Residential segregation and Latino, black and white mortality in New York City

A matter of measurement? A Swedish register-based study of migrant residential segregation and all-cause mortality

Background

In recent decades, Sweden has become an increasingly diverse society by origin, but one in which residential segregation by migrant background has also increased. This study examines how different aspects of migrant residential segregation are associated with all-cause mortality among native-born and migrant populations.

Methods

Using Swedish population-based registers, this longitudinal open cohort study assessed associations between four local level indices of migrant residential segregation and all-cause mortality among adult migrant and native-born residents of Sweden's three largest metropolitan areas (Stockholm, Gothenburg, and Malmö) between 2004 and 2016. Multilevel Poisson regression models, adjusted for individual-level sociodemographic and socioeconomic factors as well as area-level socioeconomic conditions, were used to estimate associations between these indices and all-cause mortality.

Results

Moderate decreased mortality risks were observed among migrants in residential areas with higher levels of migrant density, isolation, and exposure in fully adjusted models. However, isolation and exposure effects could not be distinguished due to a high degree of correlation between the isolation and exposure measures. In fully adjusted models mortality gradients were largely unobserved among native-born individuals in relation to migrant residential segregation. The evenness dimension of segregation showed limited relevance for mortality risk in both groups.

Conclusions

This study provides evidence that higher migrant density is associated with lower mortality risks among migrants, suggesting that residential areas with higher proportions of migrants may offer health benefits for migrants. These findings highlight the importance of residential contexts in shaping migrant health outcomes.

The Interaction of Racial-Ethnic and Economic Concentration and its Association with Premature Mortality in U.S. Neighborhoods

Recent research shows a significant link between race-ethnicity and income concentration and premature death rates in the U.S. However, most studies focus on Black-White residential concentration, overlooking racial-ethnic diversity. Our study examines the impact of racial-ethnic majority composition on mortality and how this relationship varies across different levels of economic concentration in neighborhoods, as defined by census tracts. Premature death rates (under 65 years of age) were retrieved from abridged period life tables from 67,140 U.S. census tracts derived from the U.S. Small-area Life Expectancy Project. Covariate factors were retrieved from the 2011-2015 American Community Survey (ACS) 5-year estimates. We measured racial-ethnic concentration by grouping neighborhoods using each tract's majority racial-ethnic group, and approximated income concentration using the Index of Concentration of the Extremes. We used three-level random intercept models to examine the interaction of racial-ethnic and income concentration and its association with neighborhood mortality risk, accounting for covariates. Our study yielded three salient findings. First, mortality risk varied greatly in poor neighborhoods with different racial-ethnic compositions compared to affluent neighborhoods, with notable higher risk in Black-majority areas. Second, in diverse neighborhoods where no single ethnic group forms a majority-referred to as Minority-majority neighborhoods-the mortality risk is comparable to that in White-majority neighborhoods. Third, Hispanic/Latino- and Asian-majority neighborhoods had lower mortality risk than White-majority neighborhoods in areas with a high concentration of poverty, but similar mortality risk in affluent areas. The study suggests that racial-ethnic and socioeconomic area-based measures are important to consider together to address mortality inequities accurately.

The effects of residential segregation on cognition among U.S. older adults: a systematic review based on the social determinants of health model

OBJECTIVES

This systematic review aims to advance the understanding of the complicated effects of segregation on older adults' cognition and provide guidance for future research.

METHOD

A systematic review using the Social Determinants of Health framework to examine the relationship between segregation and cognition across the selected literature.

RESULTS

Eight papers met the criteria for inclusion. All selected studies examined the influence of living in a segregated area on older adults' cognition, covering older adults from different racial/ethnic groups. The association between segregation and cognition was found in different directions across different racial/ethnic groups. The effects can be varied depending on race/ethnicity, level of education, neighborhood socioeconomic status, or social context.

CONCLUSION

This review identified existing gaps in understanding the relationship between segregation and cognition. Future studies should carefully adopt the segregation measures, acknowledge the varying segregation experience among different racial/ethnic groups, and consider more social determinant factors in research.

Racial and economic segregation and diabetes mortality in the USA, 2016-2020

BACKGROUND

The purpose of this study was to examine the association between racial and economic segregation and diabetes mortality among US counties from 2016 to 2020.

METHODS

We conducted a cross-sectional ecological study that combined county-level diabetes mortality data from the National Vital Statistics System and sociodemographic information drawn from the 2016-2020 American Community Survey (n=2380 counties in the USA). Racialized economic segregation was measured using the Index Concentration at the Extremes (ICE) for income (ICEincome), race (ICErace) and combined income and race (ICEcombined). ICE measures were categorised into quintiles, Q1 representing the highest concentration and Q5 the lowest concentration of low-income, non-Hispanic (NH) black and low-income NH black households, respectively. Diabetes was ascertained as the underlying cause of death. County-level covariates included the percentage of people aged ≥65 years, metropolitan designation and population size. Multilevel Poisson regression was used to estimate the adjusted mean mortality rate and adjusted risk ratios (aRR) comparing Q1 and Q5.

RESULTS

Adjusted mean diabetes mortality rate was consistently greater in counties with higher concentrations of low-income (ICEincome) and low-income NH black households (ICEcombined). Compared with counties with the lowest concentration (Q1), counties with the highest concentration (Q5) of low-income (aRR 1.96; 95% CI 1.81 to 2.11 for ICEincome), NH black (aRR 1.32; 95% CI 1.18 to 1.47 for ICErace) and low-income NH black households (aRR 1.70; 95% CI 1.56 to 1.84 for ICEcombined) had greater diabetes mortality.

CONCLUSION

Racial and economic segregation is associated with diabetes mortality across US counties.

Racial/Ethnic Residential Segregation, Neighborhood Health Care Provision, and Choice of Pediatric Health Care Provider Across the USA

Much research has been conducted that demonstrates a link between racial/ethnic residential segregation and health care outcomes. We suggest that minority segregated neighborhoods may have diminished access to organizations and that this differential access may contribute to differences in health care outcomes across communities. We analyze this specifically using the case of pediatric health care provider choice. To examine this association, we estimate a series of multinomial logistic regression models using restricted data with ZIP code level geoidentifiers from the 2011-2012 National Survey of Children's Health (NSCH). We find that racial/ethnic residential segregation is related to a greater reliance on non-ideal forms of health care, such as clinics, and hospital outpatient departments, instead of pediatric physician's offices. This association is at least partially attenuated by the distribution of health care facilities in the local area, physician's offices, and health care practitioners in particular. Additionally, families express greater dissatisfaction with these other forms of care compared to physician's offices, demonstrating that the lack of adequate health care provision is meaningful for health care outcomes. This study expands the literature by examining how the siting of health organizations has consequences for individuals residing within these areas.

Fear of a Black Neighborhood: Anti-Black Racism and the Health of White Americans

Does anti-Black racism harm White Americans? We advance hypotheses that address this question within the neighborhood context. Hypotheses are tested with neighborhood and survey data from a probability sample of White residents of Nashville, Tennessee. We find that regardless of neighborhood crime rates or socioeconomic compositions, Whites report heightened perceptions of crime and danger in their neighborhoods as the proportion of Black residents increases. Perceived neighborhood danger, in turn, predicts increased symptoms of psychophysiological distress. When stratified by socioeconomic status (SES), however, low-SES Whites also report perceptions of higher status when living near more Black neighbors, which entirely offsets their distress. We conclude that although anti-Black racism can ironically harm the health of White Americans, compensatory racist ideologies can also offset these harms, particularly for lower-status Whites. We situate our findings within broader discussions of anti-Black racism, residential segregation, and psychiatric disorders commonly observed among White Americans.

Association of neighborhood segregation with 6-year incidence of metabolic syndrome in the Hispanic community health study/study of Latinos

PURPOSE

Examine the association between neighborhood segregation and 6-year incident metabolic syndrome (MetSyn) in the Hispanic Community Health Study/Study of Latinos.

METHODS

Prospective cohort of adults residing in Miami, Chicago, the Bronx, and San Diego. The analytic sample included 6,710 participants who did not have MetSyn at baseline. The evenness and exposure dimensions of neighborhood segregation, based on the Gini and Isolation indices, respectively, were categorized into quintiles (Q). Racialized economic concentration was measured with the Index of Concentration at the Extremes (continuously and Q).

RESULTS

Exposure, but not evenness, was associated with higher disease odds (Q1 (lower segregation) vs. Q4, OR = 1.53, 95% CI = 1.082.17; Q5, OR = 2.29, 95% CI = 1.493.52). Economic concentrationprivilege (continuous OR = 0.87, 95% CI = 0.770.98), racial concentrationracialized privilege (Q1 (greater concentration) vs. Q2 OR = 0.75, 95% CI = 0.541.04; Q3 OR = 0.68, 95% CI = 0.441.05; Q4 OR = 0.68, 95% CI = 0.451.01; Q5 OR = 0.64, 95% CI = 0.420.98)(continuous OR = 0.93, 95% CI = 0.821.04), and racialized economic concentrationprivilege (i.e., higher SES non-Hispanic White, continuous OR = 0.86, 95% CI = 0.760.98) were associated with lower disease odds.

CONCLUSION

Hispanics/Latino adults residing in neighborhoods with high segregation had higher risk of incident MetSyn compared to those residing in neighborhoods with low segregation. Research is needed to identify the mechanisms that link segregation to poor metabolic health.

Historic Redlining Practices and Contemporary Determinants of Health in the Detroit Metropolitan Area

Objectives. To examine how redlining, a historical racially discriminatory housing policy implemented by the Home Owners' Loan Corporation (HOLC), is associated with current neighborhood determinants of health in the Detroit Metropolitan Area. Methods. We analyzed associations between census tract‒level HOLC color grades (red = "hazardous"; yellow = "declining"; blue = "desirable"; and green = "best") and a developed neighborhood determinants of health index (DOHI) consisting of 8 indicators of economic, social, governance, and physical environment characteristics using spatial regression analysis and controlling for change in the census tract's percentage of White residents. Results. A total of 484 Detroit Metropolitan Area census tracts had HOLC grades. The mean redlining score across all census tracts was 3.02 (min = 1.0; max = 4.0). The mean contemporary DOHI was 19.11 (min = 8.0; max = 36.0). Regression models show significantly higher DOHI scores in yellowlined (b = 2.71; 95% confidence interval [CI] = 1.52, 3.91), bluelined (b = 5.33; 95% CI = 3.65, 7.01), and greenlined (b = 9.25; 95% CI = 6.86, 11.64) neighborhoods compared with redlined neighborhoods. Conclusions. Historical redlined neighborhoods experience contemporary determinants of health conditions that are less conducive to health compared with those in nonredlined neighborhoods. These differences also reflect the accumulation of resources essential for health in greenlined neighborhoods. Public Health Implications. Neighborhood development initiatives should consider the impacts of historical redlining on contemporary neighborhood conditions. (Am J Public Health. 2023;113(S1): S49-S57. https://doi.org/10.2105/AJPH.2022.307162).

A Bibliometric Analysis on Research Regarding Residential Segregation and Health Based on CiteSpace

Considerable scholarly attention has been directed to the adverse health effects caused by residential segregation. We aimed to visualize the state-of-the-art residential segregation and health research to provide a reference for follow-up studies. Employing the CiteSpace software, we uncovered popular themes, research hotspots, and frontiers based on an analysis of 1211 English-language publications, including articles and reviews retrieved from the Web of Science Core Collection database from 1998 to 2022. The results revealed: (1) The Social Science & Medicine journal has published the most studies. Roland J. Thorpe, Thomas A. LaVeist, Darrell J. Gaskin, David R. Williams, and others are the leading scholars in residential segregation and health research. The University of Michigan, Columbia University, Harvard University, the Johns Hopkins School of Public Health, and the University of North Carolina play the most important role in current research. The U.S. is the main publishing country with significant academic influence. (2) Structural racism, COVID-19, mortality, multilevel modelling, and environmental justice are the top five topic clusters. (3) The research frontier of residential segregation and health has significantly shifted from focusing on community, poverty, infant mortality, and social class to residential environmental exposure, structural racism, and health care. We recommend strengthening comparative research on the health-related effects of residential segregation on minority groups in different socio-economic and cultural contexts.

Residential Segregation, Social Cohesion, and Aging in Place: Health and Mental Health Inequities

BACKGROUND AND OBJECTIVES

Research shows that living in segregated neighborhoods may have deleterious health outcomes via social, physical, and socioeconomic contexts that deepen existing inequities. However, there has been limited scholarship examining the effects of segregation on older adults, despite an increasing focus on aging in place. Guided by the Ecological Model of Aging, we examined the effects of segregation on older adults' self-rated health and mental health, accounting for both individual characteristics and neighborhood opportunities and risks (e.g., social cohesion) and the potential moderating role of race and economic vulnerability.

RESEARCH DESIGN AND METHODS

We used data from the first four rounds of the National Health & Aging Trends Study (2011-2014) merged with tract-level census data for a final sample size of 3084 community-dwelling older adults in urban areas. We conducted multivariate regression analyses after conditioning on residential location selection variables.

RESULTS

There was no significant association between neighborhood segregation and self-rated health or between segregation and anxiety and depression symptoms. Consistent with the literature, perceived social cohesion was protective of health in each model.

DISCUSSION AND IMPLICATIONS

Our findings highlight the need for more rigorous research on segregation and older residents that utilize longitudinal and spatial data. Our findings also have implications for policies and programs that aim to support the ability to age in place for older adults who have different racial identities and live in different neighborhood contexts. Since social cohesion can be a protective factor for older adults' health and mental health, policymakers and practitioners should support initiatives to increase social cohesion.

All-cause mortality and residential racial and ethnic segregation and composition as experienced differently by individual-level race, ethnicity, and gender: Mortality disparities in american communities data

PURPOSE

Use a large nationally representative population to evaluate whether differences in mortality in relation to residential racial and ethnic segregation and diversity varied by gender, and race or Hispanic ethnicity in the United States.

METHODS

The Mortality Disparities in American Communities (MDAC) was used to evaluate mortality risk in relation to segregation. MDAC is a nationally representative record linkage of the 2008 American Community Survey data with mortality outcomes derived from the National Death Index through 2015. Gender-stratified mortality risk for White, Black, and Hispanic groups in relation to quartiles of residential segregation, composition, and diversity were modeled using parametric survival regression with an exponential distribution, adjusted for individual-level socioeconomic characteristics.

RESULTS

The study population included >3,950,000 individuals and >273,000 all-cause mortality outcomes. Statistically significant differences in associations were observed with Black segregation vs. Hispanic segregation across Black or Hispanic groups; some differences in stratification by gender for Hispanic and Non-Hispanic Black groups, but gender-stratified associations were more similar in non-Hispanic Whites.

CONCLUSIONS

Future multidisciplinary and ethnographic research is needed to identify the specific structural mechanisms by which these associations differ to support means by which to more effectively target public health interventions.

Characterizing the performance of emergency medical transport time metrics in a residentially segregated community

OBJECTIVE

To derive and characterize the performance of various metrics of emergency transport time in assessing for sociodemographic disparities in the setting of residential segregation. Secondarily to characterize racial disparities in emergency transport time of suspected stroke patients in Austin, Texas.

DATA SOURCES

We used a novel dataset of 2518 unique entries with detailed spatial and temporal information on all suspected stroke transports conducted by a public emergency medical service in Central Texas between 2010 and 2018.

STUDY DESIGN

We conducted one-way ANOVA tests with post-hoc pairwise t-tests to assess how mean hospital transport times varied by patient race. We also developed a spatially-independent metric of emergency transport urgency, the ratio of expected duration of self-transport to a hospital and the measured transport time by an ambulance.

DATA COLLECTION/EXTRACTION

We calculated ambulance arrival and destination times using sequential temporospatial coordinates. We excluded any entries in which patient race was not recorded. We also excluded entries in which ambulances' routes did not pass within 100 m of either the patient's location or the documented hospital destination.

PRINCIPAL FINDINGS

We found that mean transport time to a hospital was 2.5 min shorter for black patients compared to white patients. However, white patients' transport times to a hospital were found to be, on average, 4.1 min shorter than expected compared to 3.4 min shorter than expected for black patients. One-way ANOVA testing for the spatially-independent index of emergency transport urgency was not statistically significant, indicating that average transport time did not vary significantly across racial groups when accounting for variations in transport distance.

CONCLUSIONS

Using a novel transport urgency index, we demonstrate that these findings represent race-based variation in spatial distributions rather than racial bias in emergency medical transport. These results highlight the importance of closely examining spatial distributions when utilizing temporospatial data to investigate geographically-dependent research questions.

Independent and joint contributions of economic, social and physical environmental characteristics to mortality in the Detroit Metropolitan Area: A study of cumulative effects and pathways

OBJECTIVE

Previous studies have demonstrated associations between race-based residential segregation, neighborhood socioeconomic and physical environmental characteristics, and mortality. Relatively few studies have examined independent and joint effects of these multiple neighborhood characteristics and mortality, including potential mediating pathways. In this study we examine the extent to which associations between race-based residential segregation and all-cause mortality may be explained by multiple socioeconomic indicators and exposure to air pollutants.

METHODS

Drawing on data from multiple sources, we assessed bivariate associations between race-based residential segregation (operationalized as percent non-Hispanic Black), education (percent with graduate equivalency degree), poverty (percent below poverty), income inequality (GINI coefficient) and air pollution (ambient PM2.5) and age adjusted all-cause, all race mortality (henceforth all cause mortality) at the census tract level in the Detroit Metropolitan Area. We used inequality curves to assess the (in)equitable distribution of economic and environmental characteristics by census tract racial composition. Finally, we used generalized estimating equations (GEE) to examine independent and joint associations among percent NHB, education, income inequality, and air pollution to all-cause mortality, and test for mediating effects.

RESULTS

Bivariate associations between racial composition, education, poverty, income inequality, PM2.5 and all-cause mortality were statistically significant. Census tracts with higher concentrations of NHB residents had significantly lower educational attainment, higher poverty, and greater exposure to PM2.5. In multivariate models, education, income inequality and PM2.5 fully attenuated associations between racial composition and all-cause mortality.

CONCLUSIONS

Results are consistent with the hypothesis that race-based residential segregation is associated with heightened all-cause mortality, and that those effects are mediated by education, income inequality, and exposure to air pollution at the census tract level. Public health and cross-sector interventions to eliminate race-based residential segregation or to eliminate the maldistribution of educational and economic resources, and environmental exposures, across census tracts could substantially reduce regional inequities in all-cause mortality.

The Diverging Impacts of Segregation on Obesity Risk by Nativity and Neighborhood Poverty Among Hispanic Americans

While racial residential segregation is frequently cited as a fundamental cause of racial health disparities, its health impacts for Hispanic Americans remain unclear. We argue that several shortcomings have limited our understanding of how segregation influences Hispanic health outcomes, most notably a failure to assess the possible diverging impacts of segregation by neighborhood poverty level and the conflation of segregation with ethnic enclaves. We use multiple years of restricted geocoded data from a nationally representative sample of the US population (2006-2013 National Health Interview Survey) to investigate the association between metropolitan-level Hispanic segregation and obesity by nativity and neighborhood poverty level. We find segregation to be protective against obesity for Hispanic immigrants who reside in low poverty neighborhoods. For Hispanic immigrants residing in higher neighborhood poverty, no association between segregation and obesity was found. Among US-born Hispanics, we observe an increased risk of obesity-but only for those in high poverty neighborhoods. No association was found for those in low and medium neighborhood poverty. Results provide evidence to indicate that the relationship between segregation and health for Hispanics is not uniform within a metropolitan area. In the case of obesity, the consequences of metropolitan Hispanic segregation can be either protective, null, or deleterious depending not only on local neighborhood context but also on nativity.

Mortgage Discrimination and Racial/Ethnic Concentration Are Associated with Same-Race/Ethnicity Partnering among People Who Inject Drugs in 19 US Cities

Racial/ethnic homophily in sexual partnerships (partners share the same race/ethnicity) has been associated with racial/ethnic disparities in HIV. Structural racism may partly determine racial/ethnic homophily in sexual partnerships. This study estimated associations of racial/ethnic concentration and mortgage discrimination against Black and Latino residents with racial/ethnic homophily in sexual partnerships among 7847 people who inject drugs (PWID) recruited from 19 US cities to participate in CDC's National HIV Behavioral Surveillance. Racial/ethnic concentration was defined by two measures that respectively compared ZIP code-level concentrations of Black residents to White residents and Latino residents to White residents, using the Index of Concentration at the Extremes. Mortgage discrimination was defined by two measures that respectively compared county-level mortgage loan denial among Black applicants to White applicants and mortgage loan denial among Latino applicants to White applicants, with similar characteristics (e.g., income, loan amount). Multilevel logistic regression models were used to estimate associations. Interactions of race/ethnicity with measures of racial/ethnic concentration and mortgage discrimination were added to the final multivariable model and decomposed into race/ethnicity-specific estimates. In the final multivariable model, among Black PWID, living in ZIP codes with higher concentrations of Black vs. White residents and counties with higher mortgage discrimination against Black residents was associated with higher odds of homophily. Living in counties with higher mortgage discrimination against Latino residents was associated with lower odds of homophily among Black PWID. Among Latino PWID, living in ZIP codes with higher concentrations of Latino vs. White residents and counties with higher mortgage discrimination against Latino residents was associated with higher odds of homophily. Living in counties with higher mortgage discrimination against Black residents was associated with lower odds of homophily among Latino PWID. Among White PWID, living in ZIP codes with higher concentrations of Black or Latino residents vs. White residents was associated with lower odds of homophily, but living in counties with higher mortgage discrimination against Black residents was associated with higher odds of homophily. Racial/ethnic segregation may partly drive same race/ethnicity sexual partnering among PWID. Future empirical evidence linking these associations directly or indirectly (via place-level mediators) to HIV/STI transmission will determine how eliminating discriminatory housing policies impact HIV/STI transmission.

Divergent trends in life expectancy across the rural-urban gradient and association with specific racial proportions in the contiguous USA 2000-2005

OBJECTIVES

To estimate county-level adult life expectancy for Whites, Black/African Americans (Black), American Indian/Alaska Native (AIAN) and Asian/Pacific Islander (Asian) populations and assess the difference across racial groups in the relationship among life expectancy, rurality and specific race proportion.

METHODS

We used individual-level death data to estimate county-level life expectancy at age 25 (e25) for Whites, Black, AIAN and Asian in the contiguous USA for 2000-2005. Race-sex-stratified models were used to examine the associations among e25, rurality and specific race proportion, adjusted for socioeconomic variables.

RESULTS

Lower e25 was found in the central USA for AIANs and in the west coast for Asians. We found higher e25 in the most rural areas for Whites but in the most urban areas for AIAN and Asians. The associations between specific race proportion and e25 were positive or null for Whites but were negative for Blacks, AIAN, and Asians. The relationship between specific race proportion and e25 varied across rurality.

CONCLUSIONS

Identifying differences in adult life expectancy, both across and within racial groups, provides new insights into the geographic determinants of life expectancy disparities.

Racial density and the socioeconomic, demographic and health context in Brazilian cities in 2000 and 2010

INTRODUCTION

Racial density has not yet been explored in studies of racial inequalities in Brazil. Thisstudy identified categories of racial density in Brazilian cities and described the living and health context in these categories in 2000 and 2010, when demographic censuses were conducted.

METHOD

Ecological study which used skin color or race information from the last two censuses to calculate racial density (the ratio of people aggregated to the same racial group) of the Brazilian cities each year. Four categories of racial density (Brown; Mixed-race, predominantly black; White/Caucasian; and Mixed-race, predominantly white). Socioeconomic, demographic and health indicators were described to each category.

RESULTS

The categories of racial density captured important inequalities throughout the census and also indicated the continuance of worse living and health conditions in the cities composed by Browns and mixed-race people, predominantly Black; better conditions were indicated in cities where White/Caucasians are predominant. The cities, composed mainly of Browns and mixed-race people, predominantly Black, presented younger age structure, worse human development indexes, greater social vulnerability, income concentration, infant and premature mortality (<65 years) and lower life expectancy in both censuses, as compared to other cities.

DISCUSSION

Similarly to other countries, the racial density reflected inequalities in the Brazilian living and health context as well as a time lag among the cities.

CONCLUSION

The categories of racial density may contribute to social epidemiology and race relations studies in Brazil.

Separate and Sick: Residential Segregation and the Health of Children and Youth in Metropolitan Statistical Areas

The purpose of this study was to better understand residential segregation and child/youth health by examining the relationship between a measure of Black-White residential segregation, the index of dissimilarity, and a suite of child and youth health measures in 235 U.S. metropolitan statistical areas (MSAs). MSAs are urban areas with a population of 50,000 or more and adjacent communities that share a high degree of economic and social integration. MSAs are defined by the Office of Management and Budget. Health-related measures included child mortality (CDC WONDER), teen births (NCHS natality data), children in poverty (SAIPE program), and disconnected youth (Measure of America). Simple linear regression and two-level hierarchical linear regression models, controlling for income, total population, % Black, and census region, examined the association between segregation and Black health, White health, and Black-White disparities in health. As segregation increased, Black children and youth had worse health across all four measures, regardless of MSA total and Black population size. White children and youth in small MSAs with large Black populations had worse levels of disconnected youth and teen births with increasing segregation, but no associations were found for White children and youth in other MSAs. Segregation worsened Black-White health disparities across all four measures, regardless of MSA total and Black population size. Segregation adversely affects the health of Black children in all MSAs and White children in smaller MSAs with large Black populations, and these effects are seen in measures that span all of childhood. Residential segregation may be an important target to consider in efforts to improve neighborhood conditions that influence the health of families and children.

Neighbourhood racial/ethnic residential segregation and cardiometabolic risk: the multiethnic study of atherosclerosis

BACKGROUND

Racial residential segregation has been linked to adverse health outcomes, but associations may operate through multiple pathways. Prior studies have not examined associations of neighbourhood-level racial segregation with an index of cardiometabolic risk (CMR) and whether associations differ by race/ethnicity.

METHODS

We used data from the Multi-Ethnic Study of Atherosclerosis to estimate cross-sectional and longitudinal associations of baseline neighbourhood-level racial residential segregation with a composite measure of CMR. Participants included 5015 non-Hispanic black, non-Hispanic white and Hispanic participants aged 45-84 years old over 12 years of follow-up (2000-2012). We used linear mixed effects models to estimate race-stratified associations of own-group segregation with CMR at baseline and with the rate of annual change in CMR. Models were adjusted for sociodemographics, medication use and individual-level and neighbourhood-level socioeconomic status (SES).

RESULTS

In models adjusted for sociodemographics and medication use, high baseline segregation was associated with higher baseline CMR among blacks and Hispanics but lower baseline CMR among whites. Individual and neighbourhood-level SES fully explained observed associations between segregation and CMR for whites and Hispanics. However, associations of segregation with CMR among blacks remained (high vs low segregation: mean difference 0.17 SD units, 95% CI 0.02 to 0.32; medium vs low segregation: mean difference 0.18 SD units, 95% CI 0.03 to 0.33). Baseline segregation was not associated with change in CMR index scores over time.

CONCLUSION

Associations of own-group racial residential segregation with CMR varied by race/ethnicity. After accounting for SES, living in a more segregated neighbourhood was associated with greater risk among black participants only.

Housing Discrimination and Health: Understanding Potential Linking Pathways Using a Mixed-Methods Approach

Few studies have examined the impact of housing discrimination on health. This study explores potential pathways linking housing discrimination and health using concept mapping, a mixed-method approach. Participants included employees from twenty Fair Housing Organizations nationwide who participated in two online sessions, brainstorming, and structuring. Responses were generated representing biological, social, economic, and physical connections between housing discrimination and health. Using hierarchical cluster analysis, five clusters were identified: (1) Access and barriers; (2) Opportunities for growth; (3) Neighborhood and communities; (4) Physical effects of housing discrimination; and (5) Mental health. Clusters 1 (4.09) and 2 (4.08) were rated as most important for health, while clusters 2 (3.93) and 3 (3.90) were rated as most frequently occurring. These findings add to the limited evidence connecting housing discrimination to health and highlight the need for studies focusing on the long-term health effects of housing discrimination on individuals and neighborhoods.

Residential Racial Isolation and Spatial Patterning of Type 2 Diabetes Mellitus in Durham, North Carolina

Neighborhood characteristics such as racial segregation may be associated with type 2 diabetes mellitus, but studies have not examined these relationships using spatial models appropriate for geographically patterned health outcomes. We constructed a local, spatial index of racial isolation (RI) for black residents in a defined area, measuring the extent to which they are exposed only to one another, to estimate associations of diabetes with RI and examine how RI relates to spatial patterning in diabetes. We obtained electronic health records from 2007-2011 from the Duke Medicine Enterprise Data Warehouse. Patient data were linked to RI based on census block of residence. We used aspatial and spatial Bayesian models to assess spatial variation in diabetes and relationships with RI. Compared with spatial models with patient age and sex, residual geographic heterogeneity in diabetes in spatial models that also included RI was 29% and 24% lower for non-Hispanic white and black residents, respectively. A 0.20-unit increase in RI was associated with an increased risk of diabetes for white (risk ratio = 1.24, 95% credible interval: 1.17, 1.31) and black (risk ratio = 1.07, 95% credible interval: 1.05, 1.10) residents. Improved understanding of neighborhood characteristics associated with diabetes can inform development of policy interventions.

Individual and Neighborhood Determinants of Late HIV Diagnosis Among Latinos, Florida, 2007-2011

The objective of this study was to examine individual and neighborhood determinants of late HIV diagnosis by gender and birthplace among Latinos. Florida HIV surveillance data for 2007-2011 were merged with American Community Survey data to estimate the odds of late HIV diagnosis (AIDS within 3 months of HIV diagnosis). Of 5522 HIV-positive Latinos, 26.5 % were diagnosed late. The odds ratio (OR) for late diagnosis was 1.39 times higher for males than females [95 % confidence interval (CI) 1.14-1.69]. Neighborhood-level factors associated with late diagnosis included residing in the 3 highest quartiles of neighborhood unemployment for males. The OR was 1.22 times higher for foreign- than US-born Latinos (95 % CI 1.07-1.40). Among foreign-born, residing in areas in the 2nd and 3rd quartiles of unemployment, in rural areas, and areas with <25 % Hispanic/Latino population were associated with late diagnosis. Population-based HIV testing campaigns may require tailoring to ensure that they effectively reach male Latinos in areas with high unemployment and foreign-born Latinos in rural and predominantly non-Latino areas.

Racial residential segregation, socioeconomic disparities, and the White-Black survival gap

OBJECTIVE

To evaluate the association between racial residential segregation, a prominent manifestation of systemic racism, and the White-Black survival gap in a contemporary cohort of adults, and to assess the extent to which socioeconomic inequality explains this association.

DESIGN

This was a cross sectional study of White and Black men and women aged 35-75 living in 102 large US Core Based Statistical Areas. The main outcome was the White-Black survival gap. We used 2009-2013 CDC mortality data for Black and White men and women to calculate age-, sex- and race adjusted White and Black mortality rates. We measured segregation using the Dissimilarity index, obtained from the Manhattan Institute. We used the 2009-2013 American Community Survey to define indicators of socioeconomic inequality. We estimated the CBSA-level White-Black gap in probability of survival using sequential linear regression models accounting for the CBSA dissimilarity index and race-specific socioeconomic indicators.

RESULTS

Black men and women had a 14% and 9% lower probability of survival from age 35 to 75 than their white counterparts. Residential segregation was strongly associated with the survival gap, and this relationship was partly, but not fully, explained by socioeconomic inequality. At the lowest observed level of segregation, and with the Black socioeconomic status (SES) assumed to be at the White SES level scenario, the survival gap is essentially eliminated.

CONCLUSION

White-Black differences in survival remain wide notwithstanding public health efforts to improve life expectancy and initiatives to reduce health disparities. Eliminating racial residential segregation and bringing Black socioeconomic status (SES) to White SES levels would eliminate the White-Black survival gap.

Violent Injury and Neighborhood Racial/Ethnic Diversity in Oakland, California

Racial and ethnic segregation has been linked to a number of deleterious health outcomes, including violence. Previous studies of segregation and violence have focused on segregation between African Americans and Whites, used homicide as a measure of violence, and employed segregation measures that fail to take into account neighborhood level processes. We examined the relationship between neighborhood diversity and violent injury in Oakland, California. Violent injuries from the Alameda County Medical Center Trauma Registry that occurred between 1998 and 2002 were geocoded. A local measure of diversity among African American, White, Hispanic, and Asian populations that captured interactions across census block group boundaries was calculated from 2000 U.S. Census data and a Geographic Information System. The relationship between violent injuries and neighborhood level of diversity, adjusted for covariates, was analyzed with zero-inflated negative binomial regression. There was a significant and inverse association between level of racial and ethnic diversity and rate of violent injury (IRR 0.30; 95% CI: 0.13-0.69). There was a similar relationship between diversity and violent injury for predominantly African American block groups (IRR 0.23; 95% CI: 0.08-0.62) and predominantly Hispanic block groups (IRR 0.08; 95% CI: 0.01-0.76). Diversity was not significantly associated with violent injury in predominantly White or Asian block groups. Block group racial and ethnic diversity is associated with lower rates of violent injury, particularly for predominantly African American and Hispanic block groups.

Hispanic Segregation and Poor Health: It's Not Just Black and White

Despite the importance of understanding the fundamental determinants of Hispanic health, few studies have investigated how metropolitan segregation shapes the health of the fastest-growing population in the United States. Using 2006-2013 data from the National Health Interview Survey, we 1) examined the relationship between Hispanic metropolitan segregation and respondent-rated health for US-born and foreign-born Hispanics and 2) assessed whether neighborhood poverty mediated this relationship. Results indicated that segregation has a consistent, detrimental effect on the health of US-born Hispanics, comparable to findings for blacks and black-white segregation. In contrast, segregation was salutary (though not always significant) for foreign-born Hispanics. We also found that neighborhood poverty mediates some, but not all, of the associations between segregation and poor health. Our finding of divergent associations between health and segregation by nativity points to the wide range of experiences within the diverse Hispanic population and suggests that socioeconomic status and structural factors, such as residential segregation, come into play in determining Hispanic health for the US-born in a way that does not occur among the foreign-born.

Mortality by skin color/race and urbanity of Brazilian cities

OBJECTIVE

The skin color/race and urbanity are structural determinants of health. The relationship between these variables produces structure of social stratification that defines inequalities in the experiences of life and death. Thus, this study describes the characteristics of the mortality indicators by skin color/race according level of urbanity and aggregation to the metropolitan region (MR) of 5565 cities in Brazil, controlling for gender and age.

DESIGN

Descriptive study which included the calculation of measures relating to 1,050,546 deaths in the year survey of 2010 by skin color/race White, Black, and Brown according to both sexes, for five age groups and three levels of urbanity of cities in Brazil that were aggregated or not to the MR in the year of study. The risk of death was estimated by calculating premature mortality rate (PMR) at 65 years of age, per 100,000 and age adjusted.

RESULTS

The structure of mortality by skin color/race Black and Brown reflects worse levels of health and excessive premature deaths, with worse situation for men. The Whites, especially women, tend to live longer and in better health than other racial groups. The age-adjusted PMR indicates distinct risk of death by skin color/race, this risk was higher in men than in women and in Blacks than in other racial groups of both sexes. There have been precarious levels of health in the urban space and the MR has intensified these inequalities.

CONCLUSIONS

The research pointed out that the racial inequality in the mortality was characterized by interaction of race with other individual and contextual determinants of health. Those Blacks and Browns are the groups most vulnerable to the iniquities associated with occurrence of death, but these differences in the profile and the risk of death depend on the level of urbanity and aggregation MR of Brazilian cities in 2010.

Racial/Ethnic Residential Segregation, Obesity, and Diabetes Mellitus

Persistent racial/ethnic disparities in obesity and type 2 diabetes mellitus seen in the US are likely due to a combination of social, biological, and environmental factors. A growing number of studies have examined the role of racial/ethnic residential segregation with respect to these outcomes because this macro-level process is believed to be a fundamental cause of many of the factors that contribute to these disparities. This review provides an overview of findings from studies of racial/ethnic residential segregation with obesity and diabetes published between 2013 and 2015. Findings for obesity varied by geographic scale of the segregation measure, gender, ethnicity, and racial identity (among Hispanics/Latinos). Recent studies found no association between racial/ethnic residential segregation and diabetes prevalence, but higher segregation of Blacks was related to higher diabetes mortality. Implications of these recent studies are discussed as well as promising areas of future research.

Comparison of small-area deprivation measures as predictors of chronic disease burden in a low-income population

Background

Measures of small-area deprivation may be valuable in geographically targeting limited resources to prevent, diagnose, and effectively manage chronic conditions in vulnerable populations. We developed a census-based small-area socioeconomic deprivation index specifically to predict chronic disease burden among publically insured Medicaid recipients in South Carolina, a relatively poor state in the southern United States. We compared the predictive ability of the new index with that of four other small-area deprivation indicators.

Methods

To derive the ZIP Code Tabulation Area-Level Palmetto Small-Area Deprivation Index (Palmetto SADI), we evaluated ten census variables across five socioeconomic deprivation domains, identifying the combination of census indicators most highly correlated with a set of five chronic disease conditions among South Carolina Medicaid enrollees. In separate validation studies, we used both logistic and spatial regression methods to assess the ability of Palmetto SADI to predict chronic disease burden among state Medicaid recipients relative to four alternative small-area socioeconomic deprivation measures: the Townsend index of material deprivation; a single-variable poverty indicator; and two small-area designations of health care resource deprivation, Primary Care Health Professional Shortage Area and Medically Underserved Area/Medically Underserved Population.

Results

Palmetto SADI was the best predictor of chronic disease burden (presence of at least one condition and presence of two or more conditions) among state Medicaid recipients compared to all alternative deprivation measures tested.

Conclusions

A low-cost, regionally optimized socioeconomic deprivation index, Palmetto SADI can be used to identify areas in South Carolina at high risk for chronic disease burden among Medicaid recipients and other low-income Medicaid-eligible populations for targeted prevention, screening, diagnosis, disease self-management, and care coordination activities.

Environmental Predictors of US County Mortality Patterns on a National Basis

A growing body of evidence has found that mortality rates are positively correlated with social inequalities, air pollution, elevated ambient temperature, availability of medical care and other factors. This study develops a model to predict the mortality rates for different diseases by county across the US. The model is applied to predict changes in mortality caused by changing environmental factors. A total of 3,110 counties in the US, excluding Alaska and Hawaii, were studied. A subset of 519 counties from the 3,110 counties was chosen by using systematic random sampling and these samples were used to validate the model. Step-wise and linear regression analyses were used to estimate the ability of environmental pollutants, socio-economic factors and other factors to explain variations in county-specific mortality rates for cardiovascular diseases, cancers, chronic obstructive pulmonary disease (COPD), all causes combined and lifespan across five population density groups. The estimated models fit adequately for all mortality outcomes for all population density groups and, adequately predicted risks for the 519 validation counties. This study suggests that, at local county levels, average ozone (0.07 ppm) is the most important environmental predictor of mortality. The analysis also illustrates the complex inter-relationships of multiple factors that influence mortality and lifespan, and suggests the need for a better understanding of the pathways through which these factors, mortality, and lifespan are related at the community level.

Residential Segregation and Diabetes Risk among Latinos

OBJECTIVE

To examine whether residence in ethnically segregated metropolitan areas is associated with increased diabetes risk for Latinos in the United States.

METHODS

Population data from the 2005 Behavioral Risk Factor Surveillance System and the 2005 American Community Survey were used to determine whether higher levels of Latino-White segregation across metropolitan statistical areas (MSAs) in the United States is associated with increased diabetes risk among Latinos (n=7462).

RESULTS

No significant relationship (P<.05) between levels of segregation and diabetes risk was observed.

CONCLUSION

The research literature examining the impact of residential segregation on health outcomes remains equivocal for Latinos.

Individual and neighborhood predictors of mortality among HIV-positive Latinos with history of injection drug use, Florida, 2000-2011

BACKGROUND

The objectives are to examine disparities in all-cause mortality risk among HIV-positive Latinos with injection drug use (IDU) history, and to identify individual- and neighborhood-level predictors.

METHODS

Florida surveillance data for persons diagnosed with HIV 2000-2008 were merged with 2007-2011 administrative data from the American Community Survey. Hazard ratios (HR) were calculated using multi-level weighted Cox regression adjusting for individual and neighborhood (ZCTA-level) factors.

RESULTS

Of 10,989 HIV-positive Latinos, 10.3% had IDU history. Latinos with IDU history were at increased mortality risk compared with Latinos without IDU history after controlling for individual and neighborhood factors (adjusted HR [aHR] 1.61, 95% confidence interval [CI] 1.43-1.80). Factors associated with mortality for those with IDU history included: being 40-59 (aHR 6.48, 95% CI 1.41-121.05) and ≥60 years (aHR 18.75, 95% CI 3.83-356.45) compared with 13-19 years of age; being diagnosed with AIDS within 3 months of HIV (aHR 2.31, 95% CI 1.87-2.86); residing in an area with ≥50% Latinos compared with <25% Latinos (aHR 1.56, 95% CI 1.19-2.04); and residing in a rural compared with an urban area at the time of diagnosis (aHR 1.73, 95% CI 1.06-2.70). Race and neighborhood poverty were not predictors among those with IDU, but were among those without.

CONCLUSION

HIV-positive Latinos with IDU history are at increased mortality risk and have unique contributing factors. Tertiary prevention strategies should target those who are older, diagnosed at later stages, and those who live in predominantly Latino and rural areas.

Neighborhood Latino ethnic density and mortality among HIV-positive Latinos by birth country/region, Florida, 2005-2008

OBJECTIVE

Lower mortality for Latinos has been reported in high Latino density areas. The objective was to examine the contribution of neighborhood Latino density to mortality among HIV-positive Latinos.

METHODS

Florida HIV surveillance data for 2005-2008 were merged with the 2007-2011 American Community Survey data using zip code tabulation areas. Hazard ratios (HR) were calculated using multi-level weighted Cox regression and adjusted for individual-level factors and neighborhood poverty.

RESULTS

Of 4649 HIV-positive Latinos, 11.8% died. There was no difference in mortality risk across categories of Latino ethnic density for Latinos as a whole. There were subgroup effects wherein mortality risk differed by ethnic density category for Latinos born in some countries/regions. Residing in an area with ≥50% Latinos compared with <25% was associated with increased mortality risk for Latinos born in Puerto Rico (HR 1.67; 95% confidence interval [CI] [1.01-2.70]). Residing in an area where Mexicans were the majority Latino group was associated with increased mortality risk for Latinos born in Mexico (HR 3.57; 95% CI [1.43-10.00]).

CONCLUSIONS

The survival advantage seen among the Latino population in high Latino density areas was not seen among HIV-positive Latinos. Research is needed to determine if this may be related to stigma or another mechanism.

Neighborhood-level racial/ethnic residential segregation and incident cardiovascular disease: the multi-ethnic study of atherosclerosis

BACKGROUND

Previous research suggests that neighborhood-level racial/ethnic residential segregation is linked to health, but it has not been studied prospectively in relation to cardiovascular disease (CVD).

METHODS AND RESULTS

Participants were 1595 non-Hispanic black, 2345 non-Hispanic white, and 1289 Hispanic adults from the Multi-Ethnic Study of Atherosclerosis free of CVD at baseline (aged 45-84 years). Own-group racial/ethnic residential segregation was assessed by using the Gi* statistic, a measure of how the neighborhood racial/ethnic composition deviates from surrounding counties' racial/ethnic composition. Multivariable Cox proportional hazards modeling was used to estimate hazard ratios for incident CVD (first definite angina, probable angina followed by revascularization, myocardial infarction, resuscitated cardiac arrest, coronary heart disease death, stroke, or stroke death) over 10.2 median years of follow-up. Among blacks, each standard deviation increase in black segregation was associated with a 12% higher hazard of developing CVD after adjusting for demographics (95% confidence interval, 1.02-1.22). This association persisted after adjustment for neighborhood-level characteristics, individual socioeconomic position, and CVD risk factors (hazard ratio, 1.12; 95% confidence interval, 1.02-1.23). For whites, higher white segregation was associated with lower CVD risk after adjusting for demographics (hazard ratio, 0.88; 95% confidence interval, 0.81-0.96), but not after further adjustment for neighborhood characteristics. Segregation was not associated with CVD risk among Hispanics. Similar results were obtained after adjusting for time-varying segregation and covariates.

CONCLUSIONS

The association of residential segregation with cardiovascular risk varies according to race/ethnicity. Further work is needed to better characterize the individual- and neighborhood-level pathways linking segregation to CVD risk.

Ethnic density effects on psychological distress among Latino ethnic groups: an examination of hypothesized pathways

Studies among US Latinos provide the most consistent evidence of ethnic density effects. However, most studies conducted to date have focused on Mexican Americans, and it is not clear whether ethnic density effects differ across Latino sub-groups, generational status, or measures of ethnic density. In addition, the mechanisms behind ethnic density are not well understood. This study uses a multi-group structural equation modeling approach to analyze the Latino sample from the National Latino and Asian-American Study (n=1940) and examine ethnic density effects on psychological distress among Latino sub-groups, and explore two hypothesized mechanisms: increased neighborhood cohesion and reduced exposure to interpersonal racism. Results of the main effects between ethnic density and health, and of the hypothesized mechanisms, show clear differences across Latino ethnic groups, generational categories and measures of ethnic density. Findings highlight that ethnic density effects and their mechanisms depend on the current and historical context of Latino sub-groups, including reasons for migration and rights upon arrival.

Capturing the two dimensions of residential segregation at the neighborhood level for health research

Two conceptual and methodological foundations of segregation studies are that (i) segregation involves more than one group, and (ii) segregation measures need to quantify how different population groups are distributed across space. Therefore, percentage of population belonging to a group is not an appropriate measure of segregation because it does not describe how populations are spread across different areal units or neighborhoods. In principle, evenness and isolation are the two distinct dimensions of segregation that capture the spatial patterns of population groups. To portray people’s daily environment more accurately, segregation measures need to account for the spatial relationships between areal units and to reflect the situations at the neighborhood scale. For these reasons, the use of local spatial entropy-based diversity index (SH_i) and local spatial isolation index (S_i) to capture the evenness and isolation dimensions of segregation, respectively, are preferable. However, these two local spatial segregation indexes have rarely been incorporated into health research. Rather ineffective and insufficient segregation measures have been used in previous studies. Hence, this paper empirically demonstrates how the two measures can reflect the two distinct dimensions of segregation at the neighborhood level, and argues conceptually and set the stage for their future use to effectively and meaningfully examine the relationships between residential segregation and health.

Racial/ethnic disparities in alcohol-related problems: differences by gender and level of heavy drinking

BACKGROUND

While prior studies have reported racial/ethnic disparities in alcohol-related problems at a given level of heavy drinking (HD), particularly lower levels, it is unclear whether these occur in both genders and are an artifact of racial/ethnic differences in drink alcohol content. Such information is important to understanding disparities and developing specific, targeted interventions. This study addresses these questions and examines disparities in specific types of alcohol problems across racial-gender groups.

METHODS

Using 2005 and 2010 National Alcohol Survey data (N = 7,249 current drinkers), gender-stratified regression analyses were conducted to assess black-white and Hispanic-white disparities in alcohol dependence and negative drinking consequences at equivalent levels of HD. HD was measured using a gender-specific, composite drinking-patterns variable derived through factor analysis. Analyses were replicated using adjusted-alcohol consumption variables that account for group differences in drink alcohol content based on race/ethnicity, gender, age, and alcoholic beverage.

RESULTS

Compared with white men, black and Hispanic men had higher rates of injuries/accidents/health and social consequences, and marginally greater work/legal consequences (p < 0.10). Hispanic women had marginally higher rates of social consequences. In main effects models controlling for demographics, light drinking and HD, only black women and men had greater odds of alcohol-related problems relative to whites. Interaction models indicated that compared with whites, black women had greater odds of dependence at all levels of HD, while both black and Hispanic men had elevated risk of alcohol problems only at lower levels of HD. Drink alcohol content adjustments did not significantly alter findings for either gender.

CONCLUSIONS

This study highlights the gender-specific nature of racial/ethnic disparities. Interventions focused on reducing HD might not address disparities in alcohol-related problems that exist at low levels of HD. Future research should consider the potential role of environmental and genetic factors in these disparities.

The association between neighborhood socioeconomic status and clinical outcomes among patients 1 year after hospitalization for cardiovascular disease

Residing in lower socioeconomic status (SES) neighborhoods is associated with increased risk of morbidity and mortality. Few studies have examined this association for cardiovascular disease (CVD) outcomes in a treated population in New York City (NYC). The purpose of this study was to determine the relationship between neighborhood level poverty and 1-year clinical outcomes (rehospitalization and/or death) among hospitalized patients with CVD. Data on rehospitalization and/or death at 1-year were collected from consecutive patients admitted at a university medical center in NYC from November 2009 to September 2010. NYC residents totaled 2,198. U.S. Census 2000 zip code data was used to quantify neighborhood SES into quintiles of poverty (Q1 = lowest poverty to Q5 = highest poverty). Univariate analyses were used to determine associations between neighborhood poverty and baseline characteristics and comorbidities. A logistic regression analysis was used to calculate odds ratios for the association between quintiles of poverty and rehospitalization/death at 1 year. Fifty-five percent of participants experienced adverse outcomes. Participants in Q5 (9 %) were more likely to be female [odds ratio (OR) = 0.49, 95 % confidence interval (CI) 0.33-0.73], younger (OR = 0.50, 95 % CI 0.34-0.74), of minority race/ethnicity (OR = 18.24, 95 % CI 11.12-29.23), and have no health insurance (OR = 4.79, 95 % CI 2.92-7.50). Living in Q5 was significantly associated with increased comorbidities, including diabetes mellitus and hypertension, but was not a significant predictor of rehospitalization/death at 1 year. Among patients hospitalized with CVD, higher poverty neighborhood residence was significantly associated with a greater prevalence of comorbidities, but not of rehospitalization and/or death. Affordable, accessible resources targeted at reducing the risk of developing CVD and these comorbidities should be available in these communities.

Ethnic density effects on physical morbidity, mortality, and health behaviors: a systematic review of the literature

It has been suggested that people in racial/ethnic minority groups are healthier when they live in areas with a higher concentration of people from their own ethnic group, a so-called ethnic density effect. Ethnic density effects are still contested, and the pathways by which ethnic density operates are poorly understood. The aim of this study was to systematically review the literature examining the ethnic density effect on physical health, mortality, and health behaviors. Most studies report a null association between ethnic density and health. Protective ethnic density effects are more common than adverse associations, particularly for health behaviors and among Hispanic people. Limitations of the literature include inadequate adjustment for area deprivation and limited statistical power across ethnic density measures and study samples.

Understanding ethnic and nativity-related differences in low cardiovascular risk status among Mexican-Americans and non-Hispanic Whites

OBJECTIVE

Recent guidelines highlight the importance of improving cardiovascular health in the general population in addition to disease prevention among high risk individuals. We investigated factors associated with ethnic and nativity-related differences in the prevalence of low cardiovascular risk (optimal levels of all major cardiovascular risk factors).

METHODS

We used logistic regression to estimate differences in likelihood of being low risk (not currently smoking; no diabetes; untreated total cholesterol <200mg/dL; untreated blood pressure <120/<80; and body mass index <25 kg/m(2)) among 8693 foreign- and U.S.-born Mexican-American and non-Hispanic White 2003-2008 U.S. National Health and Nutrition Examination Survey participants before and after adjustment for socioeconomic, lifestyle, and acculturation-related factors.

RESULTS

Foreign-born Mexican-Americans were more likely to be low risk than non-Hispanic Whites after adjustment for all covariates (Odds Ratio [OR]: 1.53; 95% Confidence Interval [CI]: 1.00, 2.34). In contrast, U.S.-born Mexican-Americans were less likely to be low risk compared to Whites (OR: 0.60; 95% CI: 0.43, 0.84). Differences between foreign-born and U.S.-born Mexican-Americans were largely attenuated after adjustment for acculturation indicators.

CONCLUSIONS

Our findings support the healthy migrant hypothesis and suggest that acculturation-related factors may be important drivers of ethnic and nativity-related differences in low cardiovascular risk.

Impact of ethnic variation and residential segregation on long-term survival following myocardial perfusion SPECT

BACKGROUND

Ethnic characteristics of a neighborhood may impact upon all-cause mortality (ACM). It is not known whether this consideration remains a risk modifier among those being evaluated for CAD.

METHODS

6,477 pts (60 ± 13 years, male 38%) residing in NYC with normal or abnormal stress SPECT studies were assessed for ACM during a mean follow-up of 9 ± 3.8 years. Baseline CAD risk factors and ethnic characteristics of patient neighborhoods were considered. Zip-codes with >70% of one ethnicity was considered to be predominant of that ethnicity.

RESULTS

There were 573 (20%) Hispanics (HS), 765 (27%) African-Americans (AA), and 250 (30%) Caucasians (CC) residing in areas >70% of their own ethnicity. Compared to CC, the risk for ACM was lower in HS (hazard ratio (HR) 0.68, 95% CI 0.57-0.8, P < .0001) and similar among AA (HR 1.1, 95% CI 0.95-1.41, P = .2). Among HS, there was a lower ACM among those residing in HS areas compared to those residing in a non-HS areas (HR 0.7 95% CI 0.56-0.9, P = .03) despite a lower median household income ($27,838 ± 3,328 vs $37,751 ± 17,036; P < .0001). This survival difference was not seen in CC and AA.

CONCLUSION

Among patients referred for nuclear SPECT studies for suspected CAD, HS ethnicity was an independent predictor of a favorable prognosis. Among HS, the ethnic characteristic of patients' neighborhoods was an independent predictor of ACM. These results imply that ethnic social support is a potentially powerful modifier of patient outcomes among certain patient groups.

Do diabetic patients living in racially segregated neighborhoods experience different access and quality of care?

BACKGROUND

Place of residence, particularly residential segregation, has been implicated in health and health care disparities. However, prior studies have not focused on care for diabetes, a prevalent condition for minority populations.

OBJECTIVE

To examine the association of residential segregation with a range of access and quality of care outcomes among black and Hispanics with diabetes using a nationally representative US sample.

RESEARCH DESIGN

Cross-sectional study using data for 1598 adult patients with diabetes from the 2006 Medical Expenditure Panel Survey linked to residential segregation information for blacks and Hispanics on the basis of the 2000 census. Relationships of 5 dimensions of residential segregation (dissimilarity, isolation, clustering, concentration, and centralization) with access and quality of care outcomes were examined using linear, logistic, and multinomial logistic regression models, controlling for respondent characteristics and community utilization and hospital capacity.

RESULTS

Black and Hispanics with diabetes had comparable or better access to providers, but received fewer recommended services. Living in a segregated community was associated with more recommended services received, but also problems with seeing a specialist. The relationship of residential segregation to diabetes care varied depending on type of segregation and race/ethnic group assessed.

CONCLUSIONS

Residential segregation influences the care experience of patients with diabetes in the United States. Our study highlights the importance of investigating how different types of segregation may affect diabetes care received by patients from different race and ethnic groups.

Psychiatric treatment needs among the medically underserved: a study of black and white primary care patients residing in a racial minority neighborhood

OBJECTIVE

Racial disparities in psychiatric treatment are well documented. A growing body of research demonstrates that residing in a racial minority neighborhood adversely affects access to health care and may in part account for psychiatric treatment disparities. The study objective is to determine the role of race in psychiatric treatment disparities among blacks and whites residing in a racial minority neighborhood.

METHOD

A systematic sample of black (n = 345) and white (n = 57) patients from a primary care clinic in a racial minority neighborhood in northern Manhattan, New York, was analyzed. Logistic regression models were utilized to assess the effect of race on psychiatric treatment. The study was conducted during 1998-1999 and 2001-2003.

RESULTS

Blacks were less likely than whites to have a lifetime psychiatric disorder (OR = 0.17; 95% CI, 0.06-0.53). Among patients with a current psychiatric disorder, there were no significant black-white differences in psychiatric treatment (OR = 0.72; 95% CI, 0.21-2.49). Yet, there were significant and substantial differences among patients without a current psychiatric disorder, with blacks less likely to receive psychiatric treatment than whites (OR = 0.09; 95% CI, 0.04-0.21).

CONCLUSIONS

The study findings suggest that neighborhood residence moderates the relationship between race and psychiatric treatment. Black and white primary care patients with a current disorder residing in this racial minority neighborhood had similar rates of psychiatric treatment. Yet, whites, who were the minority in the clinic and the neighborhood from which the clinic draws patients, appear to have more chronic psychiatric problems for which they are receiving treatment. Primary care clinics can serve as a vital tool in addressing the persistent disparities in psychiatric treatment and the psychiatric conditions among whites residing in racial minority neighborhoods.

Institutional racism and pregnancy health: using Home Mortgage Disclosure act data to develop an index for Mortgage discrimination at the community level

OBJECTIVES

We used Home Mortgage Disclosure Act (HMDA) data to demonstrate a method for constructing a residential redlining index to measure institutional racism at the community level. We examined the application of the index to understand the social context of health inequities by applying the residential redlining index among a cohort of pregnant women in Philadelphia.

METHODS

We used HMDA data from 1999-2004 to create residential redlining indices for each census tract in Philadelphia County, Pennsylvania. We linked the redlining indices to data from a pregnancy cohort study and the 2000 Census. We spatially mapped the levels of redlining for each census tract for this pregnancy cohort and tested the association between residential redlining and other community-level measures of segregation and individual health.

RESULTS

From 1999-2004, loan applicants in Philadelphia County, Pennsylvania, of black race/ethnicity were almost two times as likely to be denied a mortgage loan compared with applicants who were white (e.g., 1999 odds ratio [OR] = 2.00, 95% confidence interval [CI] 1.63, 2.28; and 2004 OR=2.26, 95% CI 1.98, 2.58). The majority (77.5%) of the pregnancy cohort resided in redlined neighborhoods, and there were significant differences in residence in redlined areas by race/ethnicity (p<0.001). Among the pregnancy cohort, redlining was associated with residential segregation as measured by the percentage of black population (r=0.155), dissimilarity (r=0.250), exposure (r=-0.115), and isolation (r=0.174) indices.

CONCLUSIONS

The evidence of institutional racism may contribute to our understanding of health disparities. Residential redlining and mortgage discrimination against communities may be a major factor influencing neighborhood structure, composition, development, and wealth attainment. This residential redlining index as a measure for institutional racism can be applied in health research to understand the unique social and neighborhood contexts that contribute to health inequities.

Black preterm birth risk in nonblack neighborhoods: effects of Hispanic, Asian, and non-Hispanic white ethnic densities

PURPOSE

Studies of ethnic density and health in the United States have documented poorer health outcomes among black individuals living in black compared with nonblack neighborhoods, but few studies have considered the identities of the populations in nonblack neighborhoods.

METHODS

New York City birth records from 1995 through 2003 and a spatial measure of ethnic density were used to examine preterm birth risks among non-Hispanic black women associated with non-Hispanic white, Hispanic, Asian, and non-Hispanic black neighborhood densities. Logistic regression models were used to estimate the effect on black preterm birth risks of replacing white neighbors with Hispanic, Asian, and black neighbors. Risk differences were computed for changes from the 10th to the 90th percentiles of ethnic density.

RESULTS

Increasing Hispanic density was associated with reduced preterm birth risks among non-Hispanic black women, especially if the black women were foreign-born (RD = -19.1 per 1,000 births; 95% confidence interval. -28.6 to -9.5). Estimates for increasing Asian density were null. Increasing black density was associated with increasing black preterm birth risk, with a threshold at greater levels of black density.

CONCLUSIONS

The low risks of preterm birth among foreign-born non-Hispanic black women in majority-Hispanic neighborhoods may be related to protective psychosocial or lifestyle and warrant further investigation.

Racial/ethnic residential segregation and self-reported hypertension among US- and foreign-born blacks in New York City

BACKGROUND

Research examining the association of residence in racially segregated neighborhoods with physical and mental health outcomes among blacks is mixed. Research elucidating the relationship between segregation and hypertension has been limited. This study examines the association between segregation and hypertension among US- and foreign-born blacks in New York City (NYC).

METHODS

Individual-level data from the NYC Community Health Survey (n = 4,499) were linked to neighborhood-level data from the US Census and Infoshare Online. Prevalence ratios (PRs) for the association between segregation and self-reported hypertension among US- and foreign-born blacks were estimated.

RESULTS

After adjusting for individual- and neighborhood-level covariates, segregation was not associated with hypertension among US-born blacks or foreign-born blacks under 65 years of age. Older foreign-born blacks in highly segregated areas had a 46% lower probability (PR = 0.54; 95% confidence interval, 0.40-0.72) of reporting hypertension than older foreign-born blacks residing in low segregation areas.

CONCLUSIONS

In this NYC-based sample, no association between segregation and hypertension was observed among US-born or younger foreign-born blacks; however, our results suggest possible benefits of segregation for older foreign-born blacks. Further studies should determine whether this association is observed in other cities and identify factors that may mitigate against the adverse effects of segregation.

Racial/ethnic residential segregation: framing the context of health risk and health disparities

An increasing body of public health literature links patterns of racial/ethnic residential segregation to health status and health disparities. Despite substantial new empirical work, meaningful understanding of the pathways through which segregation operates to influence health remains elusive. The literature on segregation and health was appraised with an emphasis on select conceptual, methodological, and analytical issues. Recommendations for advancing the next generation of racial/ethnic residential segregation and health research will require closer attention to sharpening the methodology of measuring segregation, testing mediating pathways and effect modification, incorporating stronger test of causality, exploring factors of resilience in segregated areas, applying a life-course perspective, broadening the scope of the investigation of segregation to include nativity status in blacks and other racial/ethnic groups, and linking segregation measures with biological data.

Neighborhood ethnic density and preterm birth across seven ethnic groups in New York City

Residential segregation limits non-white ethnic groups' access to white neighborhood resources, but may also reduce their exposure to discrimination and facilitate social support. We computed adjusted preterm birth risk differences (RDs) for seven ethnic groups comparing >25% to ≤ 25% ethnic density neighborhoods using 1995-2003 New York City birth records and a spatial ethnic density measure. RDs ranged from -15.0 per 1000 (95% CI: -18.5, -11.4) for whites to 6.4 per 1000 (95% CI: 2.8, 9.9) for blacks, with Hispanic and Asian estimates falling in between but tending to be protective. Results suggest that ethnic density is uniquely harmful for non-Hispanic blacks.

Ethnic density and preterm birth in African-, Caribbean-, and US-born non-Hispanic black populations in New York City

Segregation studies suggest that the health of blacks in the United States is poorer in majority-black compared with mixed-race neighborhoods. However, segregation studies have not examined black immigrants, who may benefit from social support and country-of-origin foods in black immigrant areas. The authors used 1995-2003 New York City birth records and a spatial measure of ethnic density to conduct a cross-sectional investigation of the risks of preterm birth for African-, Caribbean-, and US-born non-Hispanic black women associated with neighborhood-level African-, Caribbean-, and US-born non-Hispanic black density, respectively. Preterm birth risk differences were computed from logistic model coefficients, comparing neighborhoods in the 90th percentile of ethnic density with those in the 10th percentile. African black preterm birth risks increased with African density, especially in more deprived neighborhoods, where the risk difference was 6.1 per 1,000 (95% confidence interval: 1.9, 10.2). There was little evidence of an ethnic density effect among non-Hispanic black Caribbeans. Among US-born non-Hispanic blacks, an increase in preterm birth risk associated with US-born black density was observed in more deprived neighborhoods only (risk difference = 12.5, 95% confidence interval: 6.6, 18.4). Ethnic density seems to be more strongly associated with preterm birth for US-born non-Hispanic blacks than for non-Hispanic black immigrants.