Trends in Mortality Disparities by Area-Based Poverty in New York City, 1990–2010

Abstract

Residing in a high-poverty area has consistently been associated with higher mortality rates, but the association between poverty and mortality can change over time. We examine the association between neighborhood poverty and mortality in New York City (NYC) during 1990-2010 to document mortality disparity changes over time and determine causes of death for which disparities are greatest. We used NYC and New York state mortality data for years 1990, 2000, and 2010 to calculate all-cause and cause-specific age-adjusted death rates (AADRs) by census tract poverty (CTP), which is the proportion of persons in a census tract living below the federal poverty threshold. We calculated mortality disparities, measured as the difference in AADR between the lowest and highest CTP groups, within and across race/ethnicity, nativity, and sex categories by year. We observed higher all-cause AADRs with higher CTP for each year for all race/ethnicities, both sexes, and US-born persons. Mortality disparities decreased progressively during 1990-2010 for the NYC population overall, for each race/ethnic group, and for the majority of causes of death. The overall mortality disparity between the highest and lowest CTP groups during 2010 was 2.55 deaths/ 1000 population. The largest contributors to mortality disparities were heart disease (51.52 deaths/100,000 population), human immunodeficiency virus (19.96/100,000 population), and diabetes (19.59/100,000 population). We show that progress was made in narrowing socioeconomic disparities in mortality during 1990-2010, but substantial disparities remain. Future efforts toward achieving health equity in NYC mortality should focus on areas contributing most to disparities.

Can Electronic Health Records Be Used for Population Health Surveillance? Validating Population Health Metrics Against Established Survey Data

“…To reduce the impact of patient and practice selection bias, each indicator was weighted to the sex (male, female), age group (20–39, 40–59, 60–100), and neighborhood poverty distribution of the adult NYC population in care. Neighborhood poverty was defined as the percent of the population in the patient’s home ZIP code with an annual income below the federal poverty threshold (<10.0 percent, 10.0–19.9 percent, 20.0–29.9 percent, 30.0–100.0 percent) 13. Combined 2008–2012 ACS ZIP code approximations were used to identify the percent living in poverty 14…”

Increasing Antibiotic Resistance inShigellaspp. from Infected New York City Residents, New York, USA

“…Shigella- infected case-patients were matched to the NYC HIV Surveillance Registry ( 6 ). We determined neighborhood poverty level as described ( 7 ) and compared proportions of those infected by age group, sex, and HIV status using χ 2 tests. To identify factors associated with DSA or ciprofloxacin-resistant Shigella infection and with hospitalization, we used logistic regression analysis (SAS version 9.2; SAS Institute, Cary, NC, USA).…”

Hepatitis C infection among men who have sex with men living with HIV in New York City, 2000–2015

“…We also examined the distribution of year of HIV diagnosis (pre-2000, 2000–2005, 2006–2010 and 2011–2015) within the HIV/HCV coinfected and HIV monoinfected groups. We calculated neighbourhood poverty level at HIV diagnosis as a proxy for socioeconomic status, defined as the percentage of residents in a zip code with annual income <100% of the federal poverty level 16. Neighbourhood poverty level at HIV diagnosis was divided into four categories: low (0% to <10%), medium (10% to <20%), high (20% to <30%) or very high (≥30%).…”