Dr. Azita Amiri, an associate professor with the College of Nursing at the University of Alabama in Huntsville, a part of the University of Alabama System, has been awarded a $25,000 Network of Practice Grant by the Bloomberg American Health Initiatives, Johns Hopkins Bloomberg School of Public Health, to examine life expectancy inequities in Alabama.
The researcher plans to use findings from the project to develop a community-centric blueprint designed to address social environmental determinants of health in selected neighborhoods in the region.
“Evidence is convincing that social and built-environmental conditions affect health, including life expectancy, as much as genetics and other personal characteristics,” Amiri said. “In the United States, life expectancy varies widely across geographical regions, neighborhoods, and even city blocks. Equitable societies and built environments, such as access to healthcare centers or healthy food groceries, are essential for equal life expectancies.”
Fifty-five out of 67 Alabama counties are considered rural, comprising 44% of the state’s population, based on 2020 U.S. census data, and 58 of the counties are designated “medically underserved,” Amiri said.
“Rural populations in Alabama suffer from an unequal distribution of resources, poverty, low literacy, environmental injustice and unequal disease burdens from cancer, diabetes, cardiovascular disease and all-cause mortality,” he said.
The study will use life expectancy data from the Center for Disease Control’s U.S. Small-area Life Expectancy Estimates Project to support the effort, as well as health data from the Agency for Healthcare Research and Quality within the U.S. Department of Health and Human Services.
“Based on the 2022 America’s Health Rankings composite measure, Alabama is ranked 45th out of 50 states in America’s Health Rankings, according to the most recent data, and among the states with the lowest life expectancy, Alabama is 49th after Mississippi,” said Amiri. “Multiple factors, including the lack of access to care and high rates of physical inactivity, premature death, low birth weight, multiple chronic conditions and obesity drive this poor standing.”
Amiri will be supported by Dr. Shuang Zhao of the UAH Political Sciences Department, certified in public health policy, and a UAH Nursing Ph.D. candidate. The research will focus in particular on environmental challenges in the areas selected for study, and the findings of the initiative will be presented to state officials to propose cost-effective interventions aimed at addressing these challenges.
“Five neighborhoods with low life expectancies and high disparities will be selected, and focus group sessions for each will be arranged to discuss the problems and seek input and solutions from community members and leaders,” Amiri said.
Dr. Shima Hamidi, a Bloomberg assistant professor in the Department of Environmental Health and Engineering, will act as faculty advisor for the project and will tour the selected areas, discuss data analysis and address community member feedback.
“Dr. Hamidi and community representatives will meet with state officials, such as the Governor, state representatives and the head of the Alabama Department of Public Health in Montgomery to discuss proposed next steps,” Amiri said.
Environmental determinants affecting life expectancy will be identified using a variety of relevant databases. Examples include the Food Access Research Atlas for locating food ‘deserts’ where it is difficult to buy affordable or good-quality fresh food; Walkscore Inc., for indicators of walkability and transit access; the Fatality Analysis Reporting System within the National Highway Traffic Safety Administration for data on traffic crashes and fatalities; the American Community Survey for population density, socioeconomic and demographic indicators; and the National Incident-Based Reporting System for violence and crime rates.
“We will include socioeconomic and demographic variables in the analysis as well,” Dr. Amiri says. “This will include the proportion of black and other minorities, marital status, education, sex, employment status, race, income/poverty ratio, food stamp/supplemental nutrition assistance programs participants, household income, immigration status, self-care difficulty and insurance/Medicaid coverage.”
In addition, geospatial and census tract data will be used to measure the distance between neighborhoods and health centers, healthy food locations and industrial pollution, while air pollution in each area will be assessed using measurements of particulate matter from the U.S. Environmental Protection Agency.
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