Place-Based Inequity in Smoking Prevalence in the Largest Cities in the United States

Abstract

This study uses data from the 500 Cities Project to characterize inequities in cigarette smoking both between and within cities and their association with sociodemographic factors and chronic diseases.

Figure.. Smoking Prevalence Inequities and Their Association With Inequities in Chronic Diseases

A, All cities have at least some inequity (Gini coefficient ≥0.03) and 4 cities (Washington, DC; Atlanta, Georgia; Fort Lauderdale, Florida; and Miami, Florida) have particularly high inequity (Gini ≥0.20). B, The prevalence of current self-reported asthma, chronic obstructive pulmonary disease (COPD), and coronary heart disease (CHD) is higher in tracts with higher prevalence of current smoking. Estimates shown in Figure 1B result from multivariable linear mixed models that adjust for percent non-Hispanic white population, median household income, total population size, and a random effect for city. We calculated the expected percent increase in prevalence of each chronic disease of changing from the 10th to 90th percentile of smoking prevalence (from 10.7% to 27.6%) and the corresponding 95% confidence intervals using these multivariable linear mixed models and by using 1000 draws from the multivariate normal distribution with the mean equal to the maximum likelihood point estimate and the variance equal to the coefficient covariance matrix. C, Differences in tract-level smoking prevalence for the city with the greatest inequity in smoking prevalence: Washington, DC (Gini = 0.23). The color in the image uses Jenks natural breaks (9 classes) based on the data for the Washington, DC, census tracts. One Washington, DC, census tract had insufficient data to make a smoking prevalence estimate and is illustrated in gray. Data sources and analytical methods are further detailed in the supplementary appendix.