Racialized economic segregation, the built environment, and assault-related injury: Moderating role of green space...

To examine the association between racialized economic segregation and assault-related injury hospital visits in metropolitan neighborhoods spanning five American states, and whether this relationship varies by vacant housing and green space.

Data on assault visits from 2016 to 2019 Healthcare Cost and Utilization Project were linked with population, landcover, and park data for Arizona, Florida, Georgia, North Carolina, and New York. Racialized economic segregation was operationalized using Index of Concentration at the Extremes (ICE) for household income by race. All assault and firearm assault visits were aggregated by ZIP Code Tabulation Area and discharge year. Negative binomial regression was used to calculate incident rate ratios (aIRR) to estimate associations between segregation and assaults. Interaction terms between segregation and each green space and vacant housing moderator were included in separate models, adjusting for state, year of discharge, and population demographics.

For each 1-SD increase in ICE (increased advantage), all assault and firearm assault visit rates decreased (aIRR 0.62[0.60,0.64] and aIRR 0.43[0.41,0.45], respectively). Higher levels of vacant housing were associated with more all assault visits in the most disadvantaged neighborhoods but not in advantaged neighborhoods. Higher levels of forest space were protective for all assault and firearm assault visits in the most disadvantaged neighborhoods but not in advantaged neighborhoods.

Neighborhoods with the least economic and social resources had higher all assault and firearm assault visit rates than neighborhoods with more. Our results highlight the potential mitigating role of forest space on the relationship between segregation and assault hospital visits.