Tip of the iceberg: Measuring racial discrimination in studies of health

Examining Racial Discrimination Index and Black-Years of Potential Life Lost (YPLL) in South Carolina: A Real-Time Social Media Research

PURPOSE

Despite efforts to reduce health disparities, Black Americans still face higher mortality rates than Whites. Racism has been recognized as a significant social determinant of health. Using social media data, human-being qualitative coding, and AI, we created a county-level racial discrimination index, exploring its association with years of potential life lost (YPLL) rates.

METHODS

Through human-AI collaborative approaches using X/Twitter data, we calculated yearly county-level racial discrimination index (RDI)-number of racial discrimination posts per 100,000 in-county non-duplicated posts and examined the relationship between RDI terciles and YPLL per 100,000 non-Hispanic Black individuals. Annual data for the covariates were derived from 2018-2022 County Health Rankings and American Community Surveys across all South Carolina (SC) counties.

RESULTS

RDI increased from 2018 (mean [SD], 1.443 [1.991]) to 2022 (3.439 [5.761]). Adjusting for county sociodemographic factors and historical trends, RDI was associated with the YPLL rate (marginal effects, highest vs. lowest tercile, 421.3; 95% confidence interval, 134.7-709.8; p = 0.006).

CONCLUSIONS

Digital racial discrimination was highly associated with Black YPLL rates, confirming the importance of racial discrimination in health disparity, especially premature deaths. Addressing explicit and implicit racism in highly affected counties is crucial for reducing persistent health inequities and promoting equity in communities.

Racial and ethnic socioenvironmental inequity and neuroimaging in psychiatry: a brief review of the past and recommendations for the future

Neuroimaging is a major tool that holds immense translational potential for understanding psychiatric disorder phenomenology and treatment. However, although epidemiological and social research highlights the many ways inequity and representativeness influences mental health, there is a lack of consideration of how such issues may impact neuroimaging features in psychiatric research. More specifically, the potential extent to which racialized inequities may affect underlying neurobiology and impact the generalizability of neural models of disorders is unclear. The present review synthesizes research focused on understanding the potential consequences of racial/ethnic inequities relevant to neuroimaging in psychiatry. We first discuss historical and contemporary drivers of inequities that persist today. We then discuss the neurobiological consequences of these inequities as revealed through current research, and note emergent research demonstrating the impact such inequities have on our ability to use neuroimaging to understand psychiatric disease. We end with a set of recommendations and practices to move the field towards more equitable approaches that will advance our abilities to develop truly generalizable neurobiological models of psychiatric disorders.

The community food environment as an effect modifier of the relationship between racial discrimination and food insecurity among adults in Southern Brazil

BACKGROUND

Racial discrimination is linked to unhealthy food environments and a higher prevalence of food insecurity. However, no study has explored their interrelated effects. We analyzed the relationship between racial discrimination, community food environment, and food insecurity in adults of different socioeconomic status. We also investigated the potential modifying effect of the food environment on the relationship between racism and food insecurity.

METHODS

This was a cross-sectional study of 400 adults aged 20-70 years residing in the central area of ​​Porto Alegre, the capital of Rio Grande do Sul state. Race and racial discrimination were assessed by self-reported race/skin color using the Experiences of Discrimination scale (EOD), respectively. The food environment was assessed using the Nutrition Environment Measures Survey in Stores (NEMS-S) tool. Food insecurity was assessed using the short version of the Brazilian Food Insecurity Scale (EBIA for short, in Portuguese). Poisson regression with robust variance was employed for the multivariate analysis.

RESULTS

The prevalence of food insecurity was higher in areas with a poorer food environment (areas 1 and 3; 56.6% and 58.8%, respectively). Racial discrimination was associated with food insecurity, where every 1-point increase in the racial discrimination score increased the likelihood of food insecurity by 7% (prevalence ratio [PR] 1.07; 95% CI, 1.03-1.20). When stratifying the analyses by food environment, racial discrimination was associated with food insecurity only in areas with a poorer food environment (PR 1.06; 95% CI, 1.01-1.10).

CONCLUSIONS

Experiences of racial discrimination were associated with a higher prevalence of food insecurity in the study population. The community food environment was an effect modifier of this relationship, highlighting the relevance of interventions in the food environment focused on areas with a greater presence of Black people as a way of combating racism and food insecurity.

Education, Income, Wealth, and Discrimination in Black-White Allostatic Load Disparities

INTRODUCTION

Allostatic load (AL) is a significant marker of aging, associated with disease and mortality. Research has elucidated the impact of education and income on AL. However, the roles of wealth and discrimination in contributing to AL and shaping AL disparities remain underexplored. This study aimed to investigate the association between wealth and AL, while also examining the independent contributions of education, income, wealth, and everyday discrimination in shaping AL disparities.

METHODS

Using 2016 data from the nationally representative Health and Retirement Study (N=3,866), this study employed multilinear regression analysis to quantify the association between education and income, wealth (calculated as assets minus debts), and everyday discrimination with AL. Oaxaca-Blinder decomposition analysis was conducted to determine the proportion of AL disparities between Black and White participants attributed to education and income, wealth, and everyday discrimination. Analyses were performed in 2023.

RESULTS

Having a college degree or more (b = -0.32; 95% CI: -0.46, -0.17), higher income (b = -0.06; 95% CI: -0.11, -0.01), and greater wealth (b = -0.11; 95% CI: -0.16, -0.07) were linked to reduced AL. Conversely, increased experiences of everyday discrimination were associated with heightened AL (b = 0.07; 95% CI: 0.01, 0.16). Collectively, differences in possessing a college degree or more, wealth, and exposure to discrimination accounted for about 18% of the observed Black-White AL disparities.

CONCLUSIONS

Education, income, wealth, and experiences of discrimination may independently contribute to AL and partially explain Black-White disparities in AL. There is a need to elucidate the underlying mechanisms governing these relationships, particularly wealth, and extend the research to additional social determinants of racial health disparities.

Direct and indirect associations of experience of racial discrimination, dietary patterns and obesity in adults from southern Brazil

OBJECTIVE

To analyse the direct and indirect associations of experience of racial discrimination on dietary patterns (DP), obesity and abdominal obesity.

DESIGN

This is a cross-sectional population-based study. The main exposure was self-reported experiences of racial discrimination (Experiences of Discrimination scale). The mediator variables were the DP: healthy, Brazilian traditional, sugar and carbohydrates, and fast food. The outcomes were obesity (BMI ≥ 30 kg/m2) and abdominal obesity (waist circumference ≥ 88 cm for women; ≥ 102 cm for men). Structural equation modelling was applied.

SETTING

Porto Alegre, Brazil.

PARTICIPANTS

Totally, 400 adults aged between 20 and 70 years were participated.

RESULTS

The mean age of participants was 47·2 years (sd = 13·9), and 75 % were women. Experiencing racial discrimination had a positive direct effect on obesity (healthy DP: β = 0·153, P < 0·05; Brazilian DP: β = 0·156, P < 0·05; sugar and carbohydrates DP: β = 0·156, P < 0·05; and fast-food DP: β = 0·153, P < 0·05) and abdominal obesity (healthy DP: β = 0·206, P < 0·01; Brazilian DP: β = 0·210, P < 0·01; sugar and carbohydrates DP: β = 0·204, P < 0·01; and fast-food DP: β = 0·204, P < 0·01). The experience of racial discrimination did not have a direct effect on DP, nor did it exert an indirect effect on obesity and abdominal obesity through any DP.

CONCLUSIONS

A higher experience of racial discrimination is associated with obesity and abdominal obesity, independent of diet.

The cost of doubt: assessing the association between attributional ambiguity and mental health

OBJECTIVE

To quantify the association between attributional ambiguity-the uncertainty of whether an experience is discrimination-and mental health.

METHODS

Using a nationally representative sample of U.S. adults recruited through an online survey by Ipsos (April 23 and May 3, 2021), attributional ambiguity was quantified by asking participants if they experienced anything in the past 6 months that they were unsure was discrimination. The survey also assessed the degree to which these experiences caused participants to feel bothered and to ruminate on them. Multiple linear regression models were used to analyze associations between attributional ambiguity and depressive symptoms and mental health status.

RESULTS

Black and Hispanic participants reported higher rates of attributional ambiguity than White participants. Experiencing attributional ambiguity was associated with higher levels of depressive symptoms and poorer self-reported mental health status. Among those who reported attributional ambiguity, increases in bother and rumination scores were positively associated with depressive symptoms.

CONCLUSION

Attributional ambiguity is an important yet overlooked social determinant of mental health. More research is needed to fully understand the impact of this stressor on population health, particularly among minoritized populations.

Disentangling Socioeconomic Status and Race in Infant Brain, Birth Weight, and Gestational Age at Birth: A Neural Network Analysis

Background

Race is commonly used as a proxy for multiple features including socioeconomic status. It is critical to dissociate these factors, to identify mechanisms that affect infant outcomes, such as birth weight, gestational age, and brain development, and to direct appropriate interventions and shape public policy.

Methods

Demographic, socioeconomic, and clinical variables were used to model infant outcomes. There were 351 participants included in the analysis for birth weight and gestational age. For the analysis using brain volumes, 280 participants were included after removing participants with missing magnetic resonance imaging scans and those matching our exclusion criteria. We modeled these three different infant outcomes, including infant brain, birth weight, and gestational age, with both linear and nonlinear models.

Results

Nonlinear models were better predictors of infant birth weight than linear models (R2 = 0.172 vs. R2 = 0.145, p = .005). In contrast to linear models, nonlinear models ranked income, neighborhood disadvantage, and experiences of discrimination higher in importance than race while modeling birth weight. Race was not an important predictor for either gestational age or structural brain volumes.

Conclusions

Consistent with the extant social science literature, the findings related to birth weight suggest that race is a linear proxy for nonlinear factors related to structural racism. Methods that can disentangle factors often correlated with race are important for policy in that they may better identify and rank the modifiable factors that influence outcomes.

Patterns and Life Course Determinants of Black-White Disparities in Biological Age Acceleration: A Decomposition Analysis

Despite the prominence of the weathering hypothesis as a mechanism underlying racialized inequities in morbidity and mortality, the life course social and economic determinants of Black-White disparities in biological aging remain inadequately understood. This study uses data from the Health and Retirement Study (n = 6,782), multivariable regression, and Kitagawa-Blinder-Oaxaca decomposition to assess Black-White disparities across three measures of biological aging: PhenoAge, Klemera-Doubal biological age, and homeostatic dysregulation. It also examines the contributions of racial differences in life course socioeconomic and stress exposures and vulnerability to those exposures to Black-White disparities in biological aging. Across the outcomes, Black individuals exhibited accelerated biological aging relative to White individuals. Decomposition analyses showed that racial differences in life course socioeconomic exposures accounted for roughly 27% to 55% of the racial disparities across the biological aging measures, and racial disparities in psychosocial stress exposure explained 7% to 11%. We found less evidence that heterogeneity in the associations between social exposures and biological aging by race contributed substantially to Black-White disparities in biological aging. Our findings offer new evidence of the role of life course social exposures in generating disparities in biological aging, with implications for understanding age patterns of morbidity and mortality risks.

Racial Discrimination and Romantic Relationship Dynamics among Black Americans: A Systematic Review

Despite increasing research, the links between racial discrimination and Black Americans' romantic relationship dynamics remain unclear. Guided by models of mundane extreme environmental stress (Peters & Massey, 1983), sociocultural family stress (McNeil Smith & Landor, 2018), and Black marital outcomes (Bryant et al., 2010), we conducted a systematic review of the literature examining racial discrimination and relationship dynamics among Black Americans in same-race and interracial romantic relationships. Synthesizing findings from 32 published empirical articles, we find support for manifestations of each component of MEES in Black intimate life. We uncover evidence that racial discrimination is associated with compromised relationship functioning for Black Americans. Several psychosocial resources were also identified as either buffering these associations or posing drawbacks/limitations for Black Americans. We discuss notable gaps in the literature and directions for future research including intersectional investigations, broader examination of the MEES context, and de-centering whiteness among studies of interracial relationship dynamics.

The social patterning of vicarious discrimination: Implications for health equity

BACKGROUND

Most research on discrimination and health operationalizes discrimination as direct individual experiences. Here, we examine the social patterning of vicarious discrimination, an important but largely overlooked dimension of discrimination.

METHODS

Drawing on community-based participatory research with a multi-stage probability sample (n = 178) of African Americans in Tallahassee, Florida, we measured vicarious discrimination, or exposure to discrimination through one's family and friends. We used chi-square tests to examine gender differences in the social domains and relational sources of vicarious discrimination. Negative binomial regression models were fit to identify predictors of exposure to vicarious discrimination.

RESULTS

Vicarious discrimination is more prevalent than direct experiences of discrimination (73 versus 61%) and more than 20% of participants report vicarious discrimination in the absence of direct discrimination. For women, vicarious discrimination most often involved the workplace; for men, police. However, gender differences are smaller for vicarious versus direct discrimination. Close friends and children were top relational sources of vicarious discrimination for men and women, respectively. Middle-aged participants reported the most vicarious discrimination.

CONCLUSIONS

Overall, our data show that vicarious discrimination is more common than widely understood and associated with individual-level sociodemographic characteristics that index one's position in broader social systems. The prevalence of vicarious discrimination in the absence of direct discrimination suggests that standard approaches, which measure individual exposures in isolation, are subject to misclassification bias. Our results imply that existing research on discrimination and health, which already demonstrates substantial harm, underestimates African Americans' true exposures to salient aspects of discrimination.

Immediate and delayed effects of everyday racial discrimination on mental health among Black college students: A mixed-methods approach

Experiences of racial discrimination significantly contribute to both mental and physical health outcomes. In this mixed-methods study, we examine both the immediate and delayed effect of discrimination experienced in daily life. Black students at a predominantly White university reported instances of racial discrimination, affect, anxiety, and depression several times per day over 4 weeks ( N = 114); this was followed by qualitative focus groups ( N = 25). Reporting an instance of discrimination corresponded with an acute decline in psychological wellbeing (higher negative affect, anxiety, and depression), consistent with previous work. However, this effect did not carry forward to later assessments during the same day or the following day as expected. Instead, positive affect temporarily increased in the hours following experiences of discrimination. Qualitative focus groups revealed social support, emotional reflection and processing, and feelings of taking action as important factors contributing to this bump in positive affect.

Police killings and suicide among Black Americans

Black Americans are killed at higher rates by police than whites. Previous studies have shown that discrimination can lead to suicidal ideation, and that mental health of Black Americans deteriorates after police killings. The objective of this study is to examine whether police killings are associated with an increase in suicide rates amongst Black Americans. Controlling for a number of factors, we found that on months with at least one killing of a Black person by police, there were, on average, 0.0472 additional suicides per 100,000 Black Americans in the U.S. Census Division where the killing occurred. We did not find any spillover effects on other divisions. This association persisted when controlling for gun ownership, and did not seem to be a result of variance in deaths by assault. There was no association between killings of Black Americans and white suicides; white killings and Black suicides; or white killings and white suicides. This study highlights another reason for urgent action on reducing police killings.

Capturing the dynamic nature of stress exposure in the Pittsburgh Girls Study

Background

The science of stress exposure and health in humans has been hampered by differences in operational definitions of exposures and approaches to defining timing, leading to results that lack consistency and specificity. In the present study we aim to empirically derive variability in type, timing and chronicity of stress exposure for Black and White females using prospectively collected data in the Pittsburgh Girls Study (PGS).

Methods

The PGS is an ongoing 20-year longitudinal, community-based study. In this paper we focused on annual caregiver reports of three domains of stress: subsistence (e.g., resource strain, overcrowding); safety (e.g., community violence, inter-adult aggression), and caregiving (e.g., separation, maternal depression) from early childhood through adolescence. Z-scores were used to conduct a finite mixture model-based latent class trajectory analysis. Model fit was compared using the Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC). We examined differences in timing and chronicity of stress exposure between Black and White girls.

Results

Distinct trajectory groups characterized by differential timing and chronicity of stress exposure were observed across all stress domains. Six trajectories characterized subsistence and safety stress, and five characterized caregiving stress. Variability in initial level, chronicity, and magnitude and timing of change was observed within and across domains of stressors. Race differences also varied across the domains: race differences in timing and chronicity were most pronounced for the subsistence and safety domains, whereas Black and White girls had similar levels of exposure to caregiving stress.

Conclusions

Substantial variability in timing and chronicity was observed within and across stress domains. Modeling specific domains and dimensions of stress exposure is likely important in testing associations between exposure and health; such specificity may lead to more effective deployment of preventive interventions based on stress exposure.

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Distinct trajectories in exposure were observed for subsistence, safety, and caregiving stress domains.

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Race differences in timing and chronicity of exposure were pronounced for subsistence and safety domains.

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Patterns of exposure (e.g., level, timing) are likely critical for understanding the impact on stress exposure on health.