redlining’s impacts on present-day residential segregation and health outcomes.

These results provide preliminary evidence for the use of the ICE measure in examining structural barriers to healthy birth outcomes.

IntroductionPoor-quality cause-of-death reporting reduces reliability of mortality statistics used to direct public health efforts. Overreporting of heart disease has been documented in New York City (NYC) and nationwide. Our objective was to evaluate the immediate and longer-term effects of a cause-of-death (COD) educational program that NYC’s health department conducted at 8 hospitals on heart disease reporting and on average conditions per certificate, which are indicators of the quality of COD reporting.MethodsFrom June 2009 through January 2010, we intervened at 8 hospitals that overreported heart disease deaths in 2008. We shared hospital-specific data on COD reporting, held conference calls with key hospital staff, and conducted in-service training. For deaths reported from January 2009 through June 2011, we compared the proportion of heart disease deaths and average number of conditions per death certificate before and after the intervention at both intervention and nonintervention hospitals.ResultsAt intervention hospitals, the proportion of death certificates that reported heart disease as the cause of death decreased from 68.8% preintervention to 32.4% postintervention (P < .001). Individual hospital proportions ranged from 58.9% to 79.5% preintervention and 25.9% to 45.0% postintervention. At intervention hospitals the average number of conditions per death certificate increased from 2.4 conditions preintervention to 3.4 conditions postintervention (P < .001) and remained at 3.4 conditions a year later. At nonintervention hospitals, these measures remained relatively consistent across the intervention and postintervention period.ConclusionThis NYC health department’s hospital-level intervention led to durable changes in COD reporting.

Deaths attributable to hepatitis C (HCV) infection are increasing in the USA even as highly effective treatments become available. Neighborhood-level inequalities create barriers to care and treatment for many vulnerable populations. We seek to characterize citywide trends in HCV mortality rates over time and identify and describe neighborhoods in New York City (NYC) with disproportionately high rates and associated factors. We used a multiple cause of death (MCOD) definition for HCV mortality. Cases identified between January 1, 2006, and December 31, 2014, were geocoded to NYC census tracts (CT). We calculated age-adjusted HCV mortality rates and identified spatial clustering using a local Moran's I test. Temporal trends were analyzed using joinpoint regression. A multistep global and local Poisson modeling approach was used to test for neighborhood associations with sociodemographic indicators. During the study period, 3697 HCV-related deaths occurred in NYC, with an average annual percent increase of 2.6% (p = 0.02). The HCV mortality rates ranged from 0 to 373.6 per 100,000 by CT, and cluster analysis identified significant clustering of HCV mortality (I = 0.23). Regression identified positive associations between HCV mortality and the proportion of non-Hispanic black or Hispanic residents, neighborhood poverty, education, and non-English-speaking households. Local regression estimates identified spatially varying patterns in these associations. The rates of HCV mortality in NYC are increasing and vary by neighborhood. HCV mortality is associated with many indicators of geographic inequality. Results identified neighborhoods in greatest need for place-based interventions to address social determinants that may perpetuate inequalities in HCV mortality.