{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T08:55:41Z","timestamp":1791276941773,"version":"4.1.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2019,8,1]],"date-time":"2019-08-01T00:00:00Z","timestamp":1564617600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007271","name":"University of Tennessee Health Science Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007271","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Our objective was to develop and test a new concept (affinity) analogous to multimorbidity of chronic conditions for individuals at census tract level in Memphis, TN. The use of affinity will improve the surveillance of multiple chronic conditions and facilitate the design of effective interventions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used publicly available chronic condition data (Center for Disease Control and Prevention 500 Cities project), socio-demographic data (US Census Bureau), and demographics data (Environmental Systems Research Institute). We examined the geographic pattern of the affinity of chronic conditions using global Moran\u2019s I and Getis-Ord Gi* statistics and its association with socio-economic disadvantage (poverty, unemployment, and crime) using robust regression models. We also used the most common behavioral factor, smoking, and other demographic factors (percent of the male population, percent of the population 67 years, and over and total population size) as control variables in the model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A geo-distinctive pattern of clustered chronic affinity associated with socio-economic deprivation was observed. Statistical results confirmed that neighborhoods with higher rates of crime, poverty, and unemployment were associated with an increased likelihood of having a higher affinity among major chronic conditions. With the inclusion of smoking in the model, however, only the crime prevalence was statistically significantly associated with the chronic affinity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Chronic affinity disadvantages were disproportionately accumulated in socially disadvantaged areas. We showed links between commonly co-observed chronic diseases at the population level and systematically explored the complexity of affinity and socio-economic disparities. Our affinity score, based on publicly available datasets, served as a surrogate for multimorbidity at the population level, which may assist policymakers and public health planners to identify urgent hot spots for chronic disease and allocate clinical, medical and healthcare resources efficiently.<\/jats:p><\/jats:sec>","DOI":"10.1093\/jamiaopen\/ooz029","type":"journal-article","created":{"date-parts":[[2019,8,1]],"date-time":"2019-08-01T15:20:29Z","timestamp":1564672829000},"page":"317-322","source":"Crossref","is-referenced-by-count":24,"title":["Geo-clustered chronic affinity: pathways from socio-economic disadvantages to health disparities"],"prefix":"10.1093","volume":"2","author":[{"given":"Eun Kyong","family":"Shin","sequence":"first","affiliation":[{"name":"Department of Pediatrics, The University of Tennessee Health Science Center \u2013 Oak-Ridge National Laboratory (UTHSC-ORNL), Center for Biomedical Informatics, Memphis, Tennessee, USA"},{"name":"Department of Sociology, Korea University, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youngsang","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Earth Science, The University of Memphis, Memphis, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2047-4759","authenticated-orcid":false,"given":"Arash","family":"Shaban-Nejad","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, The University of Tennessee Health Science Center \u2013 Oak-Ridge National Laboratory (UTHSC-ORNL), Center for Biomedical Informatics, Memphis, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,8,1]]},"reference":[{"key":"2020013108075632100_ooz029-B1","volume-title":"The Growing Crisis of Chronic Disease in the United States","author":"Wu","year":"2000"},{"issue":"3","key":"2020013108075632100_ooz029-B2","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.phr.2004.04.005","article-title":"The growing burden of chronic disease in America","volume":"119","author":"Anderson","year":"2004","journal-title":"Public Health Rep"},{"key":"2020013108075632100_ooz029-B3","volume-title":"Multiple Chronic Conditions Chartbook","author":"Gerteis","year":"2014"},{"issue":"S3","key":"2020013108075632100_ooz029-B4","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s11606-007-0322-1","article-title":"Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs","volume":"22","author":"Vogeli","year":"2007","journal-title":"J Gen Intern Med"},{"key":"2020013108075632100_ooz029-B5","author":"Okhmatovskaia"},{"key":"2020013108075632100_ooz029-B6"},{"issue":"7","key":"2020013108075632100_ooz029-B7","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/S0895-4356(00)00363-2","article-title":"Causes and consequences of comorbidity: a review","volume":"54","author":"Gijsen","year":"2001","journal-title":"J Clin Epidemiol"},{"issue":"1","key":"2020013108075632100_ooz029-B8","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1111\/jep.12587","article-title":"Multimorbidity\u2019as the manifestation of network disturbances","volume":"23","author":"Sturmberg","year":"2017","journal-title":"J Eval Clin Pract"},{"issue":"9836","key":"2020013108075632100_ooz029-B9","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/S0140-6736(12)60240-2","article-title":"Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study","volume":"380","author":"Barnett","year":"2012","journal-title":"Lancet"},{"issue":"1","key":"2020013108075632100_ooz029-B10","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1111\/jep.12723","article-title":"Multimorbidity\u2014A manifestation of network disturbances? How to investigate? How to treat?","volume":"23","author":"Miles","year":"2017","journal-title":"J Eval Clin Pract"},{"key":"2020013108075632100_ooz029-B11","author":"World Health Organization","year":"2010"},{"key":"2020013108075632100_ooz029-B12"},{"issue":"1","key":"2020013108075632100_ooz029-B13","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1111\/jep.12599","article-title":"Multimorbidity: a sociological perspective of systems","volume":"23","author":"Walker","year":"2017","journal-title":"J Eval Clin Pract"},{"issue":"2","key":"2020013108075632100_ooz029-B14","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/S1353-8292(01)00002-8","article-title":"The fear of crime and area differences in health","volume":"7","author":"Chandola","year":"2001","journal-title":"Health Place"},{"issue":"1","key":"2020013108075632100_ooz029-B15","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/1353-8292(95)00004-6","article-title":"Individuals and their ecologies: analysing the geography of chronic illness within a multilevel modelling framework","volume":"1","author":"Jones","year":"1995","journal-title":"Health & Place"},{"key":"2020013108075632100_ooz029-B16","doi-asserted-by":"crossref","first-page":"46281","DOI":"10.1109\/ACCESS.2018.2866069","article-title":"Urban decay and pediatric asthma prevalence in Memphis, Tennessee: urban data integration for efficient population health surveillance","volume":"6","author":"Shin","year":"2018","journal-title":"IEEE Access"},{"key":"2020013108075632100_ooz029-B17","first-page":"436","article-title":"Geo-distinctive comorbidity networks of pediatric asthma","volume":"247","author":"Shin","year":"2018","journal-title":"Stud Health Technol Inform"},{"key":"2020013108075632100_ooz029-B18","volume-title":"2013 Memphis Poverty Fact Sheet","author":"Delavega","year":"2013"},{"key":"2020013108075632100_ooz029-B19","author":"Shelby County Health Department","year":"2015"},{"issue":"9339","key":"2020013108075632100_ooz029-B20","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/S0140-6736(02)11133-0","article-title":"The world report on violence and health","volume":"360","author":"Krug","year":"2002","journal-title":"The Lancet"},{"issue":"6","key":"2020013108075632100_ooz029-B21","doi-asserted-by":"crossref","first-page":"910","DOI":"10.2307\/2657519","article-title":"The significance of socioeconomic status in explaining the racial gap in chronic health conditions","volume":"65","author":"Hayward","year":"2000","journal-title":"Am Sociol Rev"},{"issue":"2","key":"2020013108075632100_ooz029-B22","doi-asserted-by":"crossref","first-page":"596","DOI":"10.3390\/ijerph7020596","article-title":"Text and structural data mining of influenza mentions in web and social media","volume":"7","author":"Corley","year":"2010","journal-title":"Int J Environ Res Public Health"},{"issue":"8","key":"2020013108075632100_ooz029-B23","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1002\/2327-6924.12215","article-title":"Health consequences of adverse childhood experiences: a systematic review","volume":"27","author":"Kalmakis","year":"2015","journal-title":"J Am Assoc Nurse Pract"},{"key":"2020013108075632100_ooz029-B24","author":"Applied Geographic Solutions"},{"issue":"3","key":"2020013108075632100_ooz029-B25","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1111\/j.1538-4632.1992.tb00261.x","article-title":"The analysis of spatial association by use of distance statistics","volume":"24","author":"Getis","year":"2010","journal-title":"Geogr Anal"},{"key":"2020013108075632100_ooz029-B26","volume-title":"Robust Regression and Outlier Detection","author":"Rousseeuw","year":"2005"},{"key":"2020013108075632100_ooz029-B27","doi-asserted-by":"crossref","DOI":"10.5888\/pcd10.120203","article-title":"Peer reviewed: prevalence of multiple chronic conditions among US adults: estimates from the National Health Interview Survey, 2010","volume":"10","author":"Ward","year":"2013","journal-title":"Prev Chronic Dis"},{"issue":"6835","key":"2020013108075632100_ooz029-B28","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1038\/35077207","article-title":"Cancer genetics","volume":"411","author":"Ponder","year":"2001","journal-title":"Nature"},{"key":"2020013108075632100_ooz029-B29","author":"American Cancer Society","year":"2008"}],"container-title":["JAMIA Open"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jamiaopen\/article-pdf\/2\/3\/317\/32298943\/ooz029.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jamiaopen\/article-pdf\/2\/3\/317\/32298943\/ooz029.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,15]],"date-time":"2021-01-15T20:14:38Z","timestamp":1610741678000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamiaopen\/article\/2\/3\/317\/5542687"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,1]]},"references-count":29,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2019,8,1]]},"published-print":{"date-parts":[[2019,10,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jamiaopen\/ooz029","relation":{},"ISSN":["2574-2531"],"issn-type":[{"value":"2574-2531","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,10]]},"published":{"date-parts":[[2019,8,1]]}}}