Ricardo Basurto-Davila

Neighborhoods and cumulative biological risk profiles by race/ethnicity in a national sample of U.S. Adults: NHANES III.

PURPOSE To examine race/ethnic-specific patterns of association between neighborhood socioeconomic status (NSES) and a cumulative biological risk index in a nationally representative population. METHODS The study sample included 13,199 white, black, and Mexican-American men and women, ages 20 and older, who attended the National Health and Examination Survey examination (1988-1994). Neighborhoods were defined as census tracts and linked to U.S. Census measures from 1990 and 2000, interpolated to the survey year; the NSES score included measures of income, education, poverty, and unemployment and was categorized into quintiles, with the highest indicating greater NSES. A summary biological risk score, allostatic load (AL; range 0-9), was created from 9 biological indicators of elevated risk: serum levels of C-reactive protein, albumin, glycated hemoglobin, total and high-density lipoprotein cholesterol, waist-to-hip ratio, systolic and diastolic blood pressure, and resting heart rate. Regression models stratified by race/ethnicity examined AL as a continuous and dichotomous (>or=3 vs. <3) outcome. RESULTS We found strong inverse associations between NSES and AL for black subjects, after adjusting for age, sex, U.S. birth, urban location, and individual SES. These associations were weaker and less consistent for Mexican Americans and whites. CONCLUSIONS Our results indicate that living in low NSES neighborhoods is most strongly associated with greater cumulative biological risk profiles in the black U.S. population.

Does place explain racial health disparities? Quantifying the contribution of residential context to the Black/white health gap in the United States

The persistence of the black health disadvantage has been a puzzling component of health in the United States in spite of general declines in rates of morbidity and mortality over the past century. Studies that have focused on well-established individual-level determinants of health such as socio-economic status and health behaviors have been unable to fully explain these disparities. Recent research has begun to focus on other factors such as racism, discrimination, and segregation. Variation in neighborhood context-socio-demographic composition, social aspects, and built environment-has been postulated as an additional explanation for racial disparities, but few attempts have been made to quantify its overall contribution to the black/white health gap. This analysis is an attempt to generate an estimate of place effects on explaining health disparities by utilizing data from the U.S. National Health Interview Survey (NHIS) (1989-1994), combined with a methodology for identifying residents of the same blocks both within and across NHIS survey cross-sections. Our results indicate that controlling for a single point-in-time measure of residential context results in a roughly 15-76% reduction of the black/white disparities in self-rated health that were previously unaccounted for by individual-level controls. The contribution of residential context toward explaining the black/white self-rated health gap varies by both age and gender such that contextual explanations of disparities decline with age and appear to be smaller among females.

Does mental health history explain gender disparities in insomnia symptoms among young adults

BACKGROUND Insomnia is the most commonly reported sleep disorder, characterized by trouble falling asleep, staying asleep, or waking up too early. Previous epidemiological data reveal that women are more likely than men to suffer from insomnia symptoms. We investigate the role that mental health history plays in explaining the gender disparity in insomnia symptoms. METHODS Using logistic regression, we analyze National Health and Nutritional Examination Survey (NHANES) III interview and laboratory data, merged with data on sociodemographic characteristics of the residential census tract of respondents. Our sample includes 5469 young adults (ages 20-39) from 1429 census tracts. RESULTS Consistent with previous research, we find that women are more likely to report insomnia symptoms compared to men (16.7% vs. 9.2%). However, in contrast to previous work, we show that the difference between womens and mens odds of insomnia becomes statistically insignificant after adjusting for history of mental health conditions (OR=1.08, p>.05). CONCLUSIONS The gender disparity in insomnia symptoms may be driven by higher prevalence of affective disorders among women. This finding has implications for clinical treatment of both insomnia and depression, especially among women.

Racial/ethnic differences in US health behaviors: a decomposition analysis.

OBJECTIVE To quantify contributions of individual sociodemographic factors, neighborhood socioeconomic status (NSES), and unmeasured factors to racial/ethnic differences in health behaviors for non-Hispanic (NH) whites, NH blacks, and Mexican Americans. METHODS We used linear regression and Oaxaca decomposition analyses. RESULTS Although individual characteristics and NSES contributed to racial/ethnic differences in health behaviors, differential responses by individual characteristics and NSES also played a significant role. CONCLUSIONS There are racial/ethnic differences in the way that individual-level determinants and NSES affect health behaviors. Understanding the mechanisms for differential responses could inform community interventions and public health campaigns that target particular groups.