ArticleHealth services research2020
Relationship of neighborhood social determinants of health on racial/ethnic mortality disparities in US veterans-Mediation and moderating effects.
Article in Health services research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 25 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it.
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- Social Vulnerability as a Neighborhood-Level Determinant of Pancreatic Cancer Survivorship: A National Analysis of Veterans Affairs Patients.Annals of surgical oncology · 2026Article
- The Interaction of Racial-Ethnic and Economic Concentration and its Association with Premature Mortality in U.S. Neighborhoods.Journal of racial and ethnic health disparities · 2026Article
- The relationship between neighborhood disadvantage and markers of chronic pain risk: Findings from the Oklahoma Study of Native American Pain Risk (OK-SNAP).The journal of pain · 2025Article
- High-Risk Infant Developmental Outcome Is Associated with Medical Complexity and Neighborhood Opportunity.The Journal of pediatrics · 2025Article
- Hepatitis C Care in the Greater New Orleans Area: Patient Perspectives on the Barriers and Facilitators to Care.Journal of health care for the poor and underserved · 2025Article
- The Association of Frailty and Neighborhood Disadvantage with Emergency Department Visits and Hospitalizations in Older Adults.Journal of general internal medicine · 2024Observational
- Investigation of the role of perceived access to primary care in mediating and moderating racial and ethnic disparities in chronic disease control in the veterans health administration.Health services research · 2024Article
- Estimated Average Treatment Effect of Psychiatric Hospitalization in Patients With Suicidal Behaviors: A Precision Treatment Analysis.JAMA psychiatry · 2024Article
- Association Between Social Determinants of Health and Communication Difficulties in Poststroke U.S. Hispanic and Non-Hispanic White Populations.American journal of speech-language pathology · 2024Article
- Mediating and Moderating Effects of Internet Use on Urban-Rural Disparities in Health Among Older Adults: Nationally Representative Cross-Sectional Survey in China.Journal of medical Internet research · 2023Article
- Association between modifiable social determinants and mental health among post-9/11 Veterans: A systematic review.Journal of military, veteran and family health · 2023Article
- Inclusion of Race and Ethnicity With Neighborhood Socioeconomic Deprivation When Assessing COVID-19 Hospitalization Risk Among California Veterans Health Administration Users.JAMA network open · 2023Article
- Association of maternal education, neighborhood deprivation, and racial segregation with gestational age at birth by maternal race/ethnicity and United States Census region in the ECHO cohorts.Frontiers in public health · 2023Article
- Association of Retail Environment and Neighborhood Socioeconomic Status With Mortality Among Community-Dwelling Older Adults in the United States: Cardiovascular Health Study.The journals of gerontology. Series A, Biological sciences and medical sciences · 2022Article
- Neighborhood Disadvantage, Patterns of Unhealthy Alcohol Use, and Differential Associations by Gender, Race/Ethnicity, and Rurality: A Study of Veterans Health Administration Patients.Journal of studies on alcohol and drugs · 2022Article
- The Role of Community-Level Factors on Disparities in COVID-19 Infection Among American Indian/Alaska Native Veterans.Journal of racial and ethnic health disparities · 2022Article
- Risk of COPD exacerbation is increased by poor sleep quality and modified by social adversity.Sleep · 2022Observational
Corrections and comments
- Erratum issued
Authors and funding
5 authors.
Funding
Abstract
objectiveTo examine mediation and moderation of racial/ethnic all-cause mortality disparities among Veteran Health Administration (VHA)-users by neighborhood deprivation and residential segregation. DATA SOURCES: Electronic medical records for 10/2008-9/2009 VHA-users linked to National Death Index, 2000 Area Deprivation Index, and 2006-2009 US Census. STUDY
designRacial/ethnic groups included American Indian/Alaskan Native (AI/AN), Asian, non-Hispanic black, Hispanic, Native Hawaiian/Other Pacific Islander, and non-Hispanic white (reference). We measured neighborhood deprivation by Area Deprivation Index, calculated segregation for non-Hispanic black, Hispanic, and AI/AN using the Isolation Index, evaluated mediation using inverse odds-weighted Cox regression models and moderation using Cox regression models testing for neighborhood*race/ethnicity interactions. PRINCIPAL
findingsMortality disparities existed for AI/ANs (HR = 1.07, 95%CI:1.01-1.10) but no other groups after covariate adjustment. Neighborhood deprivation and Hispanic segregation neither mediated nor moderated AI/AN disparities. Non-Hispanic black segregation both mediated and moderated AI/AN disparities. The AI/AN vs. non-Hispanic white disparity was attenuated for AI/ANs living in neighborhoods with greater non-Hispanic black segregation (P = .047). Black segregation's mediating effect was limited to VHA-users living in counties with low black segregation. AI/AN segregation also mediated AI/AN mortality disparities in counties that included or were near AI/AN reservations.
conclusionsNeighborhood characteristics, particularly black and AI/AN residential segregation, may contribute to AI/AN mortality disparities among VHA-users, particularly in communities that were rural, had greater black segregation, or were located on or near AI/AN reservations. This suggests the importance of neighborhood social determinants of health on racial/ethnic mortality disparities. Living near reservations may allow AI/AN VHA-users to maintain cultural and tribal ties, while also providing them with access to economic and other resources. Future research should explore the experiences of AI/ANs living in black communities and underlying mechanisms to identify targets for intervention.
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