Veterans Affairs (VA) Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California.
Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA).
JAMA Netw Open. 2023 Mar 1;6(3):e231471. doi: 10.1001/jamanetworkopen.2023.1471.
Despite complexities of racial and ethnic residential segregation (hereinafter referred to as segregation) and neighborhood socioeconomic deprivation, public health studies, including those on COVID-19 racial and ethnic disparities, often rely on composite neighborhood indices that do not account for residential segregation.
To examine the associations by race and ethnicity among California's Healthy Places Index (HPI), Black and Hispanic segregation, Social Vulnerability Index (SVI), and COVID-19-related hospitalization.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included veterans with positive test results for COVID-19 living in California who used Veterans Health Administration services between March 1, 2020, and October 31, 2021.
Rates of COVID-19-related hospitalization among veterans with COVID-19.
The sample available for analysis included 19 495 veterans with COVID-19 (mean [SD] age, 57.21 [17.68] years), of whom 91.0% were men, 27.7% were Hispanic, 16.1% were non-Hispanic Black, and 45.0% were non-Hispanic White. For Black veterans, living in lower-HPI (ie, less healthy) neighborhoods was associated with higher rates of hospitalization (odds ratio [OR], 1.07 [95% CI, 1.03-1.12]), even after accounting for Black segregation (OR, 1.06 [95% CI, 1.02-1.11]). Among Hispanic veterans, living in lower-HPI neighborhoods was not associated with hospitalization with (OR, 1.04 [95% CI, 0.99-1.09]) and without (OR, 1.03 [95% CI, 1.00-1.08]) Hispanic segregation adjustment. For non-Hispanic White veterans, lower HPI was associated with more frequent hospitalization (OR, 1.03 [95% CI, 1.00-1.06]). The HPI was no longer associated with hospitalization after accounting for Black (OR, 1.02 [95% CI, 0.99-1.05]) or Hispanic (OR, 0.98 [95% CI, 0.95-1.02]) segregation. Hospitalization was higher for White (OR, 4.42 [95% CI, 1.62-12.08]) and Hispanic (OR, 2.90 [95% CI, 1.02-8.23]) veterans living in neighborhoods with greater Black segregation and for White veterans in more Hispanic-segregated neighborhoods (OR, 2.81 [95% CI, 1.96-4.03]), adjusting for HPI. Living in higher SVI (ie, more vulnerable) neighborhoods was associated with greater hospitalization for Black (OR, 1.06 [95% CI, 1.02-1.10]) and non-Hispanic White (OR, 1.04 [95% CI, 1.01-1.06]) veterans.
In this cohort study of US veterans with COVID-19, HPI captured neighborhood-level risk for COVID-19-related hospitalization for Black, Hispanic, and White veterans comparably with SVI. These findings have implications for the use of HPI and other composite neighborhood deprivation indices that do not explicitly account for segregation. Understanding associations between place and health requires ensuring composite measures accurately account for multiple aspects of neighborhood deprivation and, importantly, variation by race and ethnicity.
尽管种族和族裔居住隔离（以下简称隔离）以及邻里社会经济剥夺的复杂性，包括 COVID-19 种族和族裔差异的公共卫生研究，通常依赖于不考虑居住隔离的综合邻里指数。
在加利福尼亚州的健康场所指数（HPI）、黑人和西班牙裔隔离、社会脆弱性指数（SVI）和 COVID-19 相关住院之间，按种族和族裔进行关联分析。
设计、地点和参与者：本队列研究包括在加利福尼亚州使用退伍军人健康管理局服务的 COVID-19 检测呈阳性的退伍军人，他们于 2020 年 3 月 1 日至 2021 年 10 月 31 日期间接受了治疗。
COVID-19 相关住院率在 COVID-19 退伍军人中的变化。
可用于分析的样本包括 19495 名 COVID-19 退伍军人（平均[标准差]年龄，57.21[17.68]岁），其中 91.0%为男性，27.7%为西班牙裔，16.1%为非西班牙裔黑人，45.0%为非西班牙裔白人。对于黑人退伍军人来说，生活在 HPI 较低（即健康状况较差）的社区与较高的住院率相关（优势比[OR]，1.07[95%置信区间，1.03-1.12]），即使在考虑到黑人隔离之后（OR，1.06[95%置信区间，1.02-1.11]）。对于西班牙裔退伍军人来说，生活在 HPI 较低的社区与住院无关（OR，1.04[95%置信区间，0.99-1.09]）和没有西班牙裔隔离（OR，1.03[95%置信区间，1.00-1.08]）调整。对于非西班牙裔白人退伍军人来说，HPI 较低与更频繁的住院相关（OR，1.03[95%置信区间，1.00-1.06]）。在考虑到黑人（OR，1.02[95%置信区间，0.99-1.05]）或西班牙裔（OR，0.98[95%置信区间，0.95-1.02]）隔离后，HPI 与住院不再相关。白人（OR，4.42[95%置信区间，1.62-12.08]）和西班牙裔（OR，2.90[95%置信区间，1.02-8.23]）退伍军人居住在黑人隔离程度较高的社区，以及居住在西班牙裔隔离程度较高的社区的非西班牙裔白人退伍军人（OR，2.81[95%置信区间，1.96-4.03]）的住院率更高，同时调整了 HPI。生活在 SVI 较高（即更脆弱）的社区与黑人（OR，1.06[95%置信区间，1.02-1.10]）和非西班牙裔白人（OR，1.04[95%置信区间，1.01-1.06]）退伍军人的住院率增加相关。
在这项针对美国 COVID-19 退伍军人的队列研究中，HPI 与 SVI 相比，可比较地捕获了与 COVID-19 相关住院的黑人和西班牙裔以及非西班牙裔白人士兵的社区风险。这些发现对 HPI 和其他不明确考虑隔离的综合邻里剥夺指数的使用具有影响。了解地点与健康之间的关系需要确保综合措施准确地考虑到邻里剥夺的多个方面，重要的是，需要考虑种族和族裔的差异。
