‘Can you put down your mission and plug into mine?’ How place-based initiatives leverage collaborations with academic institutions to enhance their ABCD and CBR potential

Place-Based Initiatives (PBIs) involve efforts to mobilise and coordinate local resources, services and expertise across multiple organisations and sectors in order to strengthen the social, structural, physical and economic conditions of historically disinvested neighbourhoods. While promising, these initiatives have had some documented challenges, and some are leveraging partnerships with academic institutions to address those challenges. In this article, we explore perspectives of leaders and staff from three PBI organisations in Charlotte, NC to better understand the benefits of PBI-academic partnerships and the conditions under which they are most effective. Thematic analysis of 23 semi-structured interviews revealed that PBIs leverage partnerships with academic institutions to accomplish two key goals. First, these partnerships stimulate asset- based community development (ABCD) by connecting community organisations and neighbourhood residents with academic resources and by strengthening PBI service delivery. Second, some partnerships give rise to community-based research efforts that help address external accountability challenges and inform PBI programming. The findings also illuminated several pitfalls in academic-PBI partnerships, sometimes rooted in conflicting priorities and approaches of academic researchers and non-profit practitioners. Finally, insights delineate key recommendations for improving PBI-academic collaborations, including countering academic exploitation by plugging into PBIs’ mission and respecting PBI expertise

Lifetime healthcare expenses across demographic and cardiovascular risk groups: The application of a novel modeling strategy in a large multiethnic cohort study

Objective: To understand the burden of healthcare expenses over the lifetime of individuals and evaluate differences among those with cardiovascular risk factors and among disadvantaged groups based on race/ethnicity and sex. Methods: We linked data from the longitudinal multiethnic Dallas Heart Study, which recruited participants between 2000 and 2002, with inpatient and outpatient claims from all hospitals in the Dallas-Fort Worth metroplex through December 2018, capturing encounter expenses. Race/ethnicity and sex, as well as five risk factors, hypertension, diabetes, hyperlipidemia, smoking, and overweight/obesity, were defined at cohort enrollment. For each individual, expenses were indexed to age and cumulated between 40 and 80 years of age. Lifetime expenses across exposures were evaluated as interactions in generalized additive models. Results: A total of 2184 individuals (mean age, 45±10 years; 61% women, 53% Black) were followed between 2000 and 2018. The mean modeled lifetime cumulative healthcare expenses were $442,629 (IQR,$423,850 to $461,408). In models that included 5 risk factors, Black individuals had$21,306 higher lifetime healthcare spending compared with non-Black individuals (P < .001), and men had modestly higher expenses than women ($5987, P < .001). Across demographic groups, the presence of risk factors was associated with progressively higher lifetime expenses, with significant independent association of diabetes ($28,075, P < .001), overweight/obesity ($8816, P < .001), smoking ($3980, P = .009), and hypertension ($528, P = .02) with excess spending. Conclusion: Our study suggests Black individuals have higher lifetime healthcare expenses, exaggerated by the substantially higher prevalence of risk factors, with differences emerging in older age