Promoting Health Equity Through Preventing or Mitigating the Effects of Gentrification: A Theoretical and Methodological Guide

Cole, Helen; Anguelovski, Isabelle; Triguero-Mas, Margarita; Mehdipanah, Roshanak; Arcaya, Mariana

doi:10.1146/annurev-publhealth-071521-113810

Cited by 8 publications

(1 citation statement)

References 107 publications

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“…First, while this study measured area-level SDoH at the Census tract – a relatively small geographic level – it is possible that it still is too large of an area to finely measure SDoH. Second, often by the time these area-level measures are available for analysis, they may be outdated [ 37 ], and no longer accurately reflect that community. Finally, while social risks are influenced by the area-level SDoH they ultimately reflect the unique needs of that individual.…”

Section: Discussionmentioning

confidence: 99%

Area-level social determinants of health and individual-level social risks: Assessing predictive ability and biases in social risk screening

Bensken,

McGrath,

Gold

et al. 2023

J. Clin. Trans. Sci.

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Introduction: Area-level social determinants of health (SDoH) and individual-level social risks are different, yet area-level measures are frequently used as proxies for individual-level social risks. This study assessed whether demographic factors were associated with patients being screened for individual-level social risks, the percentage who screened positive for social risks, and the association between SDoH and patient-reported social risks in a nationwide network of community-based health centers. Methods: Electronic health record data from 1,330,201 patients with health center visits in 2021 were analyzed using multilevel logistic regression. Associations between patient characteristics, screening receipt, and screening positive for social risks (e.g., food insecurity, housing instability, transportation insecurity) were assessed. The predictive ability of three commonly used SDoH measures (Area Deprivation Index, Social Deprivation Index, Material Community Deprivation Index) in identifying individual-level social risks was also evaluated. Results: Of 244,155 (18%) patients screened for social risks, 61,414 (25.2%) screened positive. Sex, race/ethnicity, language preference, and payer were associated with both social risk screening and positivity. Significant health system-level variation in both screening and positivity was observed, with an intraclass correlation coefficient of 0.55 for social risk screening and 0.38 for positivity. The three area-level SDoH measures had low accuracy, sensitivity, and area under the curve when used to predict individual social needs. Conclusion: Area-level SDoH measures may provide valuable information about the communities where patients live. However, policymakers, healthcare administrators, and researchers should exercise caution when using area-level adverse SDoH measures to identify individual-level social risks.

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Section: Discussionmentioning

confidence: 99%

Area-level social determinants of health and individual-level social risks: Assessing predictive ability and biases in social risk screening

Bensken,

McGrath,

Gold

et al. 2023

J. Clin. Trans. Sci.

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Historical Redlining, Contemporary Gentrification, and Severe Maternal Morbidity in California, 2005-2018

Gao,

Morello-Frosch,

Nuru-Jeter

et al. 2024

JAMA Netw Open

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ImportanceHistorically redlined neighborhoods may experience disinvestment, influencing their likelihood of gentrification, a process of neighborhood (re-)development that unequally distributes harms and benefits by race and class. Understanding the combined outcomes of redlining and gentrification informs how the mutually constitutive systems of structural racism and racial capitalism affect pregnancy outcomes.ObjectiveTo examine if historical redlining and contemporary gentrification is associated with increased severe maternal morbidity (SMM) odds.Design, Setting, and ParticipantsThis cross-sectional study used data from a statewide population-based sample of all live hospital births at 20 weeks’ gestation or more between 2005 and 2018 in California. Analysis was conducted from March 2023 to January 2024.ExposureRedlining (as characterized by the federal Home Owners’ Loan Corporation mortgage security maps) and displacement (using present-day sociodemographic and housing market information).Main Outcomes and MeasuresMixed-effects logistic regression models were used to assess the association of census tract–level exposure to historical redlining and contemporary gentrification with increased SMM odds, adjusting for sociodemographic and pregnancy related factors. Outcome classification was based on the Centers for Disease Control and Prevention SMM index, which defines SMM as having any of the 21 procedures and diagnoses based on the International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes.ResultsThe study sample included 1 554 837 births (median [SD] maternal age, 29.0 [6.4] years; 3464 American Indian or Alaskan Native [0.2%], 224 774 Asian [14.5%], 132 240 Black [8.5%], 880 104 Hispanic [56.6%], 312 490 White [20.1%]), with 22 993 cases of SMM (1.4%). Residents in historically redlined neighborhoods that were undergoing gentrification or displacement were more likely to be Black, Hispanic, and American Indian or Alaskan Native. Independent of individual-level characteristics, SMM odds were greater for individuals living in redlined neighborhoods that experienced displacement (OR, 1.21; 95% CI, 1.14-1.28) and in redlined neighborhoods undergoing gentrification (OR, 1.21; 95% CI, 1.13-1.29) compared with those in continuously advantaged neighborhoods.Conclusions and RelevanceFindings from this cross-sectional study demonstrate that the legacies of redlining, intertwined with current dynamics of displacement and gentrification, affect SMM. Place-based sociopolitical mechanisms that inequitably distribute resources may be important intervention points to address structural drivers of adverse pregnancy outcomes and their racial inequities.

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The Influence of Gentrification on Adverse Birth Outcomes in California

Gao,

Mujahid,

Nuru-Jeter

et al. 2024

J Urban Health

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Evidence has documented the effects of place on perinatal outcomes, but less is known about the sociopolitical mechanisms, such as gentrification, that shape neighborhood context and produce spatialized inequities in adverse birth outcomes. Leveraging a diverse sample in California, we assessed the associations between gentrification and birth outcomes: preterm birth, small-for-gestational-age, and low birth weight. Gentrification was measured using the Freeman method and the Displacement and Gentrification Typology. Descriptive analysis assessed outcome prevalence and race and ethnicity distribution by exposure and participant characteristics. Overall and race and ethnicity-stratified mixed effects logistic models examined associations between gentrification and birth outcomes, sequentially adjusting for sociodemographic status and pregnancy factors, with a random intercept to account for clustering by census tract. In a sample of 5,116,131 births, outcome prevalence ranged from 1.0% for very preterm birth, 5.0% for low birth weight, 7.9% for preterm birth, and 9.4% for small-for-gestational-age. Adjusting for individual-level factors, gentrification was associated with increased odds of preterm birth (Freeman OR = 1.09, 95% CI 1.07–1.10; Displacement and Gentrification Typology OR = 1.11, 95% CI 1.09–1.13). While Displacement and Gentrification Typology–measured gentrification was consistently associated with greater odds of adverse outcomes, Freeman-measured gentrification was associated with slightly lower odds of small-for-gestational-age and low birth weight. Furthermore, gentrification was associated with birth outcome odds across multiple racial and ethnic groups, but the directions and magnitudes of the associations varied depending on the gentrification assessment methodology and the outcome assessed. Results demonstrate that gentrification plays a role in shaping adverse birth outcomes in California.

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Promoting Health Equity Through Preventing or Mitigating the Effects of Gentrification: A Theoretical and Methodological Guide

Cited by 8 publications

References 107 publications

Area-level social determinants of health and individual-level social risks: Assessing predictive ability and biases in social risk screening

Area-level social determinants of health and individual-level social risks: Assessing predictive ability and biases in social risk screening

Historical Redlining, Contemporary Gentrification, and Severe Maternal Morbidity in California, 2005-2018

The Influence of Gentrification on Adverse Birth Outcomes in California

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