Forest fires burned near the Hoopa Valley Indian Reservation in northern California from late August until early November in 1999. The fires generated particulate matter reaching hazardous levels. We assessed the relationship between patients seeking care for six health conditions and PM(10) exposure levels during the 1999 fires and during the corresponding period in 1998 when there were no fires. Multivariate logistic regression analysis indicated that daily PM(10) levels in 1999 were significant predictors for patients seeking care for asthma, coronary artery disease and headache after controlling for potential risk factors. Stratified multivariate logistic regression models indicated that daily PM(10) levels in 1999 were significant predictors for patients seeking care for circulatory illness among residents of nearby communities and new patients, and for respiratory illness among residents of Hoopa and those of nearby communities.

Although low levels of social support have been related to mortality from coronary heart disease, little is known about the role of social support among Mexican Americans. The authors therefore examined the relationship between social support and long-term survival in the Corpus Christi Heart Project. They developed a social support scale that used data collected during in-hospital interviews of 292 Mexican Americans and 304 non-Hispanic Whites who survived a myocardial infarction for more than 28 days. The scale incorporated three measures: marital status; if not married, whether living alone; and whether advised to seek help. During an average follow-up period of 43 months, 115 participants died. Survival following myocardial infarction was greater for those with high or medium social support than for those with low social support. With age, gender, ethnicity, education, employment, smoking, diabetes, hypertension, and hypercholesterolemia included in a proportional hazards regression model, the relative risk of mortality was 1.89 (95% CI, 1.20-2.97) for those with low social support. But when the two ethnic groups were analyzed separately, low social support was no longer a significant predictor of mortality for non-Hispanic Whites, whereas for Mexican Americans, the relative risk of mortality was 3.38 (95% CI, 1.73-6.62) for those with low social support.

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The objective of this study is to explore relationships among neighborhood socioeconomic characteristics (for example, income and ethnicity), spatial access to health care, and emergency department (ED) visits for ambulatory care sensitive conditions (ACSC) for adults aged 65 years and over.ED visit data were from 15 counties in the Texas Coastal Bend from September 1, 2009 and August 1, 2012. ED visits for ACSC that were common for elderly were estimated based on Agency for Healthcare Research and Quality's (AHRQ's) ACSC and Prevention Quality Indicators. The U.S. Census American Community Service (ACS) data provided neighborhood socioeconomic characteristics. Spatial access to general practices and to hospitals, respectively at the zip code level were estimated using the enhanced two-step floating catchment area method. Using multivariable regression models, we estimated associations of elderly ACSC ED visits with neighborhood socioeconomic characteristics and spatial accessibility of healthcare.We found higher rates of elderly ACSC ED visits are significantly associated with higher rates of elderly Hispanic and poverty at the zip code level. Spatial access to general practices and hospitals play inverse roles in the rate of elderly ACSC ED visits. Poorer access to general practices but easier access to hospitals contributes to the higher elderly ACSC ED rate at the zip code level.Neighborhood socioeconomic characteristics and spatial access to healthcare affect the rate of elderly ACSC ED visits. Research informing policy action is needed to decrease racial/ethnic and economic disadvantage and increase equitable spatial access to primary care for the elderly.

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