Public Housing Relocations and Relationships of Changes in Neighborhood Disadvantage and Transportation Access to Unmet Need for Medical Care

Abstract

Introduction Cross-sectional research suggests that neighborhood characteristics and transportation access shape unmet need for medical care. This longitudinal analysis explores relationships of changes in neighborhood socioeconomic disadvantage and transportation access to unmet need for medical care. Methods We analyzed seven waves of data from African American adults (N = 172) relocating from severely distressed public housing complexes in Atlanta, Georgia. Surveys yielded individual-level data and administrative data characterized census tracts. We used hierarchical generalized linear models to explore relationships. Results Unmet need declined from 25% pre-relocation to 12% at Wave 7. Post-relocation reductions in neighborhood disadvantage were inversely associated with reductions in unmet need over time (OR = 0.71, 95% CI = 0.51–0.99). More frequent transportation barriers predicted unmet need (OR = 1.16, 95% CI = 1.02–1.31). Conclusion These longitudinal findings support the importance of neighborhood environments and transportation access in shaping unmet need and suggest that improvements in these exposures reduce unmet need for medical care in this vulnerable population.

Cross-sectional association between medical expenses and intellectual activity in community-dwelling older adults

“…Because a prior study suggested that environmental factors can either facilitate or hamper medical care utilization [ 29 ], we assessed neighborhood environment using the Japanese version of the International Physical Activity Questionnaire Environment Module (IPAQ-E) [ 30 ]. To evaluate neighborhood environment related to ME, we used two items from IPAQ-E: access to public facilities including medical institutions and access to public transport.…”

Impact of Health Care and Socioeconomic Needs on Health Care Utilization and Disease Management: The University of New Mexico Hospital Care One Program

“…6 Unmet social needs such as inadequate housing, food insecurity, and unemployment have been related to physical and mental health problems, shorter life expectancy, and increased health care utilization and costs. [7][8][9][10][11][12][13][14][15][16][17] Evidence of the impact of social factors on health outcomes and health care cost is prompting providers to develop models and implement interventions that incorporate patients' social needs into standard care. Models include educating medical students on social determinants of health, 18 and developing a culture in which assessing and addressing social determinants of health is considered part of high-quality primary care.…”

Neighborhood Health Care Access and Sexually Transmitted Infections Among Women in the Southern United States: A Cross-Sectional Multilevel Analysis

“…10 People without insurance are more likely to report poor access to health care (e.g., not having a primary care provider) and unmet needs for health care. 8, 11 Poor health care access may promote ongoing STI transmission and endemicity by increasing the proportion of the population with untreated STIs, thereby increasing the likelihood that a woman will be exposed to an infected sexual partner. 5 People with or at increased risk for HIV and other STIs tend to live closer to their sexual partners than do people from lower risk populations, 12 and a growing body of research suggests that features of the social (e.g., neighborhood socioeconomic advantage) and built (e.g., health care infrastructure) environment are associated with STIs as well as unmet needs for health care.…”

“…5 People with or at increased risk for HIV and other STIs tend to live closer to their sexual partners than do people from lower risk populations, 12 and a growing body of research suggests that features of the social (e.g., neighborhood socioeconomic advantage) and built (e.g., health care infrastructure) environment are associated with STIs as well as unmet needs for health care. 11, 13–15 To date, no multilevel studies have explored relationships between neighborhood-level health care access and STIs. An understanding of whether and how neighborhood health care access is associated with having an STI can inform local STI prevention programming and structural interventions, including health care policy.…”

“…17 The G-AMVP has been used successfully to describe predisposing , enabling , and need predictors of infectious disease and health care utilization among vulnerable populations (e.g., minorities, people living in poverty) in the US. 11, 18, 19 Predisposing characteristics include individual-level factors existing prior to the perception of illness (e.g., sociodemographics) and variables that reflect vulnerability (e.g., substance use). Enabling characteristics include facilitators or barriers to care (e.g., neighborhood health care access).…”