Ethnic inequalities in physico-chemical, physical and social neighborhood exposures: An individual-level data analysis of 13,926,781 adults

Abstract

INTRODUCTION: Ethnic minority populations may be disproportionally affected by unhealthy environmental exposures, increasing health inequities. This study aims to identify whether residential neighborhood exposures differ between ethnic groups in the Netherlands. METHODS: This cross-sectional study included all adult residents of the Netherlands registered in the national population register on 01/01/2022 (N = 13,926,871). Exposure data (physico-chemical, food and physical environment, socio-economic characteristics, health and social well-being) were obtained from Statistics Netherlands, GECCO and the Dutch Health Monitor, and linked to individuals based on geocoded home addresses. Ethnicity was based on country of birth of individuals and their parents. Estimated marginal means were calculated and ethnic differences in exposure determined using multiple linear regression, adjusted for age and sex, stratified by socio-economic status (SES) and population density. RESULTS: Compared to Dutch-origin, ethnic minority populations had less favorable physico-chemical exposures (e.g. 0.87 µg/m3 [95 %-CI: 0.86;0.88] higher PM2.5 exposure for Moroccans in "high SES-high population density"). Conversely, the food and physical activity environment was more favorable for ethnic minorities (e.g. 1.82 km/ha [95 %-CI 1.80;1.83] higher bike path density among Turks in the "low SES-low population" density category). Socio-economic characteristics of the environment were generally less favorable for ethnic minorities (e.g. difference between Dutch Caribbeans and Dutch-origin -4.23 % [95 %-CI -4.35;-4.11] in "high income-high population density"). Ethnic differences in health and social well-being varied. Neighborhood-level smoking was most prevalent among ethnic minorities, while excessive drinking was most prevalent among Dutch-origin. Exposure to vandalism and (sexual) violence was lowest among Dutch-origin and highest among Dutch Caribbean, Moroccans, Turks and Surinamese. CONCLUSION: Physico-chemical exposure, socio-economic characteristics of the environment and safety from crime were less favorable among ethnic minority populations compared to Dutch-origin. The food and physical activity environment was more favorable for ethnic minorities. Ethnic inequalities were most pronounced among Moroccans, Turks, Surinamese and Dutch Caribbeans compared to Dutch-origin.