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. 2022 Jun:41:100439.
doi: 10.1016/j.sste.2021.100439. Epub 2021 Jun 27.

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

Irena Gorski-Steiner  1 , Sean O'Dell  2 , Karen Bandeen-Roche  3 , Heather E Volk  4 , Fernando S Goes  5 , Brian S Schwartz  6
Affiliations

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

Irena Gorski-Steiner et al. Spat Spatiotemporal Epidemiol. 2022 Jun.

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).

Keywords: Adolescents; Anxiety; Depression; Environmental risk factors; Geographic disparities.

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Conflict of interest statement

Declaration of interest

The authors all report no financial interests or potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Map showing study region by classifications of urban/rural status, administrative community type, and their overlap (combined community definition).
See this image and copyright information in PMC

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