Urban neighborhood poverty and the incidence of depression in a population-based cohort study

PURPOSE: It has long been suggested that certain characteristics of the urban environment may influence population mental health. However, evidence from multilevel research addressing the relation between intraurban environments and depression has been conflicting, and prospective evidence in this regard has been limited. We assessed the relation between urban neighborhood poverty and incident depression in a population-based prospective cohort study. METHODS: Using random-digit-dial telephone surveys, we recruited 1570 adult residents of New York City (NYC) in 2002. All persons interviewed at baseline were contacted again for follow-up 6 and 18 months after the initial interview. Eighty-one percent of the sample completed at least one follow-up visit. Analysis was restricted to 1120 persons who could be geocoded to NYC neighborhoods, which were represented by NYC community districts (N=59). RESULTS: Among persons with no history of major depression at baseline (N=820) there were 113 incident cases of major depression during the 18 months of follow-up; cumulative incidence of depression during the study period was 14.6 per hundred persons (95% confidence interval, 10.9-18.3). In low-socioeconomic status (SES) neighborhoods, the cumulative incidence of depression was 19.4 per hundred persons (95% confidence interval, 13.5-25.3), which was greater than that in high-SES neighborhoods (10.5; 95% confidence interval, 5.9-15.2). In multivariable models adjusting for individual covariates (sociodemographics, individual SES, social support, stressors, traumas, and history of post-traumatic stress disorder), the relative odds of incident depression was 2.19 (95% confidence interval, 1.04-4.59) for participants living in low-SES compared with high-SES neighborhoods. CONCLUSIONS: SES of neighborhood of residence is associated with incidence of depression independent of individual SES and other individual covariates. Additional work needs to characterize the pathways that may explain the observed association between living in low-SES neighborhoods and risk for depression.     

Urban as a Determinant of Health

Cities are the predominant mode of living, and the growth in cities is related to the expansion of areas that have concentrated disadvantage. The foreseeable trend is for rising inequities across a wide range of social and health dimensions. Although qualitatively different, this trend exists in both the developed and developing worlds. Improving the health of people in slums will require new analytic frameworks. The social-determinants approach emphasizes the role of factors that operate at multiple levels, including global, national, municipal, and neighborhood levels, in shaping health. This approach suggests that improving living conditions in such arenas as housing, employment, education, equality, quality of living environment, social support, and health services is central to improving the health of urban populations. While social determinant and multilevel perspectives are not uniquely urban, they are transformed when viewed through the characteristics of cities such as size, density, diversity, and complexity. Ameliorating the immediate living conditions in the cities in which people live offers the greatest promise for reducing morbidity, mortality, and disparities in health and for improving quality of life and well being.     

Drugs and firearm deaths in New York City, 1990–1998

Firearm deaths remain among the leading causes of mortality in the United States. Changing law enforcement activities, incarceration, drug use, and socioeconomic conditions may have played roles in the declining rates of firearm deaths during the 1990s. Using records from the Office of the Chief Medical Examiner, we analyzed the role of drugs in firearm deaths in New York City between 1990 and 1998. Positive drug toxicology was present in over half of all firearm death victims during this time. Cocaine, cannabis, opiates, and alcohol accounted for almost all of these deaths with drug-positive toxicology. There were decreases in cocaine- and alcohol-positive toxicology for firearm deaths in New York City starting in the early 1990s; there was a more gradual decrease in heroin-positive toxicology for firearm deaths. Cannabis-positive toxicology for firearm deaths increased in the early part of the 1990s and then decreased starting in the mid-1990s. Although the disparities between minority and white firearm death rates narrowed during this time, minorities remained about three times more likely to be victims of fatal firearm violence than whites in 1998. The highest firearm death rates were among African American and Latino male decedents, with a larger proportion of Latinos testing cocaine or opiate positive, while a larger proportion of African Americans tested cannabis positive. These results suggest a complex role of drugs in firearm-related deaths.     

Variability and vulnerability at the ecological level: implications for understanding the social determinants of health

OBJECTIVES: We examined variability in disease rates to gain understanding of the complex interactions between contextual socioeconomic factors and health. METHODS: We compared mortality rates between New York and California counties in the lowest and highest quartiles of socioeconomic status (SES), assessed rate variability between counties for various outcomes, and examined correlations between outcomes' sensitivity to SES and their variability. RESULTS: Outcomes with mortality rates that differed most by county SES were among those whose variability across counties was high (e.g., AIDS, homicide, cirrhosis). Lower-SES counties manifested greater variability among outcome measures. CONCLUSIONS: Differences in health outcome variability reflect differences in SES impact on health. Health variability at the ecological level might reflect the impact of stressors on vulnerable populations.     

Explaining racial disparities in incidence of and survival from out-of-hospital cardiac arrest

A prospective observational study of 4,653 consecutive cases of out-of-hospital cardiac arrest (OOHCA) occurring in New York City from April 1, 2002, to March 31, 2003, was used to assess racial/ethnic differences in the incidence of OOHCA and 30-day survival after hospital discharge among OOHCA patients. The age-adjusted incidence of OOHCA per 10,000 adults was higher among Blacks than among persons in other racial/ethnic groups, and age-adjusted survival from OOHCA was higher among Whites compared with other groups. In analyses restricted to 3,891 patients for whom complete data on all variables were available, the age-adjusted relative odds of survival from OOHCA among Blacks were 0.4 (95% confidence interval: 0.2, 0.7) as compared with Whites. A full multivariable model accounting for demographic factors, prior functional status, initial cardiac rhythm, and characteristics of the OOHCA event explained approximately 41 percent of the lower age-adjusted survival among Blacks. The lower prevalence of ventricular fibrillation as the initial cardiac rhythm among Blacks relative to Whites was the primary contributor. A combination of factors probably accounts for racial/ethnic disparities in OOHCA survival. Previously hypothesized factors such as delays in emergency medical service response or differences in the likelihood of receipt of cardiopulmonary resuscitation did not appear to be substantial contributors to these racial/ethnic disparities.     

Trends of probable post-traumatic stress disorder in New York City after the September 11 terrorist attacks

The authors investigated trends in probable post-traumatic stress disorder (PTSD) prevalence in the general population of New York City in the first 6 months after the September 11 terrorist attacks. Three random digit dialing telephone surveys of adults in progressively larger portions of the New York City metropolitan area were conducted 1 month, 4 months, and 6 months after September 11, 2001. A total of 1,008, 2,001, and 2,752 demographically representative adults were recruited in the three surveys, respectively. The current prevalence of probable PTSD related to the September 11 attacks in Manhattan declined from 7.5% (95% confidence interval: 5.7, 9.3) 1 month after September 11 to 0.6% (95% confidence interval: 0.3, 0.9) 6 months after September 11. Although the prevalence of PTSD symptoms was consistently higher among persons who were more directly affected by the attacks, a substantial number of persons who were not directly affected by the attacks also met criteria for probable PTSD. These data suggest a rapid resolution of most of the probable PTSD symptoms in the general population of New York City in the first 6 months after the attacks. The psychological consequences of a large-scale disaster in a densely populated urban area may extend beyond persons directly affected by the disaster to persons in the general population.     

Hematological changes associated with marathon running

Coulter profiles with differential white cell counts, serum ferritin, and haptoglobin levels were determined in venous blood samples obtained from 90 males (M) and 25 females (F) immediately before and after completion of a competitive marathon (42.2 km) race. In an additional 20 male runners, the same measurements were performed serially during the 24 h following their completion of the race. In the pre-race samples from 90 M and 25 F, hypoferritinemia was present in 4/22 M and 1 F found to be mildly anemic. Neutropenia was detected in 4 M and 3 F and mild thrombocytopenia in 2 M. Haptoglobin levels were normal in all the female runners but reduced (less than 0.3 g/l) in 6 M. All post-race samples (88 M and 25 F) were characterized by a reactive neutrophilia and thrombocytosis including those with pre-race neutropenia or thrombocytopenia. An unexpected and incompletely explained sex difference in packed cell volume (PCV) response was observed. In males, the mean PCV increased from 0.425 +/- 0.021 to 0.444 +/- 0.028 (P less than 0.0001) whereas in females it decreased from 0.437 +/- 0.029 to 0.423 +/- 0.036 (P less than 0.05). In the post-race samples, anhaptoglobinemia was found in 13/88 M and 4/25 F. In the 20 male runners studied serially for 24 h after the race, the major changes involved a progressive increase in mean plasma volume (17.4% +/- 12.2% at 24 h) compared with the pre-race value, a progressive and significant increase in MCH and MCHC probably indicating a loss in red cell water and the gradual reversion of the reactive neutrophilia and thrombocytosis to basal levels.     

Truth cube: establishing physical standards for soft tissue simulation

Accurate real-time models of soft tissue behavior are key elements in medical simulation systems. The need for fast computation in these simulations, however, often requires simplifications that limit deformation accuracy. Validation of these simplified models remains a challenge. Currently, real-time modeling is at best validated against finite element models that have their own intrinsic limitations. This study develops a physical standard to validate real-time soft tissue deformation models. We took CT images of a cube of silicone rubber with a pattern of embedded Teflon spheres that underwent uniaxial compression and spherical indentation tests. The known material properties, geometry and controlled boundary conditions resulted in a complete set of volumetric displacement data. The results were compared to a finite element model analysis of identical situations. This work has served as a proof of concept for a robust physical standard for use in validating soft tissue models. A web site has been created to provide access to our database: http://biorobotics.harvard.edu/truthcube/ (soon to be http://www.truthcube.org).