Current Research
Area deprivation amplifies racial inequities in premature mortality in WA state
In the United States, place of residence and racial identity are closely tied to health and wellbeing. A large body of evidence has confirmed that whites living in more-affluent areas have the best chances of a long, healthy life. However, less is known about if and how race and neighborhood deprivation interact in relation to health. In this epidemiological study, we analyzed 242,667 deaths in WA state, for which we could obtain information about the last residential address for each individual at the time of their death. Addresses were used to determine decedents’ exposure to deprivation based on the Area Deprivation Index. We also classified decedents’ race using federal racial categories, as well as their education, gender, and other socioeconomic and demographic characteristics. Our resutls show that deaths among non-whites from deprived neighborhoods were between three and eight times more likely to be premature compared to more-affluent whites.
Eastern Washington Health Profile
The Eastern Washington Health Report aims evaluated the community health status and health issues known to affect individuals and communities in eastern Washington. We compared this region of the state and its distinctly different set of health and social issues to those in western Washington.
The Association Between Obesity, Socio-Economic Status, and Neighborhood Environment: A Multi-Level Analysis of Spokane Public Schools
Socio economic inequities in obesity have been attributed to individuals’ psychosocial and behavioral characteristics. School environment, where children spend a large part of their day, may play an important role in shaping their health. This study aims to assess whether prevalence of overweight and obesity among elementary school students was associated with the school’s social and built environments. Analyses were based on 28 public elementary schools serving a total of 10,327 children in the city of Spokane, Washington. Schools were classified by percentage of students eligible for free and reduced meals (FRM). Crime rates, density of arterial roads, healthy food access, and walkability were computed in a one-mile walking catchment around schools to characterize their surrounding neighborhood. In the unadjusted multilevel logistic regression analyses, age, sex, percentage of students eligible for FRM, crime, walkability, and arterial road exposure were individually associated with the odds of being overweight or obese. In the adjusted model, the odds of being overweight or obese were higher with age, being male, and percentage of students eligible for FRM. The results call for policies and programs to improve the school environment, students’ health, and safety conditions near schools.
Estimated Residential Exposure to Agricultural Chemicals and Premature Mortality by Parkinson’s Disease in Washington State
The aim of this study was to examine the relationship between estimated residential exposure to agricultural chemical application and premature mortality from Parkinson’s disease (PD) in Washington State. Washington State mortality records for 2011–2015 were geocoded using residential addresses, and classified as having exposure to agricultural land-use within 1000 meters. Generalized linear models were used to explore the association between land-use associated with agricultural chemical application and premature mortality from PD. Individuals exposed to land-use associated with glyphosate had 33% higher odds of premature mortality than those that were not exposed (Odds Ratio (OR) = 1.33, 95% Confidence Intervals (CI) = 1.06–1.67). Exposure to cropland associated with all pesticide application (OR = 1.19, 95% CI = 0.98–1.44) or Paraquat application (OR = 1.22, 95% CI = 0.99–1.51) was not significantly associated with premature mortality from PD, but the effect size was in the hypothesized direction. No significant associations were observed between exposure to Atrazine (OR = 1.21, 95% CI = 0.84–1.74) or Diazinon (OR = 1.07, 95% CI = 0.85–1.34), and premature mortality from PD. The relationship between pesticide exposure and premature mortality aligns with previous biological, toxicological, and epidemiological findings. Glyphosate, the world’s most heavily applied herbicide, and an active ingredient in Roundup® and Paraquat, a toxic herbicide, has shown to be associated with the odds of premature mortality from PD.
Spatial access to opioid treatment program and alcohol and cannabis outlets: analysis of missed doses of methadone during the first, second, and third 90 days of treatment
Background: The burden of access to opioid treatment programs (OTPs) may change as clients become eligible for take-home privileges. Our previous study showed clients who lived more than 10-miles away from an OTP were more likely to miss methadone doses during the first 30 days of treatment. Proximity to alcohol and cannabis outlets may also negatively influence treatment adherence.
Objective: To examine the association between access to this OTP, alcohol and cannabis outlets, and the number of missed methadone doses during the first, second, and third 90 days of treatment.
Methods: The number of missed methadone doses was calculated for 752, 689, and 584 clients who remained in treatment, respectively, for at least 3, 6, and 9 months (50% female). Distance between client’s home and the OTP, alcohol, and cannabis outlets was measured. Generalized linear models were employed.
Results: Shorter distance from a client’s residence to the OTP was associated with a decreased number of missed methadone doses during the first 90 days of treatment. Shorter distance to the closest cannabis retail outlet was associated with an increased number of missed methadone doses during the first and second 90 days of treatment. Shorter distance to the closest off-premise alcohol outlet was associated with an increased number of missed methadone doses during the third 90 days of treatment.
Conclusions: Improving spatial accessibility of OTPs are essential to ensure treatment opportunities are available for individuals so affected. Exploring to what extent residing in areas that facilitate alcohol and cannabis availability can influence treatment adherence is warranted.
Three-year retention in methadone opioid agonist treatment: A survival analysis of clients by dose, area deprivation, and availability of alcohol and cannabis outlets
The objective of this study was to determine the effect of clinical, socio-demographic, and contextual characteristics on treatment retention in an opioid treatment program (OTP).Using a retrospective longitudinal review of 851 clients who received methadone at the only state-funded OTP in Spokane County, Washington between 2015 and 2017. A time variable (the number of days in treatment) and a status indicator (to distinguish between clients who dropped out or censored) worked together to define retention in treatment. Our hypothesized covariates included: area deprivation, distance to the OTP, availability of cannabis retail outlets, availability of on-premise and off-premise alcohol outlets, methadone dosage, age, gender, race, and years on treatment. Cox regression within the family of survival analysis was used to model time-to-event data in the presence of censored cases.
That results showed that the median duration of retention was 394 (95%CI = 324–464) days. In the multivariable Cox regression, factors predicting treatment retention were area deprivation (HR = 1.79, 95%CI = 1.02–3.15, p = 0.04), age (HR=0.99, 95%CI=0.98-.99, p = 0.008), dosage of methadone (HR=0.98, 95%CI=0.98-0.98, p < 0.001), and the number of years on treatment (HR=1.12, 95%CI=1.06-1.18, p < 0.001).
The findings of this study showed age and methadone dosage were protective factors and area deprivation and years on treatment were risk factors for treatment retention. After dichotomizing methadone dosage, a unique finding of this study was that higher dosage of methadone did not lead to increasingly smaller HRs for dropping out of treatment. Considering that opioid use disorder is a chronic condition, efforts need to be made to target factors associated with retention.
Increased distance was associated with lower daily attendance to an opioid treatment program in Spokane County Washington
Adherence to opioid agonist therapy using methadone is associated with improved clinical and community outcomes such as reductions in drug use, criminal behavior, high-risk sexual behavior, and mortality. Unfortunately, however, the need to have patients’ methadone ingestion witnessed at the clinic on a daily basis may comprise adherence. In this study we found significant positive associations between distance to an Opioid Treatment Program (OTP) and the number of missed doses in the first month of treatment. Findings suggest the need to improve the spatial availability of OTPs to optimize opioid use disorder treatment outcomes.
Distance to HIV care and treatment adherence: Adjusting for socio-demographic and geographical heterogeneity
Distance to health services plays an important role in determining access to care and an individual's health. This study aims to examine the relationship between distance to antiretroviral therapy (ART) prescribing physician and adherence to HIV treatment in British Columbia, Canada. Only participants who provided highly accurate locational data for both place of residence and their physician were used in the analysis. Using logistic regression, a multivariable confounder model was created to assess the association between distance and adherence. A geographically weighted logistic regression was also performed to adjust for spatial dependency. There were 1528 participants in the analysis, for a median distance of 17.85km. The final model showed further away from ART prescribing physician had a higher chance of incomplete adherence to ART (adjusted odds ratio 1.31; 95% Confidence Interval 1.04–1.65). Mobile services could potentially increase adherence rates for population residing further away from their ART prescribing physician.
