A quantitative intersectional approach to measuring change in built environment amenities and the association with...

The relationship between health and the built environment is well established, but common methods conceptualizing "place" rely on static or demographic-based interpretations that do not capture its complexity. Marrying Intersectionality Theory and political economics, we conceptualize place as a manifestation of complex, mutually constructive forces that shape the lived experience, and assert that quantitative intersectionality is essential to understanding the role of place in health outcomes.

NaNDA neighborhood data were converted to person-area density across social determinants of health (SDoH) domains at the county level for each year between 2014 and 2019. Log-transformed densities were regressed against year, summed, and exponentiated to calculate the composite average annual change in a county's SDoH amenities. This composite change trend was regressed against county-level 2020 and 2021 COVID-19 and cardiovascular disease (CVD) mortality using multilevel Bayesian models adjusted for year and older population percentage, with state and SDoH intersectional strata as random intercepts.

A 0.1-unit increase in the composite change trend-approximately equivalent to the IQR of the composite trend-was associated with a 4.10% reduction in COVID-19 mortality rate (IRR = 0.959, 95% CrI = [0.944, 0.975]), all else held equal. A 0.1-unit increase in the composite change trend was significantly associated with a 3.15% reduction in a county's CVD mortality rate (IRR = 0.969, 95% CI = [0.959, 0.986]).

This novel approach to conceptualizing the built environment in epidemiological research supports the growing conversations among the fields of economics, urban planning, and public health.