Health & PlacePub Date : 2025-05-09DOI: 10.1016/j.healthplace.2025.103485
Chengzhe C. Xu, Xiaozhao Y. Yang
{"title":"Scenescape and youth tobacco use in China: a symbolic study of expressive and volatile scenes","authors":"Chengzhe C. Xu, Xiaozhao Y. Yang","doi":"10.1016/j.healthplace.2025.103485","DOIUrl":"10.1016/j.healthplace.2025.103485","url":null,"abstract":"<div><div>Previous research often measured sites and venues as proxies for place, but the place effect on health also comes from the symbolic value emanating from a place—namely the scenescape. This study investigates how scenescapes affected adolescent tobacco use by combining the number of venues and the symbolic meanings of each venue measured via separate surveys. We sampled 2800 adolescents and youths (age 15–25) from 33 schools from 4 major Sinitic cultural regions and tested whether exposure to highly expressive and volatile scenescapes increases the likelihood of tobacco use. We assessed and calculated the scores of expressiveness and volatility of the neighbourhood within the 3 km radius of the respondent's household. Then, we conducted hierarchical logistic regression on tobacco use and the scene scores, adjusted for random effects and covariates. The results indicate that adolescents living in volatile scenes were more likely to smoke combustible cigarettes (3.66, p < 0.05), whereas expressive scenes were negatively associated with smoking (−3.58, p < 0.01). Vaping e-cigarettes showed no significant association with either expressiveness or volatility. These findings highlight the importance of the symbolic scenes in understanding youth substance use.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"94 ","pages":"Article 103485"},"PeriodicalIF":3.8,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143923396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health & PlacePub Date : 2025-05-08DOI: 10.1016/j.healthplace.2025.103484
Dahabo Adi Galgalo , Patrick Nyamemba Nyakundi , Ákos Várnagy , Viktória Prémusz
{"title":"Evaluating the effectiveness of the global position system beaded bracelets to improve the uptake of antenatal care, health facility delivery, and post-natal care services among pastoralist women in Kenya","authors":"Dahabo Adi Galgalo , Patrick Nyamemba Nyakundi , Ákos Várnagy , Viktória Prémusz","doi":"10.1016/j.healthplace.2025.103484","DOIUrl":"10.1016/j.healthplace.2025.103484","url":null,"abstract":"<div><h3>Background</h3><div>Antenatal Care (ANC), Health Facility Delivery (HFD), and Postnatal Care (PNC) are the leading indicators of improving maternal and child healthcare globally. This study investigated the effectiveness of a prototyped Global Position System (GPS) beaded bracelet intervention in enhancing maternal healthcare services uptake among pastoralist communities.</div></div><div><h3>Methods</h3><div>In this Randomized Control Trial (RCT), one hundred and seven pregnant women in their first trimester were randomly allocated to the intervention group (n = 52) and control group (n = 55). A GPS-beaded bracelet was given to the intervention group for the study duration of 16 months (6 months before delivery and 10 months after delivery). Meanwhile, the non-intervention group received routine ante- and postnatal care. The Pearson X<sup>2</sup> test and multivariate logistic regression analysis were conducted using IBM SPSS version 27.0, following the Consolidated Standards of Reporting Trials (CONSORT) guidelines. Model fit was assessed using, the Omnibus test of model Co-efficient, classification table, Nagelkerke R Square, and the Hosmer-Lemeshow test. The significance level was set at p < 0.05. RCT was registered (ISRCTN15438206), and the GPS beaded bracelet was patented by Kenya Industrial Property Institutes (KIPI) NO: KE/UM/19/1211.</div></div><div><h3>Results</h3><div>Women in the intervention group have nine-fold higher likelihood of having more than four ANC visits (AOR 9.13, 95 % CI 1.75–47.54), three-fold higher likelihood of having postnatal care (AOR 2.71, 95 % CI 0.74–9.96), and a fourfold higher of giving live birth (AOR 3.56, 95 % CI 0.47–27.07) compared to women in the control group. No significant differences were noted between groups when it comes to place of delivery, indicating that while GPS may facilitate access to health facilities, it did not markedly change delivery outcomes based on location, but there is likelihood of delivering in a health facility (OR 2.0, 95 % CI 0.39–8.21). Other variables like age group, literacy level, and distance from health facility didn't exhibit a statistically significant association. All three methods of model fit assessment indicated good model fit.</div></div><div><h3>Conclusion</h3><div>The study result showed the effectiveness of GPS-beaded bracelets by significantly improving ANC, HFD, and PNC attendance and reducing infant mortality. Future studies should focus on refining these technologies to explore the long-term impacts and scalability of such interventions across diverse pastoralist populations to improve maternal and child healthcare.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"94 ","pages":"Article 103484"},"PeriodicalIF":3.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143923397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health & PlacePub Date : 2025-05-07DOI: 10.1016/j.healthplace.2025.103482
Cristela Mae C. Candelario , Eleanor C. Castillo
{"title":"Crossing waters, crossing divides: A qualitative exploration of patient navigation experiences in Philippine Island communities","authors":"Cristela Mae C. Candelario , Eleanor C. Castillo","doi":"10.1016/j.healthplace.2025.103482","DOIUrl":"10.1016/j.healthplace.2025.103482","url":null,"abstract":"<div><div>Navigating healthcare systems registers unique challenges in geographically isolated areas, where physical barriers and spatial inequities influence access to care. Patient navigation is well positioned to address these persistent health disparities, however, services remain scant in island communities of the Philippines. This study employs a situated intersectionality framework to investigate how place intersects with individual characteristics and social resources to drive patient navigation experiences in these geographically disadvantaged areas, examining the dynamic interactions between physical isolation, digital connectivity, social networks, and healthcare access. Through a relational understanding of health and place, this study utilized purposive sampling to invite participants for four focus group discussions and six key informant interviews. Thematic analysis revealed several key dimensions of patient navigation in this geographical context, including how digital navigation services help overcome geographical barriers while simultaneously creating new forms of inequality based on technological access and capability; how community resources and social capital create virtual bridges to mainland healthcare facilities; and how navigation services reduce the temporal and economic burdens unique to island settings. The analysis demonstrated how these factors interact differently across demographic groups and spatial locations within the island context. These findings elucidate how geographical context cuts through individual and social factors to create both opportunities and constraints in healthcare navigation, demonstrating the value of situated intersectionality in understanding how multiple forms of disadvantage traverse within specific spatial contexts. Recommendations include place-sensitive institutionalization of patient navigation services, strategic investment in geographically distributed technological infrastructure, and strengthening community-based navigation support systems to ensure effectiveness and sustainability of such endeavors in island communities.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"94 ","pages":"Article 103482"},"PeriodicalIF":3.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health & PlacePub Date : 2025-05-06DOI: 10.1016/j.healthplace.2025.103478
Julija Simpson , Viviana Albani , Luke Munford , Clare Bambra
{"title":"Left behind? A longitudinal ecological study of ‘regional deprivation amplification’ and life expectancy growth in in England (2004 to 2020)","authors":"Julija Simpson , Viviana Albani , Luke Munford , Clare Bambra","doi":"10.1016/j.healthplace.2025.103478","DOIUrl":"10.1016/j.healthplace.2025.103478","url":null,"abstract":"<div><div>Geographical inequalities in health are substantial and increasing in many countries. In England, there is a life expectancy gap amongst the 20 % most deprived local authorities – between those in the northern regions and those in the rest of the country. We sought to quantify the size and evolution of this gap and to investigate potential contributing factors.</div><div>We used data from official national statistics covering years 2004–2020 for the 20 % most deprived local authorities in England, divided into north and rest of England. We conducted a Blinder-Oaxaca decomposition which quantified the size of the life expectancy gap for both men and women and identified the key contributing factors drawing on ‘deprivation amplification’ concept and other theories of health inequalities.</div><div>We have found that there is a long-standing and widening gap in life expectancy between local authorities in the north and the rest of England. The gap is greater for women than for men (11.7 vs. 7.0 months on average); the widening of the gap over the past two decades has also been greater for women. Our decomposition analysis indicates that regional differences in income are the main contributor to this gap for both men and women (explaining 69 % and 44 % of the gap, respectively), with behavioural factors such as smoking having no explanatory power.</div><div>Overall, our findings suggest that providing additional income-based resources to areas lagging behind in life expectancy may be an effective way of reducing place-based health inequalities both in England and in similar regionally imbalanced economies.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"94 ","pages":"Article 103478"},"PeriodicalIF":3.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health & PlacePub Date : 2025-05-01DOI: 10.1016/j.healthplace.2025.103465
Mohammad Javad Koohsari , Koichiro Oka , Tomoki Nakaya , Emily Talen , Andrew T. Kaczynski
{"title":"Revisiting public open space and physical activity: What we know, what we still don't, and emerging issues—A decade later","authors":"Mohammad Javad Koohsari , Koichiro Oka , Tomoki Nakaya , Emily Talen , Andrew T. Kaczynski","doi":"10.1016/j.healthplace.2025.103465","DOIUrl":"10.1016/j.healthplace.2025.103465","url":null,"abstract":"<div><div>Public open spaces provide settings for physical activity, but research on their role continues to develop. A decade ago, a paper published by Koohsari et al. (2015) in <em>Health & Place</em> identified key conceptual and methodological challenges in public open spaces and physical activity research. Since its publication, the paper has been widely cited, with over 340 citations and a field-weighted citation impact of 10.70 (Scopus). The current interdisciplinary commentary revisits the original study, evaluates progress over the past decade, and discusses emerging issues. While some conceptual and methodological gaps have been addressed, challenges remain. Emerging issues such as intensifying climate change, pandemics, and technological shifts continue to shape how public open spaces influence physical activity. Further interdisciplinary studies among urban designnce, parks and recreation, geography, public health, and other relevant fields are needed to address these challenges.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"94 ","pages":"Article 103465"},"PeriodicalIF":3.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Neighborhood socioeconomic disadvantage and travel time to diabetes prevention programs in Maryland","authors":"Portia Buchongo , Jie Chen , Quynh Nguyen , Kellee White-Whilby , Dushanka Kleinman , Luisa Franzini","doi":"10.1016/j.healthplace.2025.103470","DOIUrl":"10.1016/j.healthplace.2025.103470","url":null,"abstract":"<div><h3>Background</h3><div>Transportation issues are a significant barrier for accessing the National Diabetes Prevention Program (NDPP), which remains an effective intervention to prevent type 2 diabetes. Although the link between neighborhood socioeconomic disadvantage and access to health care resources has been widely studied, its impact on travel time and access to NDPP has been underexplored.</div></div><div><h3>Methods</h3><div>Medicaid and private claims data for 2019 from the Maryland Medical Care Data Base were linked to 2019 Social Deprivation Index (SDI) data to measure neighborhood socioeconomic disadvantage. Google Distance Matrix Application Programming Interface key for Google Maps Platform was used to generate travel time estimates for enrollees diagnosed with prediabetes. Then adjusted generalized linear regression models using SDI quintiles and the interaction of SDI quintile and race and ethnicity were fitted to predict driving and public transit travel time to the nearest NDPP.</div></div><div><h3>Findings</h3><div>Enrollees living in neighborhoods with the highest SDI scores (most disadvantaged) had significantly shorter driving and public transit travel time to the nearest NDPP compared to enrollees living in neighborhoods with the lowest SDI scores (least disadvantaged). We found differences in the magnitude of shorter travel times across racial and ethnic groups and transportation mode.</div></div><div><h3>Conclusion</h3><div>Our findings fill a major gap in the literature on neighborhood socioeconomic disadvantage and travel time to NDPP. Findings highlight the role state policies may have had in expanding access to NDPP. More research is needed to examine strategies to address racial and ethnic disparities, and transportation needs to improve access to in-person NDPP.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"94 ","pages":"Article 103470"},"PeriodicalIF":3.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health & PlacePub Date : 2025-04-30DOI: 10.1016/j.healthplace.2025.103462
Yuru Huang , Tom RP. Bishop , Jean Adams , Steven Cummins , Matthew Keeble , Chiara Rinaldi , Annie Schiff , Thomas Burgoine
{"title":"Understanding the socio-spatial distribution of “dark retail” in England: Development of a unique retail location dataset","authors":"Yuru Huang , Tom RP. Bishop , Jean Adams , Steven Cummins , Matthew Keeble , Chiara Rinaldi , Annie Schiff , Thomas Burgoine","doi":"10.1016/j.healthplace.2025.103462","DOIUrl":"10.1016/j.healthplace.2025.103462","url":null,"abstract":"<div><div>Online food delivery services (OFDS) are an increasingly popular way of accessing both ready-to-consume foods and groceries. Such foods are sometimes delivered from facilities not open to the public - so called ‘dark retail’. However, there is a lack of data on ‘dark retail’, which limits understanding of their location, prevalence and growth. We identified different types of dark kitchens (i.e., “virtual brands”, “ghost kitchens”) and dark grocery stores (i.e., “large dark grocers”, “small/independent dark grocers”). Using data on 113,370 unique online food outlets from three major food delivery platforms (<em>Uber Eats, JustEat, and Deliveroo</em>) in England, we created a database of dark retail locations and analysed their socio-spatial distribution. Dark retail accounted for 14 % of all online food outlets, with the majority being virtual brands. Overall, dark retail is more likely to be located in more deprived areas. The extent of dark retail observed highlights the importance of incorporating them into existing regulatory frameworks. Our database and findings provide insights into the socio-spatial distribution of dark retail, which could inform future research and policy development in this area.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"94 ","pages":"Article 103462"},"PeriodicalIF":3.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health & PlacePub Date : 2025-04-30DOI: 10.1016/j.healthplace.2025.103477
Wenbo Guo , Tim Schwanen , Christian Brand , Yanwei Chai
{"title":"The associations of real-time and perceived air pollution exposure with episode-level subjective wellbeing: a case study of a suburban community in Beijing","authors":"Wenbo Guo , Tim Schwanen , Christian Brand , Yanwei Chai","doi":"10.1016/j.healthplace.2025.103477","DOIUrl":"10.1016/j.healthplace.2025.103477","url":null,"abstract":"<div><h3>Background</h3><div>The dynamics of everyday life and mobility patterns are often neglected in studies examining the association between air pollution and subjective wellbeing (SWB). We investigated the association between air pollution exposure, both by ambient and perceived measurement, and subjective wellbeing for individuals’ activity episodes and trips in Beijing.</div></div><div><h3>Methods</h3><div>Data on 1688 activities and 573 trips were obtained from the activity-travel diary survey in the Meiheyuan residential community, Beijing, from November 2017 to January 2018. Real-time exposure to ambient air pollution (AAP) in the form of fine particulate matter (PM<sub>2.5</sub>) was collected using portable air pollution sensors, and perceived air pollution (PAP) and SWB at the episode level were acquired through activity-travel diaries. Multi-level structural equation modelling (ML-SEM) was used to investigate the associations between air pollution and SWB separately for daily activity episodes and trips.</div></div><div><h3>Results</h3><div>PAP is not only directly associated with SWB at both activity and trip episodes but also mediates between AAP and SWB for activities. A time-lagged effect of AAP on SWB is observed for trips, where AAP of the preceding episode is directly linked to SWB at the current episode. Location plays a fundamental role in shaping individuals’ AAP, PAP and SWB at activity episodes. The effects of start time, location, activity type and duration are primarily mediated by location and location-PAP. life circumstances shape their exposure to and perceptions of air pollution, as well as their SWB during activity and trip episodes.</div></div><div><h3>Conclusion</h3><div>People's perception of air pollution bears a more pronounced relationship with their satisfaction with individual activities and trips compared to the objective measurements of ambient PM<sub>2.5</sub> exposure. It also highlights that ambient PM<sub>2.5</sub> exposure during the preceding activity episode has a time-lagged effect on satisfaction with the current trip episode.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"94 ","pages":"Article 103477"},"PeriodicalIF":3.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health & PlacePub Date : 2025-04-30DOI: 10.1016/j.healthplace.2025.103475
Jason Wong , Emma Zang
{"title":"Regional disparities in cognitive life expectancy: The role of birth and current residence in the United States","authors":"Jason Wong , Emma Zang","doi":"10.1016/j.healthplace.2025.103475","DOIUrl":"10.1016/j.healthplace.2025.103475","url":null,"abstract":"<div><div>Regional disparities in cognitive impairment are well-documented, but the combined impact of birth and current residence remains unclear. Prior studies examine geographic patterns, yet none estimate years spent in different cognitive states—key for understanding long-term health and policy implications. Using data from the 1998–2020 Health and Retirement Study (105,491 observations from 19,213 individuals), we employ a Bayesian multistate life table approach to estimate cognitively healthy and impaired life expectancies at age 50 across different combinations of birth and current regions. Our findings show that birth region plays a stronger role in cognitive impairment risk than current residence. At age 50, Southern-born individuals, regardless of where they live later, have fewer years without cognitive impairment (Men: 20.5–21.5; Women: 24.8–25.4) and more years with dementia (Men: 2.3–2.5; Women: 3.0–3.1) than those born elsewhere. Those both born and living in the South have the shortest cognitively healthy life expectancy. Regional differences based on current residence alone are minimal and only evident when considered alongside birthplace. Beyond the Southern birth disadvantage, we also identify a Western birth disadvantage, particularly in life expectancy with dementia and, for women, a higher percentage of life spent with cognitive impairment but not dementia. This suggests that Western-born individuals, especially women, may experience prolonged cognitive decline even if they avoid full-blown dementia. These findings provide new evidence of the lasting impact of early-life geographic exposures on cognitive impairment risk, underscoring that growing up in certain regions, particularly the South and, in some respects, the West, can shape cognitive health trajectories decades later.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"94 ","pages":"Article 103475"},"PeriodicalIF":3.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health & PlacePub Date : 2025-04-30DOI: 10.1016/j.healthplace.2025.103476
Valdés-Giraldo Paulina , Munera-Moreno Viviana , Ordóñez-Monak Ivonne Andrea , Arroyave Ivan , Trujillo Natalia
{"title":"Echoes of Inequity: Charting Colombia's stroke mortality shifts and socioeconomic and spatial disparities over two decades","authors":"Valdés-Giraldo Paulina , Munera-Moreno Viviana , Ordóñez-Monak Ivonne Andrea , Arroyave Ivan , Trujillo Natalia","doi":"10.1016/j.healthplace.2025.103476","DOIUrl":"10.1016/j.healthplace.2025.103476","url":null,"abstract":"<div><h3>Background</h3><div>Stroke remains a significant public health challenge globally and in Colombia, influenced by socioeconomic and demographic factors. Despite declining mortality rates, inequities persist. This study explores trends in stroke mortality in Colombia (1999–2017), focusing on inequalities by age, sex, and educational attainment.</div></div><div><h3>Method</h3><div>A descriptive longitudinal retrospective study was conducted using mortality data from the National Administrative Department of Statistics. Standardized Mortality Rates (SMRs) were calculated, adjusting for age and sex. Poisson regression models and the Relative Index of Inequality (RII) assessed inequalities. Geographic analyses examined spatial mortality patterns using Geographic Information Systems.</div></div><div><h3>Results</h3><div>Between 1999 and 2017, 262,350 stroke deaths occurred, predominantly in older adults and individuals with lower educational attainment. Stroke mortality declined over time but remained higher among men (66.01/100,000) compared to women (65.74/100,000). Mortality rates were highest in individuals with primary education and lowest in those with tertiary education. Geographic analysis revealed higher mortality in more economically developed regions, suggesting potential underreporting in less developed areas. The RII highlighted pronounced inequalities, especially among women and younger age groups.</div></div><div><h3>Conclusions</h3><div>While stroke mortality in Colombia has decreased, marked inequities persist, particularly by educational level and geographic region. Addressing these inequalities requires targeted public health policies to enhance healthcare access and promote equity.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"94 ","pages":"Article 103476"},"PeriodicalIF":3.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}