Geographic disparities in new onset of internalizing disorders in Pennsylvania adolescents using electronic health records

Irena Gorski-Steiner, Sean O'Dell, Karen Bandeen-Roche, Heather E. Volk, Fernando S. Goes, Brian S. Schwartz

Research output: Contribution to journalArticlepeer-review

Abstract

We evaluated associations of community types and features with new-onset internalizing disorders among Pennsylvania adolescents to identify the location and scale of risk. Using a nested case-control study, we drew subjects from electronic health records 2008–2016, requiring cases (n = 7974) to have two medication orders or diagnoses indicating an internalizing disorder; controls (n = 31,895) were frequency-matched. Subjects were assigned to three community classifications: townships, boroughs, city census tracts; urbanized areas, urban clusters, rural areas; and a combination. Using logistic regression with generalized estimating equations, we found that compared to rural-townships, the highest odds were in urban cluster-city census tracts (odds ratio, 95% confidence interval: 1.78, 1.41–2.26); lowest in urbanized area-city census tracts (0.85, 0.74–0.97). Higher community socioeconomic deprivation was associated with increased odds in urban clusters (1.21, 1.00–1.48) and higher greenness with decreased odds in urban clusters (0.73, 0.62–0.86).

Original languageEnglish (US)
Article number100439
JournalSpatial and Spatio-temporal Epidemiology
DOIs
StateAccepted/In press - 2021

Keywords

  • Adolescents
  • Anxiety
  • Depression
  • Environmental risk factors
  • Geographic disparities

ASJC Scopus subject areas

  • Epidemiology
  • Geography, Planning and Development
  • Infectious Diseases
  • Health, Toxicology and Mutagenesis

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