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A lack of fine, spatially-resolute case data for the U.S. has prevented the examination of how COVID-19 burden has been distributed across neighborhoods, a known geographic unit of both risk and resilience, and is hampering efforts to identify and mitigate the long-term fallout from COVID-19 in vulnerable communities. Using spatially-referenced data from 21 states at the ZIP code or census tract level, we documented how the distribution of COVID-19 at the neighborhood-level varies significantly within and between states. The median case count per neighborhood (IQR) in Oregon was 3,608 (2,487) per 100,000 population, indicating a more homogenous distribution of COVID-19 burden, whereas in Vermont the median case count per neighborhood (IQR) was 8,142 (11,031) per 100,000. We also found that the association between features of the neighborhood social environment and burden varied in magnitude and direction by state. Our findings underscore the importance of local contexts when addressing the long-term social and economic fallout communities will face from COVID-19.

Objectives: Socialization predicts cognitive aging outcomes. Neighborhoods may facilitate socially engaged aging and thus shape cognition. We investigated places where older adults socialized and whether availability of these sites was associated with cognitive outcomes. Methods: Qualitative analysis of interviews and ethnography with 125 older adults (mean age 71 years) in Minneapolis identified where participants socialized outside of home. This informed quantitative analysis of a national sample of 21,151 older Americans (mean age at baseline 67 years) from the Reasons for Geographic and Racial Differences in Stroke study. Multilevel generalized additive models described associations between access to key social places and cognitive function and decline. Results: Qualitative analysis identified eateries, senior centers, and civic groups as key places to socialize. We identified significant positive associations between kernel density of senior centers, civic/social organizations, and cognitive function. Discussion: Specific neighborhood social infrastructures may support cognitive health among older adults aging in place.

Stark geographic variation in later-life health outcomes suggests that local built and social environments are critical in shaping disease and disability, physical and cognitive function, and engagement in everyday life among older adults. This paper presents a community-engaged mapping project aiming to depict the uneven distribution of hazards and amenities relevant to cognitive aging across the United States. Living in neighborhoods with opportunities for social interaction (e.g., coffee shops, senior centers), intellectual stimulation (e.g., museums, libraries) and physical activity (e.g., parks, walkable streets) may slow rates of cognitive decline and reduce risk for Alzheimer’s disease. We assembled a community advisory board to translate research findings into a pilot website and interactive map that assesses neighborhoods for cognitive aging resources and amenities. The objective is to increase public awareness and inform public health and policy efforts to ameliorate community barriers and create more equitable opportunities to promote healthy aging in place.

Rain, snow, or ice may discourage older adults from leaving their homes with potential consequences for social isolation, decreased physical activity, and cognitive decline. This study is the first to examine potential links between annual precipitation exposure and cognitive function in a large population-based cohort of older Americans. We examined the association between precipitation (percent of days with snow or rain in the past year) and cognitive function in 25,320 individuals aged 45+ from the Reasons for Geographic and Racial Differences in Stroke Study. Linear mixed models assessed the relationship between precipitation and cognitive function, as well as rates of change in cognitive function with age. We found a non-linear relationship between precipitation and cognitive function. Compared to those exposed to infrequent precipitation (less than 20% of days with rain/snow in the past year), cognitive function was higher among older adults experiencing moderately frequent precipitation (20&ndash, 40% of annual days with precipitation). However, beyond more than about 45% of days with precipitation in the past year, there was a negative association between precipitation and cognitive function, with faster rates of cognitive decline with age. These exploratory findings motivate further research to better understand the complex role of precipitation for late-life cognitive function.

Racial disparities in cognitive function are well-known. However, the role of neighborhood environments in modifying trajectories of cognitive function by race has not been examined using national data. Using data from 26,439 non-Hispanic Black and White Americans (mean age 64) in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study we used gender-stratified growth curve models to examine how baseline census tract neighborhood environments (socioeconomic disadvantage, affluence, racial/immigrant composition, public libraries, crime rates, and urbanicity (captured through population density)) were associated with trajectories of cognitive impairment (Six-item Screener (SIS) scores

Racial residential segregation may be a fundamental cause of health disparities in the U.S., and few studies employ objective measures of segregation to estimate its impacts on cognitive decline. Using data from 21,446 REGARDS participants in urban areas, we employed race-stratified growth curve models to examine how city racial segregation was associated with trajectories of cognitive decline over time. Controlling for demographics and health conditions/behaviors, higher segregation for blacks was marginally associated with lower cognitive function at baseline (b=-0.159, p

RÉSUMÉLa littérature a documenté une relation positive entre la mobilité à l’extérieur chez les personnes âgées et les environnements bâtisables et marchables. Cependant, étonnamment, toute considération de la façon dont le temps modifie l’accessibilité piétonnière à travers les quartiers est absente. À Vancouver, au Canada, on a utilisé des données météorologiques archivées liées à des données recueillies auprès d’un échantillon d’aînés. On a constaté que, lorsqu’il neige, les quartiers où l’on dépend d’automobiles (comportant des blocs plus longs, moins d’intersections et une plus grande distance aux commodités) sont devenus inaccessibles. Même les adultes plus âgés qui vivaient dans les quartiers qui étaient très bien adaptés au traffic pietonnier marchait à 25 pour cent moins de destinations pendant la neige. Il est essentiel de tenir compte de l’impact des conditions météorologiques dans la relation entre la marchabilité des quartiers et la mobilité des personnes âgées.

Research on temperature and cognition is sparse, including effects of outdoor air temperature on cognitive testing performance. Furthermore, little is known about the modifying role of region and seasonality in temperature-cognition associations. We linked daily temperature data from National Oceanic and Atmospheric Administration weather stations to REGARDS participants by cognitive assessment date. Controlling for season, generalized linear models including spline terms for temperature showed an adverse effect of hotter temperatures on cognition. At higher temperatures (30°C vs 0°C), there was a significant decrease in cognitive performance on the Word List Learning test (β=-0.68; 95% CI: -1.1, -0.25). Results also show regional differences in testing scores on hotter and colder days. The findings provide new understanding of cognitive susceptibility to extreme temperatures and factors that exacerbate or buffer this association. This can inform development of evidence-based public health guidelines and mitigation strategies aimed at reducing temperature-related morbidity in older adults.

Snowfall, sleet and rain can adversely affect the mobility of older adults, with negative consequences for engagement in daily activities and socializing. This can lead to isolation and loneliness, which can negatively impact cognitive functioning. We tested whether long-term exposure to precipitation – particularly snow and cold rain (precipitation at ambient temperatures between 0°C and 10°C) – negatively impacts age-related cognitive function trajectories among a national sample of over 30,000 Americans (aged 45+) in the Reasons for Geographic and Racial Differences in Stroke study followed since 2003. Linear growth mixture models showed that living in an area with a 25% greater proportion of days with snow/rain in the past year was associated with a 0.6 unit decrease in cognitive function score (p

Over the last two decades, the impact of community characteristics on the physical and mental health of residents has emerged as an important frontier of research in population health and health disparities. However, the development and evaluation of measures to capture community characteristics is still at a relatively early stage. The purpose of this work was to assess the reliability of a neighborhood audit instrument administered in the city of Chicago using Google Street View by comparing these “virtual” data to those obtained from an identical instrument administered “in-person”. We find that a virtual audit instrument can provide reliable indicators of recreational facilities, the local food environment, and general land use. However, caution should be exercised when trying to gather more finely detailed observations. Using the internet to conduct a neighborhood audit has the potential to significantly reduce the costs of collecting data objectively and unobtrusively.

Herpes simplex virus (HSV) infection can be devastating in the neonate. The disease most commonly presents as 1 of 3 clinical manifestations: disseminated visceral infection (with and without central nervous system involvement), isolated meningoencephalitis, and infection limited to the skin, eyes, and/or mucous membranes (SEM). Exposure leading to neonatal infection typically occurs as peripartum vertical transmission, most typically by direct contact with urogenital lesions or infected genital secretions, or as an ascending infection exploiting disrupted chorioamniotic membranes. We present a novel case of a newborn girl who developed HSV-2 keratoconjunctivitis despite being delivered via an elective, uncomplicated, repeat cesarean over intact chorioamniotic membranes in the absence of active clinical maternal HSV infection and despite having a negative medical history of previous orolabial or genital herpetic infection.