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Richardson AS, Dubowitz T, Beyer KM, Zhou Y, Kershaw KN, Duck W, Ye F, Beckman R, Gordon-Larsen P, Shikany JM, Kiefe C. Associations of Historical Redlining With BMI and Waist Circumference in Coronary Artery Risk Development in Young Adults. AJPM FOCUS 2024; 3:100209. [PMID: 38590394 PMCID: PMC10999814 DOI: 10.1016/j.focus.2024.100209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Introduction Historical maps of racialized evaluation of mortgage lending risk (i.e., redlined neighborhoods) have been linked to adverse health outcomes. Little research has examined whether living in historically redlined neighborhoods is associated with obesity, differentially by race or gender. Methods This is a cross-sectional study to examine whether living in historically redlined neighborhoods is associated with BMI and waist circumference among Black and White adults in 1985-1986. Participants' addresses were linked to the 1930s Home Owners' Loan Corporation maps that evaluated mortgage lending risk across neighborhoods. The authors used multilevel linear regression models clustered on Census tract, adjusted for confounders to estimate main effects, and stratified, and interaction models by (1) race, (2) gender, and (3) race by gender with redlining differentially for Black versus White adults and men versus women. To better understand strata differences, they compared Census tract-level median household income across race and gender groups within Home Owners' Loan Corporation grade. Results Black adults (n=2,103) were more likely than White adults (n=1,767) to live in historically rated hazardous areas and to have higher BMI and waist circumference. Redlining and race and redlining and gender interactions for BMI and waist circumference were statistically significant (p<0.10). However, in stratified analyses, the only statistically significant associations were among White participants. White participants living in historically rated hazardous areas had lower BMI (β = - 0.63 [95% CI= -1.11, -0.15]) and lower waist circumference (β = - 1.50 [95% CI= -2.62, -0.38]) than those living in declining areas. Within each Home Owners' Loan Corporation grade, residents in White participants' neighborhoods had higher incomes than those living in Black participants' neighborhoods (p<0.0001). The difference was largest within historically redlined areas. Covariate associations differed for men, women, Black, and White adults, explaining the difference between the interaction and the stratified models. Race by redlining interaction did not vary by gender. Conclusions White adults may have benefitted from historical redlining, which may have reinforced neighborhood processes that generated racial inequality in BMI and waist circumference 50 years later.
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Affiliation(s)
- Andrea S. Richardson
- RAND Corporation, Department of Behavioral and Policy Sciences, Pittsburgh, Pennsylvania
| | - Tamara Dubowitz
- RAND Corporation, Department of Behavioral and Policy Sciences, Pittsburgh, Pennsylvania
| | | | - Yuhong Zhou
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kiarri N. Kershaw
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Waverly Duck
- University of California Santa Barbara, Santa Barbara, California
| | - Feifei Ye
- RAND Corporation, Department of Behavioral and Policy Sciences, Pittsburgh, Pennsylvania
| | - Robin Beckman
- RAND Corporation, Department of Behavioral and Policy Sciences, Santa Monica, California
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Collins TW, Grineski SE. Race, historical redlining, and contemporary transportation noise disparities in the United States. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2024:10.1038/s41370-024-00682-x. [PMID: 38760532 DOI: 10.1038/s41370-024-00682-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Legacies of discriminatory federal housing practices-e.g., racialized property appraisal by the Home Owners' Loan Corporation (HOLC) and institutionalized redlining by the Federal Housing Administration-include disparate present-day environmental health outcomes. Noise pollution is health-harming, but just one study has associated contemporary noise with redlining in some HOLC-mapped United States (US) cities, while two national studies found associations between greater neighborhood-level people of color composition and increased noise. No studies have examined noise pollution exposure disparities across all HOLC-mapped cities or based on the intersection of race/ethnicity and redlining. OBJECTIVE We address three objectives: (1) Assess disparities in fine-scale, per person transportation noise exposures by historical redlining status across all HOLC-mapped cities. (2) Quantify disparities in noise exposures by race/ethnicity nationwide. (3) Explore interactions between redlining status and race/ethnicity in noise exposures. METHODS We analyzed three data sources: (1) complete digital HOLC maps of ordered investment risk grades (A-D), (2) fine-scale (30 m) estimates of transportation noise levels (year-2020), and (3) sociodemographic characteristics of individuals in year-2020 census blocks. RESULTS We find an approximately monotonic association for excess transportation noise with HOLC grade, marked by a pronounced exposure increase (17.4 dBA or 3× loudness) between contemporary residents of grade A (highest-graded) and D (lowest-graded) neighborhoods, a pattern consistent across HOLC-mapped cities. People of color experience ~7 dBA greater (2× louder) excess transportation noise exposures than White people nationwide, a pattern consistent across US counties. Noise exposure disparities are larger by HOLC grade than by race/ethnicity. However, contemporary racial/ethnic noise exposure disparities persist within each HOLC grade at levels approximating those disparities existing in ungraded areas, indicating that historical redlining is one of multiple discriminatory practices shaping contemporary national soundscape injustices. SIGNIFICANCE Findings illustrate how historical redlining and broader racialized inequalities in US society have shaped environmental injustices nationwide. IMPACT STATEMENT Excessive noise exposures harm human health. Communities of color in the United States experience disparate noise exposures, although previous studies are limited by reliance upon aggregated data. They are also disproportionately concentrated in historically redlined areas. Legacies of redlining include persistent racial and economic inequalities and environmental health disparities. Here, we conduct the first complete national examination of contemporary noise pollution disparities with respect to historical redlining and race/ethnicity. Findings advance understanding of the historical roots and enduring salience of race-based disparities in noise pollution exposures and can inform efforts to address these disparities through noise pollution policy-making.
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Affiliation(s)
- Timothy W Collins
- School of Environment, Society & Sustainability and Center for Natural & Technological Hazards, University of Utah, Salt Lake City, UT, USA.
| | - Sara E Grineski
- Department of Sociology, School of Environment, Society & Sustainability, and Center for Natural & Technological Hazards, University of Utah, Salt Lake City, UT, USA
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Woodard N, Butler J, Ghosh D, Green KM, Knott CL. The Association between State-Level Structural Racism and Alcohol and Tobacco Use Behaviors among a National Probability Sample of Black Americans. Cancer Epidemiol Biomarkers Prev 2024; 33:261-269. [PMID: 38032218 PMCID: PMC10872984 DOI: 10.1158/1055-9965.epi-23-0873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/24/2023] [Accepted: 11/28/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Structural racism is how society maintains and promotes racial hierarchy and discrimination through established and interconnected systems. Structural racism is theorized to promote alcohol and tobacco use, which are risk factors for adverse health and cancer-health outcomes. The current study assesses the association between measures of state-level structural racism and alcohol and tobacco use among a national sample of 1,946 Black Americans. METHODS An existing composite index of state-level structural racism including five dimensions (subscales; i.e., residential segregation and employment, economic, incarceration, and educational inequities) was merged with individual-level data from a national sample dataset. Hierarchical linear and logistic regression models, accounting for participant clustering at the state level, assessed associations between structural racism and frequency of alcohol use, frequency of binge drinking, smoking status, and smoking frequency. Two models were estimated for each behavioral outcome, one using the composite structural racism index and one modeling dimensions of structural racism in lieu of the composite measure, each controlling for individual-level covariates. RESULTS Results indicated positive associations between the incarceration dimension of the structural racism index and binge drinking frequency, smoking status, and smoking frequency. An inverse association was detected between the education dimension and smoking status. CONCLUSIONS Results suggest that state-level structural racism expressed in incarceration disparities, is positively associated with alcohol and tobacco use among Black Americans. IMPACT Addressing structural racism, particularly in incarceration practices, through multilevel policy and intervention may help to reduce population-wide alcohol and tobacco use behaviors and improve the health outcomes of Black populations.
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Affiliation(s)
- Nathaniel Woodard
- Cancer Care Quality Training Program, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James Butler
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, College Park, MD, USA
| | - Debarchana Ghosh
- Department of Geography, University of Connecticut, University of Connecticut, Storrs, CT, USA
| | - Kerry M. Green
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, College Park, MD, USA
| | - Cheryl L. Knott
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, College Park, MD, USA
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Miller-Kleinhenz JM, Barber LE, Maliniak ML, Moubadder L, Bliss M, Streiff MJ, Switchenko JM, Ward KC, McCullough LE. Historical Redlining, Persistent Mortgage Discrimination, and Race in Breast Cancer Outcomes. JAMA Netw Open 2024; 7:e2356879. [PMID: 38376843 PMCID: PMC10879950 DOI: 10.1001/jamanetworkopen.2023.56879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/28/2023] [Indexed: 02/21/2024] Open
Abstract
Importance Inequities created by historical and contemporary mortgage discriminatory policies have implications for health disparities. The role of persistent mortgage discrimination (PMD) in breast cancer (BC) outcomes has not been studied. Objective To estimate the race-specific association of historical redlining (HRL) with the development of BC subtypes and late-stage disease and a novel measure of PMD in BC mortality. Design, Setting, and Participants This population-based cohort study used Georgia Cancer Registry data. A total of 1764 non-Hispanic Black and White women with a BC diagnosis and residing in an area graded by the Home Owners' Loan Corporation (HOLC) in Georgia were included. Patients were excluded if they did not have a known subtype or a derived American Joint Committee on Cancer stage or if diagnosed solely by death certificate or autopsy. Participants were diagnosed with a first primary BC between January 1, 2010, to December 31, 2017, and were followed through December 31, 2019. Data were analyzed between May 1, 2022, and August 31, 2023. Exposures Scores for HRL were examined dichotomously as less than 2.5 (ie, nonredlined) vs 2.5 or greater (ie, redlined). Contemporary mortgage discrimination (CMD) scores were calculated, and PMD index was created using the combination of HRL and CMD scores. Main Outcomes and Measures Estrogen receptor (ER) status, late stage at diagnosis, and BC-specific death. Results This study included 1764 women diagnosed with BC within census tracts that were HOLC graded in Georgia. Of these, 856 women (48.5%) were non-Hispanic Black and 908 (51.5%) were non-Hispanic White; 1148 (65.1%) were diagnosed at 55 years or older; 538 (30.5%) resided in tracts with HRL scores less than 2.5; and 1226 (69.5%) resided in tracts with HRL scores 2.5 or greater. Living in HRL areas with HRL scores 2.5 or greater was associated with a 62% increased odds of ER-negative BC among non-Hispanic Black women (odds ratio [OR], 1.62 [95% CI, 1.01-2.60]), a 97% increased odds of late-stage diagnosis among non-Hispanic White women (OR, 1.97 [95% CI, 1.15-3.36]), and a 60% increase in BC mortality overall (hazard ratio, 1.60 [95% CI, 1.17-2.18]). Similarly, PMD was associated with BC mortality among non-Hispanic White women but not among non-Hispanic Black women. Conclusions and Relevance The findings of this cohort study suggest that historical racist policies and persistent discrimination have modern-day implications for BC outcomes that differ by race. These findings emphasize the need for a more nuanced investigation of the social and structural drivers of disparate BC outcomes.
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Affiliation(s)
| | - Lauren E. Barber
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Maret L. Maliniak
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Leah Moubadder
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Maya Bliss
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Micah J. Streiff
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jeffrey M. Switchenko
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kevin C. Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lauren E. McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Fan Q, Hussaini SMQ, Barrow LCJ, Feliciano JL, Pollack CE, Yabroff KR, Nogueira L. Association of area-level mortgage denial and guideline-concordant non-small-cell lung cancer care and outcomes in the United States. Cancer Med 2024; 13:e6921. [PMID: 38205942 PMCID: PMC10911071 DOI: 10.1002/cam4.6921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 12/08/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Racial and socioeconomic disparities in receipt of care for non-small-cell lung cancer (NSCLC) are well described. However, no previous studies have evaluated the association between mortgage denial rates and receipt of timely and guideline-concordant care for NSCLC and patient outcomes. METHODS We identified individuals ≥18 years diagnosed with NSCLC between 2014 and 2019 from the National Cancer Database. Using the Home Mortgage Disclosure Act database, we calculated the proportion of denied home loans to total loans at the zip-code level and categorized them into quintiles. Our outcomes included receipt of guideline-concordant care based on clinical and pathologic stage at diagnosis and the National Comprehensive Cancer Network guidelines, time from surgery to chemotherapy initiation, and overall survival. RESULTS Of the 629,288 individuals diagnosed with NSCLC (median age 69; IQR 61-76 years, 49.1% female), 47.8% did not receive guideline-concordant care. Residing in areas with higher mortgage denial rates and lower income was associated with worse guideline-concordant care overall (aRR = 1.28; 95% CI = 1.25-1.32) and for each cancer treatment modality, worse receipt of timely chemotherapy (aHR = 1.14; 95% CI = 1.11-1.17) and worse overall survival (aHR = 1.21; 95% CI = 1.19-1.22), compared with residing in areas with the lowest mortgage denial rate and highest income. CONCLUSIONS Area-level mortgage denial rate was associated with worse receipt of timely and guideline-concordant NSCLC care and survival. This highlights the critical need to understand and address systemic practices, such as mortgage denial, that limit access to resources and are associated with worse access to quality cancer care and outcomes.
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Affiliation(s)
- Qinjin Fan
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - S M Qasim Hussaini
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Lauren C J Barrow
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Josephine L Feliciano
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Craig E Pollack
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - K Robin Yabroff
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Leticia Nogueira
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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Smarr MM, Avakian M, Lopez AR, Onyango B, Amolegbe S, Boyles A, Fenton SE, Harmon QE, Jirles B, Lasko D, Moody R, Schelp J, Sutherland V, Thomas L, Williams CJ, Dixon D. Broadening the Environmental Lens to Include Social and Structural Determinants of Women's Health Disparities. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:15002. [PMID: 38227347 PMCID: PMC10790815 DOI: 10.1289/ehp12996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Due to the physical, metabolic, and hormonal changes before, during, and after pregnancy, women-defined here as people assigned female at birth-are particularly susceptible to environmental insults. Racism, a driving force of social determinants of health, exacerbates this susceptibility by affecting exposure to both chemical and nonchemical stressors to create women's health disparities. OBJECTIVES To better understand and address social and structural determinants of women's health disparities, the National Institute of Environmental Health Sciences (NIEHS) hosted a workshop focused on the environmental impacts on women's health disparities and reproductive health in April 2022. This commentary summarizes foundational research and unique insights shared by workshop participants, who emphasized the need to broaden the definition of the environment to include upstream social and structural determinants of health. We also summarize current challenges and recommendations, as discussed by workshop participants, to address women's environmental and reproductive health disparities. DISCUSSION The challenges related to women's health equity, as identified by workshop attendees, included developing research approaches to better capture the social and structural environment in both human and animal studies, integrating environmental health principles into clinical care, and implementing more inclusive publishing and funding approaches. Workshop participants discussed recommendations in each of these areas that encourage interdisciplinary collaboration among researchers, clinicians, funders, publishers, and community members. https://doi.org/10.1289/EHP12996.
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Affiliation(s)
- Melissa M. Smarr
- Division of Extramural Research and Training, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | | | | | | | - Sara Amolegbe
- Office of the Director, National Institutes of Health, Bethesda, Maryland, USA
| | - Abee Boyles
- Division of Extramural Research and Training, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Suzanne E. Fenton
- Division of Translational Toxicology, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Quaker E. Harmon
- Division of Intramural Research, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Bill Jirles
- Office of the Director, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Denise Lasko
- Division of Translational Toxicology, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Rosemary Moody
- Division of Extramural Research, National Institute on Drug Abuse, Bethesda, Maryland, USA
| | - John Schelp
- Office of the Director, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Vicki Sutherland
- Division of Translational Toxicology, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Laura Thomas
- Division of Translational Research, National Institute of Mental Health, Bethesda, Maryland, USA
| | - Carmen J. Williams
- Division of Intramural Research, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Darlene Dixon
- Division of Translational Toxicology, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
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Pichardo MS, Ferrucci LM, Molina Y, Esserman DA, Irwin ML. Structural Racism, Lifestyle Behaviors, and Obesity-related Cancers among Black and Hispanic/Latino Adults in the United States: A Narrative Review. Cancer Epidemiol Biomarkers Prev 2023; 32:1498-1507. [PMID: 37650844 PMCID: PMC10872641 DOI: 10.1158/1055-9965.epi-22-1147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/02/2023] [Accepted: 08/29/2023] [Indexed: 09/01/2023] Open
Abstract
One in three adults in the United States has obesity; a chronic disease that is implicated in the etiology of at least 14 cancers. Cancer is the leading cause of death among U.S. Hispanic/Latino adults and the second most common cause of death, after cardiovascular disease, for Black adults. Our country's legacy in overt discrimination (e.g., slavery, segregation) generated inequities across all spheres in which people function as defined by the socioecological model-biological, individual, community, structural-and two of the many areas in which it manifests today are the disproportionate burden of obesity and obesity-related cancers in populations of color. Inequities due to environmental, social, and economic factors may predispose individuals to poor lifestyle behaviors by hindering an individual's opportunity to make healthy lifestyles choices. In this review, we examined the evidence on obesity and the lifestyle guidelines for cancer prevention in relation to cancer risk and outcomes for Black and Hispanic/Latino adults. We also discussed the role of structural and societal inequities on the ability of these two communities to adopt and maintain healthful lifestyle behaviors in accordance with the lifestyle guidelines for cancer prevention and control.
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Affiliation(s)
- Margaret S. Pichardo
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06520
- Department of Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, PA 19104
| | - Leah M. Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06520
- Yale Cancer Center, New Haven, CT 06520
| | - Yamile Molina
- School of Public Health, University of Illinois Chicago and Cancer Center University of Illinois Chicago, 60607
| | - Denise A. Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06520
| | - Melinda L. Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06520
- Yale Cancer Center, New Haven, CT 06520
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Liu JJ, DeCuir N, Kia L, Peterson J, Miller C, Issaka RB. Tools to Measure the Impact of Structural Racism and Discrimination on Gastrointestinal and Hepatology Disease Outcomes: A Scoping Review. Clin Gastroenterol Hepatol 2023; 21:2759-2788.e6. [PMID: 36549469 PMCID: PMC10279803 DOI: 10.1016/j.cgh.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/23/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS Structural racism and discrimination (SRD) are important upstream determinants of health perpetuated by discriminatory laws and policies. Therefore, measuring SRD and its impact on health is critical to developing interventions that address resultant health disparities. We aimed to identify gastrointestinal (GI) or liver studies that report measures of SRD or interventions to achieve health equity in these domains by addressing upstream determinants of health. METHODS We conducted a scoping review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping reviews guidelines. Studies that used an SRD measure or examined an upstream intervention in GI or liver disease were included. Studies that described health disparities in GI or liver conditions without mentioning SRD were excluded. Study characteristics, findings, and limitations were extracted. RESULTS Forty-six articles (19 studies using SRD measures and 27 studies of upstream interventions) were identified. Measures of residential racial segregation were reported most frequently. SRD was associated with poorer health outcomes for racial and ethnic minority populations. Although upstream intervention studies focused primarily on policies related to colon cancer screening and organ graft allocation, racial and ethnic disparities often persisted post-intervention. CONCLUSIONS To achieve health equity in GI and liver conditions, there is an urgent need for research that goes beyond describing health disparities to incorporating measures of SRD and implementing interventions that address this understudied determinant of health.
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Affiliation(s)
- Joy J Liu
- Division of Gastroenterology, Department of Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Nicole DeCuir
- Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Leila Kia
- Division of Gastroenterology, Department of Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Jonna Peterson
- Galter Health Sciences Library & Learning Center, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Corinne Miller
- Galter Health Sciences Library & Learning Center, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Rachel B Issaka
- Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington; Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Center, Seattle, Washington; Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, Washington.
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9
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Pearson AL, Zhou Y, Buxton RT, Horton TH, Pfeiffer KA, Beyer KM. The effects of contemporary redlining on the mental health of Black residents. SSM Popul Health 2023; 23:101462. [PMID: 37456619 PMCID: PMC10339054 DOI: 10.1016/j.ssmph.2023.101462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/29/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
Understanding how structural racism, including institutionalized practices such as redlining, influence persistent inequities in health and neighborhood conditions is still emerging in urban health research. Such research often focuses on historical practices, giving the impression that such practices are a thing of the past. However, mortgage lending bias can be readily detected in contemporary datasets and is an active form of structural racism with implications for health and wellbeing. The objective of the current study was to test for associations among multiple measures of mental health and a measure of contemporary redlining. We linked a redlining index constructed using Home Mortgage Disclosure Act data (2007-2013) to 2021 health data for Black/African American participants in the Study of Active Neighborhoods in Detroit (n = 220 with address data). We used multilevel regression models to examine the relationship between redlining and a suite of mental health outcomes (perceived stress, anxiety, depressive symptoms, and satisfaction with life), accounting for covariates including racial composition of the neighborhood. We considered three mediating factors: perceived neighborhood cohesion, aesthetics, and discrimination. Although all participants lived in redlined neighborhoods compared to the complete Detroit Metropolitan area, participants with very low income, low levels of experienced discrimination, and lower perceptions of neighborhood aesthetics resided in highly redlined neighborhoods (score ≥5). We observed that higher resident-reported neighborhood aesthetics were found in neighborhoods with lower redlining scores and were associated with higher levels of satisfaction with life. We found that lower levels of redlining were significantly associated with higher levels of perceived discrimination, which was significantly, positively associated with anxiety, depressive symptoms, and perceived stress scores. Our findings highlight that contemporary redlining practices may influence the aesthetics of the built environment because these neighborhoods experience less investment, with implications for residents' satisfaction with life. However, areas with lower redlining may be areas where Black/African American people experience increased perceived discrimination.
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Affiliation(s)
- Amber L. Pearson
- Department of Geography, Michigan State University, East Lansing, MI, 48824, USA
| | - Yuhong Zhou
- Institute for Health & Equity, Medical College Wisconsin, Milwaukee, WI, 53226, USA
| | - Rachel T. Buxton
- Department of Biology, Carleton University, Ottawa, K1S 5B6, Canada
| | - Teresa H. Horton
- Department of Anthropology, Northwestern University, Evanston, IL, 60208, USA
| | - Karin A. Pfeiffer
- Department of Kinesiology, Michigan State University, East Lansing, MI, 48824, USA
| | - Kirsten M.M. Beyer
- Institute for Health & Equity, Medical College Wisconsin, Milwaukee, WI, 53226, USA
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Miller-Kleinhenz JM, Moubadder L, Beyer KM, Zhou Y, Gaglioti AH, Collin LJ, Gohar J, Do W, Conneely K, Krishnamurti U, Gogineni K, Gabram-Mendola S, D’Angelo O, Henry K, Torres M, McCullough LE. Redlining-associated methylation in breast tumors: the impact of contemporary structural racism on the tumor epigenome. Front Oncol 2023; 13:1154554. [PMID: 37621676 PMCID: PMC10446968 DOI: 10.3389/fonc.2023.1154554] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/17/2023] [Indexed: 08/26/2023] Open
Abstract
Purpose Place-based measures of structural racism have been associated with breast cancer mortality, which may be driven, in part, by epigenetic perturbations. We examined the association between contemporary redlining, a measure of structural racism at the neighborhood level, and DNA methylation in breast tumor tissue. Methods We identified 80 Black and White women diagnosed and treated for a first-primary breast cancer at Emory University Hospitals (2008-2017). Contemporary redlining was derived for census tracts using the Home Mortgage Disclosure Act database. Linear regression models were used to calculate the association between contemporary redlining and methylation in breast tumor tissue. We also examined epigenetic age acceleration for two different metrics, regressing β values for each cytosine-phosphate-guanine dinucleotide (CpG) site on redlining while adjusting for covariates. We employed multivariable Cox-proportional hazards models and 95% confidence intervals (CI) to estimate the association between aberrant methylation and mortality. Results Contemporary redlining was associated with 5 CpG sites after adjustment for multiple comparisons (FDR<0.10). All genes were implicated in breast carcinogenesis, including genes related to inflammation, immune function and stress response (ANGPT1, PRG4 and PRG4). Further exploration of the top 25 CpG sites, identified interaction of 2 sites (MRPS28 and cg11092048) by ER status and 1 site (GDP1) was associated with all-cause mortality. Contemporary redlining was associated with epigenetic age acceleration by the Hannum metric (β=5.35; CI 95%=0.30,10.4) and showed positive but non-significant correlation with the other clock. Conclusion We identified novel associations between neighborhood contemporary redlining and the breast tumor DNA methylome, suggesting that racist policies leading to inequitable social and environmental exposures, may impact the breast tumor epigenome. Additional research on the potential implications for prognosis is needed.
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Affiliation(s)
| | - Leah Moubadder
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Kirsten M. Beyer
- Division of Epidemiology, Institute for Health & Society, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Yuhong Zhou
- Division of Epidemiology, Institute for Health & Society, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Anne H. Gaglioti
- National Center for Primary Care, Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA, United States
- Center for Health Integration, Population Health Research Institute at The MetroHealth System, Case Western Reserve University, Cleveland, OH, United States
| | - Lindsay J. Collin
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Jazib Gohar
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Whitney Do
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States
- Nutrition and Health Sciences Program, Laney Graduate School, Atlanta, GA, United States
| | - Karen Conneely
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, United States
| | - Uma Krishnamurti
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Keerthi Gogineni
- Department of Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | | | - Olivia D’Angelo
- Department of Surgery, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, United States
| | - Kashari Henry
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Mylin Torres
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Lauren E. McCullough
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
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11
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Jackson P, Spector AL, Strath LJ, Antoine LH, Li P, Goodin BR, Hidalgo BA, Kempf MC, Gonzalez CE, Jones AC, Foster TC, Peterson JA, Quinn T, Huo Z, Fillingim R, Cruz-Almeida Y, Aroke EN. Epigenetic age acceleration mediates the relationship between neighborhood deprivation and pain severity in adults with or at risk for knee osteoarthritis pain. Soc Sci Med 2023; 331:116088. [PMID: 37473540 PMCID: PMC10407756 DOI: 10.1016/j.socscimed.2023.116088] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/08/2023] [Accepted: 07/08/2023] [Indexed: 07/22/2023]
Abstract
An estimated 250 million people worldwide suffer from knee osteoarthritis (KOA), with older adults having greater risk. Like other age-related diseases, residents of high-deprivation neighborhoods experience worse KOA pain outcomes compared to their more affluent neighbors. The purpose of this study was to examine the relationship between neighborhood deprivation and pain severity in KOA and the influence of epigenetic age acceleration (EpAA) on that relationship. The sample of 128 participants was mostly female (60.9%), approximately half non-Hispanic Black (49.2%), and had a mean age of 58 years. Spearman bivariate correlations revealed that pain severity positively correlated with EpAA (ρ = 0.47, p ≤ 0.001) and neighborhood deprivation (ρ = 0.25, p = 0.004). We found a positive significant relationship between neighborhood deprivation and EpAA (ρ = 0.47, p ≤ 0.001). Results indicate a mediating relationship between neighborhood deprivation (predictor), EpAA (mediator), and pain severity (outcome variable). There was a significant indirect effect of neighborhood deprivation on pain severity through EpAA, as the mediator accounted for a moderate portion of the total effect, PM = 0.44. Epigenetic age acceleration may act as a mechanism through which neighborhood deprivation leads to worse KOA pain outcomes and may play a role in the well-documented relationship between the neighborhood of residence and age-related diseases.
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Affiliation(s)
- Pamela Jackson
- School of Public Health, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
| | - Antoinette L Spector
- School of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI, 53201, USA; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.
| | - Larissa J Strath
- Department of Community Dentistry and Behavioral Science, University of Florida, 1329 16th Street Southwest, Gainesville, FL, 32608, USA; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.
| | - Lisa H Antoine
- Department of Psychology, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
| | - Peng Li
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
| | - Burel R Goodin
- Washington University Pain Center, Department of Anesthesiology, Washington University School of Medicine in St. Louis, USA.
| | - Bertha A Hidalgo
- School of Public Health, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
| | - Mirjam-Colette Kempf
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
| | - Cesar E Gonzalez
- Department of Psychology, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
| | - Alana C Jones
- School of Public Health, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
| | - Thomas C Foster
- Department of Neuroscience, University of Florida, 1149 Newell Dr, Gainesville, FL, 32610, USA.
| | - Jessica A Peterson
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.
| | - Tammie Quinn
- Department of Psychology, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
| | - Zhiguang Huo
- Department of Biostatistics, University of Florida, 2004 Mowry Road, Gainesville, FL, 32603, USA.
| | - Roger Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, 1329 16th Street Southwest, Gainesville, FL, 32608, USA; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.
| | - Yenisel Cruz-Almeida
- Department of Community Dentistry and Behavioral Science, University of Florida, 1329 16th Street Southwest, Gainesville, FL, 32608, USA; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA; Department of Neuroscience, University of Florida, 1149 Newell Dr, Gainesville, FL, 32610, USA.
| | - Edwin N Aroke
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
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12
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Fan Q, Nogueira L, Yabroff KR, Hussaini SMQ, Pollack CE. Housing and Cancer Care and Outcomes: A Systematic Review. J Natl Cancer Inst 2022; 114:1601-1618. [PMID: 36073953 PMCID: PMC9745435 DOI: 10.1093/jnci/djac173] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/19/2022] [Accepted: 08/29/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Access to stable and affordable housing is an important social determinant of health in the United States. However, research addressing housing and cancer care, diagnosis, and outcomes has not been synthesized. METHODS We conducted a systematic review of studies examining associations of housing and cancer care and outcomes using PubMed, Embase, Scopus, and CINAHL. Included studies were conducted in the United States and published in English between 1980 and 2021. Study characteristics and key findings were abstracted and qualitatively synthesized. RESULTS A total of 31 studies were identified. Housing-related measures were reported at the individual level in 20 studies (65%) and area level in 11 studies (35%). Study populations and housing measures were heterogeneous. The most common housing measures were area-level housing discrimination (8 studies, 26%), individual-level housing status (8 studies, 26%), and individual-level housing concerns (7 studies, 23%). The most common cancer outcomes were screening (12 studies, 39%) and mortality (9 studies, 29%). Few studies assessed multiple dimensions of housing. Most studies found that exposure to housing insecurity was statistically significantly associated with worse cancer care (11 studies) or outcomes (10 studies). CONCLUSIONS Housing insecurity is adversely associated with cancer care and outcomes, underscoring the importance of screening for housing needs and supporting systemic changes to advance equitable access to care. Additional research is needed to develop and test provider- and policy-level housing interventions that can effectively address the needs of individuals throughout the cancer care continuum.
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Affiliation(s)
- Qinjin Fan
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Leticia Nogueira
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - S M Qasim Hussaini
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Craig E Pollack
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
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13
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Fan Q, Keene DE, Banegas MP, Gehlert S, Gottlieb LM, Yabroff KR, Pollack CE. Housing Insecurity Among Patients With Cancer. J Natl Cancer Inst 2022; 114:1584-1592. [PMID: 36130291 PMCID: PMC9949594 DOI: 10.1093/jnci/djac136] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 01/11/2023] Open
Abstract
Social determinants of health are the economic and environmental conditions under which people are born, live, work, and age that affect health. These structural factors underlie many of the long-standing inequities in cancer care and outcomes that vary by geography, socioeconomic status, and race and ethnicity in the United States. Housing insecurity, including lack of safe, affordable, and stable housing, is a key social determinant of health that can influence-and be influenced by-cancer care across the continuum, from prevention to screening, diagnosis, treatment, and survivorship. During 2021, the National Cancer Policy Forum of the National Academies of Science, Engineering, and Medicine sponsored a series of webinars addressing social determinants of health, including food, housing, and transportation insecurity, and their associations with cancer care and patient outcomes. This dissemination commentary summarizes the formal presentations and panel discussions from the webinar devoted to housing insecurity. It provides an overview of housing insecurity and health care across the cancer control continuum, describes health system interventions to minimize the impact of housing insecurity on patients with cancer, and identifies challenges and opportunities for addressing housing insecurity and improving health equity. Systematically identifying and addressing housing insecurity to ensure equitable access to cancer care and reduce health disparities will require ongoing investment at the practice, systems, and broader policy levels.
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Affiliation(s)
- Qinjin Fan
- Correspondence to: Qinjin Fan, PhD, Surveillance & Health Equity Science Department, American Cancer Society, 3380 Chastain Meadows Pkwy, NW Suite 200, Kennesaw, GA 30144, USA (e-mail: )
| | - Danya E Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Matthew P Banegas
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, CA, USA
| | - Sarah Gehlert
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Laura M Gottlieb
- Social Interventions Research and Evaluation Network, University of California, San Francisco, CA, USA
| | - K Robin Yabroff
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Craig E Pollack
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
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14
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Sadler RC, Wojciechowski TW, Trangenstein P, Harris A, Buchalski Z, Furr-Holden D. Linking Historical Discriminatory Housing Patterns to the Contemporary Alcohol Environment. APPLIED SPATIAL ANALYSIS AND POLICY 2022; 16:561-581. [PMID: 36532713 PMCID: PMC9734485 DOI: 10.1007/s12061-022-09493-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 11/16/2022] [Indexed: 05/21/2023]
Abstract
Research on alcohol outlet density consistently shows greater disparities in exposure in disinvested communities. Likewise, structural racism via discriminatory housing practices has created many of the issues that beset contemporary disinvested neighborhoods. Little work, however, has examined the relationship between housing practices and alcohol outlet disparities. The central premise of our work is that these discriminatory and inequitable practices create distinctions in the alcohol environment, and that such disparities have implications for work on alcohol policy. Here we link alcohol outlet density with a spatial database examining redlining, blockbusting, and gentrification in Baltimore, Maryland, and Flint, Michigan (two cities with common experiences of urban disinvestment over the last 50 years). Standard measures are used to account for the impacts of neighborhood racial, socioeconomic, and housing composition in a multilevel model. Our findings highlight that gentrification and redlining are strongly associated with alcohol outlet density, while blockbusting is not. Gentrification and redlining also frequently co-occur in inner-urban areas, while the more suburban phenomenon of blockbusting rarely overlaps with either. These findings further contextualize nascent work on structural racism in housing that illustrates important disparities along the lines of these distinct practices. Future work should consider how legacy impacts of discriminatory housing patterns impact our communities today.
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Affiliation(s)
| | | | | | - Alan Harris
- Michigan State University, 200 E 1st St., Flint, MI 48502 USA
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15
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Mehranbod CA, Gobaud AN, Jacoby SF, Uzzi M, Bushover BR, Morrison CN. Historical redlining and the epidemiology of present-day firearm violence in the United States: A multi-city analysis. Prev Med 2022; 165:107207. [PMID: 36027991 PMCID: PMC10155117 DOI: 10.1016/j.ypmed.2022.107207] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/14/2022] [Accepted: 08/14/2022] [Indexed: 11/16/2022]
Abstract
Firearm violence is a major cause of morbidity, mortality, and racial health disparities in the United States. Previous studies have identified associations between historically racist housing discrimination (i.e., redlining practices) and firearm violence; however, these studies generally have been limited to a single city and have yet to provide sufficient evidence through which to determine the extent and dynamics of the impact of this relationship across the country. The aim of our study was (1) to estimate the association of historical redlining on both violent and firearm death across the country in nested models; and (2) to examine spatial non-stationarity to determine whether the impact of historical redlining on violent and firearm death was the same across the U.S. We used multilevel Bayesian conditional autoregressive Poisson models to determine the relationship between redlining as illustrated through Home Owners' Loan Corporation maps and 2019 violent and firearm deaths at the ZIP code-level nested within 21 cities across the U.S. We found that at the ZIP code level, there was a dose-responsive relationship between HOLC grading and the incidence of present-day firearm deaths. In general, redlined ZIP codes had higher relative incidence of firearm deaths. Associations were not stable across cities. For example, associations were relatively stronger in Baltimore, MD and weaker in Los Angeles, CA. This research reinforces the findings of previous studies examining the impact of redlining on firearm death across the extent of the entire country in 21 cities and claim that HOLC grades are associated with present-day violence.
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Affiliation(s)
- Christina A Mehranbod
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America.
| | - Ariana N Gobaud
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Sara F Jacoby
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Mudia Uzzi
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America; Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Brady R Bushover
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Christopher N Morrison
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Australia
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16
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Historic racism in Kansas City affects Today's pediatric asthma burden. Health Place 2022; 78:102927. [DOI: 10.1016/j.healthplace.2022.102927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
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17
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Liu M, Chung JE, Robinson B, Taylor L, Andrewn RA, Li J. A home visit program for low-income African American children with asthma: Caregivers' perception of asthma triggers and a gap in action. J Pediatr Nurs 2022; 67:e79-e84. [PMID: 36328913 DOI: 10.1016/j.pedn.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 08/29/2022] [Accepted: 09/04/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE The goals are to gauge caregivers' knowledge of at-home asthma triggers and identify the areas on which educational campaigns can focus to alleviate a child's asthma symptoms. DESIGN AND METHODS Families with children with moderate to severe asthmatic symptoms who had been recently hospitalized or in the emergency room were invited to participate in a home visit program. As part of the home visit, caregivers of the asthmatic children were asked a series of questions on asthma triggers and the measures for eliminating the triggers (N = 218). RESULTS Findings show a gap between caregivers' perception of asthma triggers and the actions to mitigate or avoid such triggers. CONCLUSIONS Overall findings show that home environments were suboptimal for the management and control of child asthma conditions. Knowledge about home triggers as well as the actions and efforts by caregivers and landlords to mitigate these was found to be inadequate. Even when caregivers are aware of the presence of at-home triggers, actions to minimize exposure to the trigger do not always follow due to a lack of power, resource, and knowledge. PRACTICE IMPLICATIONS The findings raise the need for additional research to investigate the reasons for the lack of actions, advocacy for low-income families to live in a healthy environment, continued education and empowerment, and patient/caregiver-doctor partnership. Additionally, the provision of community support through community advocacy and training of culturally competent healthcare providers are needed for the successful management of pediatric asthma among African American children.
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Affiliation(s)
- Meirong Liu
- School of Social Work, Howard University, USA
| | | | | | - Lori Taylor
- Respiratory Therapy, University of the District of Columbia, USA
| | | | - Jiang Li
- Department of Electrical Engineering and Computer Science, Howard University, USA
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18
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Gutnik L, Olopade OI, Newman LA, Fayanju OM. Breast cancer among African American and sub-Saharan African women: a tale of global inequities a tale of global inequities. Cancer Causes Control 2022; 33:1387-1390. [PMID: 36239864 PMCID: PMC9568943 DOI: 10.1007/s10552-022-01641-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/03/2022] [Indexed: 12/24/2022]
Abstract
Breast Cancer is the most common female cancer worldwide with significant global disparities, particularly disadvantaging women of African Ancestry. Though the United States and Sub-Saharan Africa are seemingly very different settings, there are many important parallels between the experience of getting diagnosed and treated for breast cancer in these two geographic regions for women of African ancestry. This commentary explores the parallels and differences and proposes an agenda to move forward to narrow the disparities gaps for some of the worlds most vulnerable women.
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Affiliation(s)
- Lily Gutnik
- Department of Surgery, School of Medicine, University of Alabama at Birmingham, BLDG BDB 515, 1807 Seventh Ave South, Birmingham, AL, 35233, USA. .,O'Neal Comprehensive Cancer Center at University of Alabama at Birmingham, Birmingham, AL, USA. .,Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Olufunmilayo I Olopade
- Department of Medicine, University of Chicago, 5841 S. Maryland Ave. M/C 2115, Chicago, IL, 60637, USA.,Centre for Clinical Cancer Genetics and Global Health, University of Chicago, Chicago, IL, USA
| | - Lisa A Newman
- Department of Breast Surgery, New York Presbyterian-Weill Cornell Medicine, 1283 York Avenue, 4th Floor, New York, NY, 10065, USA.,International Center for the Study of Breast Cancer Subtypes, Weill Cornell Medicine, New York, NY, USA
| | - Oluwadamilola M Fayanju
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Silverstein 4, Philadelphia, PA, 19104, USA.,Rena Rowan Breast Center, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.,Penn Center for Cancer Care Innovation (PC3I), Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute for Economics (LDI), University of Pennsylvania, Philadelphia, PA, USA
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Logan J, Crepaz N, Luo F, Dong X, Gant Z, Ertl A, Girod C, Patel N, Jin C, Balaji A, Sweeney P. HIV Care Outcomes in Relation to Racial Redlining and Structural Factors Affecting Medical Care Access Among Black and White Persons with Diagnosed HIV-United States, 2017. AIDS Behav 2022; 26:2941-2953. [PMID: 35277807 PMCID: PMC10428000 DOI: 10.1007/s10461-022-03641-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 11/30/2022]
Abstract
Black/African American (Black) versus White persons are unequally burdened by human immunodeficiency virus (HIV) in the United States. Structural factors can influence social determinants of health, key components in reducing HIV-related health inequality by race. This analysis examined HIV care outcomes among Black and White persons with diagnosed HIV (PWDH) in relation to three structural factors: racial redlining, Medicaid expansion, and Ryan White HIV/AIDS Program (RWHAP) use. Using National HIV Surveillance System, U.S. Census, and Home Mortgage Disclosure Act data, we examined linkage to HIV care and viral suppression (i.e., viral load < 200 copies/mL) in relation to the structural factors among 12,996 Black and White PWDH with HIV diagnosed in 2017/alive at year-end 2018, aged ≥ 18 years, and residing in 38 U.S. jurisdictions with complete laboratory data, geocoding, and census tract-level redlining indexes. Compared to White PWDH, a lower proportion of Black PWDH were linked to HIV care within 1 month after diagnosis and were virally suppressed in 2018. Redlining was not associated with the HIV care outcomes. A higher prevalence of PWDH residing (v. not residing) in states with Medicaid expansion were linked to HIV care ≤ 1 month after diagnosis. A higher prevalence of those residing (v. not residing) in states with > 50% of PWDH in RWHAP had viral suppression. Direct exposure to redlining was not associated with poor HIV care outcomes. Structural factors that reduce the financial burden of HIV care and improve care access like Medicaid expansion and RWHAP might improve HIV care outcomes of PWDH.
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Affiliation(s)
- J Logan
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 1600 Clifton Road NE, MS US8-2, Atlanta, GA, 30333, USA.
| | - Nicole Crepaz
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 1600 Clifton Road NE, MS US8-2, Atlanta, GA, 30333, USA
| | - Feijun Luo
- Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Zanetta Gant
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 1600 Clifton Road NE, MS US8-2, Atlanta, GA, 30333, USA
| | - Allison Ertl
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Candace Girod
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nimeshkumar Patel
- Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Chan Jin
- ICF International, Atlanta, GA, USA
| | - Alexandra Balaji
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 1600 Clifton Road NE, MS US8-2, Atlanta, GA, 30333, USA
| | - Patricia Sweeney
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 1600 Clifton Road NE, MS US8-2, Atlanta, GA, 30333, USA
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20
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Plascak JJ, Beyer K, Xu X, Stroup AM, Jacob G, Llanos AAM. Association Between Residence in Historically Redlined Districts Indicative of Structural Racism and Racial and Ethnic Disparities in Breast Cancer Outcomes. JAMA Netw Open 2022; 5:e2220908. [PMID: 35802373 PMCID: PMC9270695 DOI: 10.1001/jamanetworkopen.2022.20908] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/20/2022] [Indexed: 11/20/2022] Open
Abstract
Importance Historical structural racism may be associated with racial, ethnic, and geographic disparities in breast cancer outcomes, but few studies have investigated these potential relationships. Objective To test associations among historical mortgage lending discrimination (using 1930s Home Owners' Loan Corporation [HOLC] redlining data), race and ethnicity, tumor clinicopathologic features, and survival among women recently diagnosed with breast cancer. Design, Setting, and Participants This cohort study used a population-based, state cancer registry to analyze breast tumor clinicopathology and breast cancer-specific death among women diagnosed from 2008 to 2017 and followed up through 2019. Participants included all primary, histologically confirmed, invasive breast cancer cases diagnosed among women aged at least 20 years and who resided in a HOLC-graded area of New Jersey. Those missing race and ethnicity data (n = 61) were excluded. Data were analyzed between June and December 2021. Exposures HOLC risk grades of A ("best"), B ("still desirable"), C ("definitely declining"), and D ("hazardous" [ie, redlined area]). Main Outcomes and Measures Late stage at diagnosis, high tumor grade, triple-negative subtype (lacking estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 expression), breast cancer-specific death. Results Among a total of 14 964 women with breast cancer, 2689 were Latina, 3506 were non-Latina Black, 7686 were non-Latina White, and 1083 were other races and ethnicities (non-Latina Asian/Pacific Islander/Native American/Alaska Native/Hawaiian or not otherwise specified); there were 1755 breast cancer-specific deaths. Median follow-up time was 5.3 years (95% CI, 5.2-5.3 years) and estimated 5-year breast cancer-specific survival was 88.0% (95% CI, 87.4%-88.6%). Estimated associations between HOLC grade and each breast cancer outcome varied by race and ethnicity; compared with residence in HOLC redlined areas, residence in HOLC areas graded "best" was associated with lower odds of late-stage diagnosis (odds ratio [OR], 0.34 [95% CI, 0.22-0.53]), lower odds of high tumor grade (OR, 0.72 [95% CI, 0.57-0.91]), lower odds of triple-negative subtype (OR, 0.67 [95% CI, 0.47-0.95]), and lower hazard of breast cancer-specific death (hazard ratio, 0.48 [95% CI, 0.35-0.65]), but only among non-Latina White women. There was no evidence supporting associations among non-Latina Black or Latina women. Conclusions and Relevance Compared with redlined areas, current residence in non-redlined areas was associated with more favorable breast cancer outcomes, but only among non-Latina White women. Future studies should examine additional factors to inform how historical structural racism could be associated with beneficial cancer outcomes among privileged racial and ethnic groups.
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Affiliation(s)
- Jesse J. Plascak
- Comprehensive Cancer Center, The Ohio State University, Columbus
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus
| | - Kirsten Beyer
- Institute for Health and Society, Division of Epidemiology, Medical College of Wisconsin, Milwaukee
| | - Xinyi Xu
- Department of Statistics, The Ohio State University, Columbus
| | - Antoinette M. Stroup
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
- Rutgers Cancer Institute of New Jersey, New Brunswick
- New Jersey State Cancer Registry, New Jersey Department of Health, Trenton
| | - Gabrielle Jacob
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Adana A. M. Llanos
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
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21
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Gaglioti AH, Rivers D, Ringel JB, Judd S, Safford MM. Individual and Neighborhood Influences on the Relationship Between Waist Circumference and Coronary Heart Disease in the REasons for Geographic and Racial Differences in Stroke Study. Prev Chronic Dis 2022; 19:E20. [PMID: 35446759 PMCID: PMC9044900 DOI: 10.5888/pcd19.210195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The objective of this study was to describe how the relationship between waist circumference and incident coronary heart disease (CHD) is influenced by individual and neighborhood factors in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. METHODS REGARDS is a cohort study of 30,239 US adults. The primary exposure was sex-specific quartiles of waist circumference. Individual covariates included sociodemographic characteristics, health status, health behavior, and usual source of care. Neighborhood (ie, zip code-level) covariates included access to primary care, poverty, rurality, and racial segregation. The main outcome was incident CHD from baseline (2003) through 2017. We used descriptive statistics, Kaplan-Meier curves, and Cox proportional hazard models to analyze the overall sample and race-sex subgroups. RESULTS During the study period, 23,042 study participants had 1,499 CHD events. We found a higher risk of incident CHD in the upper quartile of waist circumference compared with the first quartile in all 4 race-sex subgroups except African American men, among whom we found no relationship between waist circumference and incident CHD. Covariates did not attenuate these relationships. CONCLUSION In all groups except African American men, waist circumference in the highest quartile was associated with increased risk of incident CHD. Individual and neighborhood factors did not influence the relationship between waist circumference and development of CHD but differentially influenced incident CHD among race-sex subgroups.
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Affiliation(s)
- Anne H Gaglioti
- National Center for Primary Care, Department of Family Medicine, Morehouse School of Medicine, Atlanta, Georgia.,National Center for Primary Care, Department of Family Medicine, Morehouse School of Medicine, 720 Westview Dr SW; Atlanta, GA 30310.
| | - Desiree Rivers
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Joanna Bryan Ringel
- Department of Medicine, Division of General Internal Medicine, Weill Cornell School of Medicine, New York, New York
| | - Suzanne Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Monika M Safford
- Department of Medicine, Division of General Internal Medicine, Weill Cornell School of Medicine, New York, New York
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22
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Obeng-Gyasi S, Graham N, Kumar S, Lee JW, Jacobus S, Weiss M, Cella D, Zhao F, Ip EH, O'Connell N, Hong F, Peipert DJ, Gareen IIF, Timsina LR, Gray R, Wagner LI, Carlos RC. Examining allostatic load, neighborhood socioeconomic status, symptom burden and mortality in multiple myeloma patients. Blood Cancer J 2022; 12:53. [PMID: 35365604 PMCID: PMC8975964 DOI: 10.1038/s41408-022-00648-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/06/2022] [Accepted: 03/11/2022] [Indexed: 11/16/2022] Open
Abstract
The objective of this study is to examine the association between neighborhood socioeconomic status (nSES) and baseline allostatic load (AL) and clinical trial endpoints in patients enrolled in the E1A11 therapeutic trial in multiple myeloma (MM). Study endpoints were symptom burden (pain, fatigue, and bother) at baseline and 5.5 months, non-completion of induction therapy, overall survival (OS) and progression-free survival (PFS). Multivariable logistic and Cox regression examined associations between nSES, AL and patient outcomes. A 1-unit increase in baseline AL was associated with greater odds of high fatigue at baseline (adjusted OR [95% CI] = 1.21 [1.08–1.36]) and a worse OS (adjusted hazard ratio, [95% CI] = 1.21 [1.06–1.37]). High nSES was associated with worse baseline bother (middle OR = 4.22 [1.11–16.09] and high 4.49 [1.16–17.43]) compared to low nSES. There was no association between AL or nSES and symptom burden at 5.5 months, non-completion of induction therapy or PFS. Additionally, there was no association between nSES and OS. AL may have utility as a predictive marker for OS among patients with MM and may allow individualization of treatment. Future studies should standardize and validate AL patients with MM.
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Affiliation(s)
| | - Noah Graham
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | | | - Ju-Whei Lee
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Susanna Jacobus
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | | | - David Cella
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Fengmin Zhao
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Edward H Ip
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Nathaniel O'Connell
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Fangxin Hong
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Devin J Peipert
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - IIana F Gareen
- Brown University Department of Epidemiology and Center for Statistical Sciences, Providence, RI, USA
| | - Lava R Timsina
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Robert Gray
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Lynne I Wagner
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Ruth C Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
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23
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Goel N, Westrick AC, Bailey ZD, Hernandez A, Balise RR, Goldfinger E, Antoni MH, Stoler J, Kesmodel SB, Kobetz EN. Structural Racism and Breast Cancer-specific Survival: Impact of Economic and Racial Residential Segregation. Ann Surg 2022; 275:776-783. [PMID: 35081560 PMCID: PMC9102835 DOI: 10.1097/sla.0000000000005375] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the effect of economic and racial/ethnic residential segregation on breast cancer-specific survival (BCSS) in South Florida, a diverse metropolitan area that mirrors the projected demographics of many United States regions. SUMMARY BACKGROUND DATA Despite advances in diagnosis and treatment, racial and economic disparities in BCSS. This study evaluates these disparities through the lens of racial and economic residential segregation, which approximate the impact of structural racism. METHODS Retrospective cohort study of stage I to IV breast cancer patients treated at our institution from 2005 to 2017. Our exposures include index of concentration at the extremes, a measurement of economic and racial neighborhood segregation, which was computed at the census-tract level using American Community Survey data. The primary outcome was BCSS. RESULTS Random effects frailty models predicted that patients living in low-income neighborhoods had higher mortality compared to those living in high-income neighborhoods [hazard ratios (HR): 1.56, 95% confidence interval (CI): 1.23-2.00]. Patients living in low-income non-Hispanic Black and Hispanic neighborhoods had higher mortality compared to those living in high-income non-Hispanic White (NHW) neighborhoods (HR: 2.43, 95%CI: 1.72, 3.43) and (HR: 1.99, 95%CI: 1.39, 2.84), after controlling for patient characteristics, respectively. In adjusted race-stratified analysis, NHWs living in low-income non-Hispanic Black neighborhoods had higher mortality compared to NHWs living in high-income NHW neighborhoods (HR: 4.09, 95%CI: 2.34-7.06). CONCLUSIONS Extreme racial/ethnic and economic segregation were associated with lower BCSS. We add novel insight regarding NHW and Hispanics to a growing body of literature that demonstrate how the ecological effects of structural racism-expressed through poverty and residential segregation-shape cancer survival.
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Affiliation(s)
- Neha Goel
- Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, Florida, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ashly C Westrick
- Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Zinzi D Bailey
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alexandra Hernandez
- Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Raymond R Balise
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Erica Goldfinger
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael H Antoni
- Department of Psychology, University of Miami and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Psychiatry and Behavioral Sciences and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Justin Stoler
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Susan B Kesmodel
- Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, Florida, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Erin N Kobetz
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Medicine, Division of Computational Medicine and Population Health, University of Miami Miller School of Medicine, Miami, Florida, USA
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24
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Li D, Newman GD, Wilson B, Zhang Y, Brown RD. Modeling the Relationships Between Historical Redlining, Urban Heat, and Heat-Related Emergency Department Visits: An Examination of 11 Texas Cities. ENVIRONMENT AND PLANNING. B, URBAN ANALYTICS AND CITY SCIENCE 2022; 49:933-952. [PMID: 35474708 PMCID: PMC9037692 DOI: 10.1177/23998083211039854] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Place-based structural inequalities can have critical implications for the health of vulnerable populations. Historical urban policies, such as redlining, have contributed to current inequalities in exposure to intra-urban heat. However, it is unknown whether these spatial inequalities are associated with disparities in heat-related health outcomes. The aim of this study is to determine the relationships between historical redlining, intra-urban heat conditions, and heat-related emergency department visits using data from eleven Texas cities. At the zip code level, the proportion of historical redlining was determined, and heat exposure was measured using daytime and nighttime land surface temperature (LST). Heat-related inpatient and outpatient rates were calculated based on emergency department visit data that included ten categories of heat-related diseases between 2016 and 2019. Regression or spatial error/lag models revealed significant associations between higher proportions of redlined areas in the neighborhood and higher LST (Coef. = 0.0122, 95% CI = 0.0039 - 0.0205). After adjusting for indicators of social vulnerability, neighborhoods with higher proportions of redlining showed significantly elevated heat-related outpatient visit rate (Coef. = 0.0036, 95% CI = 0.0007-0.0066) and inpatient admission rate (Coef. = 0.0018, 95% CI = 0.0001-0.0035). These results highlight the role of historical discriminatory policies on the disparities of heat-related illness and suggest a need for equity-based urban heat planning and management strategies.
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Affiliation(s)
- Dongying Li
- Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX 77843, USA
| | - Galen D. Newman
- Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX 77843, USA
| | - Bev Wilson
- Urban and Environmental Planning, School of Architecture, University of Virginia, USA
| | - Yue Zhang
- Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX 77843, USA
| | - Robert D. Brown
- Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX 77843, USA
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25
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Michaels EK, Board C, Mujahid MS, Riddell CA, Chae DH, Johnson RC, Allen AM. Area-level racial prejudice and health: A systematic review. Health Psychol 2022; 41:211-224. [PMID: 35254858 PMCID: PMC8930473 DOI: 10.1037/hea0001141] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
BACKGROUND In recent years, there has been growing interest in "moving beyond the individual" to measure area-level racism as a social determinant of health. Much of this work has aggregated racial prejudice data collected at the individual-level to the area-level. OBJECTIVE As this is a rapidly emerging area of research, we conducted a systematic literature review to describe evidence of the relationship between area-level racial prejudice and health, whether results differed by race/ethnicity, and to characterize key conceptual and methodological considerations to guide future research. METHOD We searched four interdisciplinary databases for US-based, peer-reviewed articles measuring area level racial prejudice by aggregating individual-level indicators of racial prejudice and examining associations with mental or physical health outcome(s). Data extraction followed PRISMA guidelines and also included theory and conceptualization, pathways to health, and strengths and limitations. RESULTS Fourteen of 14,632 identified articles met inclusion criteria and were included in the review. Health outcomes spanned all-cause (n = 4) and cause-specific (n = 4) mortality, birth outcomes (n = 4), cardiovascular outcomes (n = 2), mental health (n = 1), and self-rated health (n = 1). All studies found a positive association between area-level racial prejudice and adverse health outcomes among racial/ethnic minoritized groups, with four studies also showing a similar association among Whites. Engagement with formal theory was limited and exposure conceptualization was mixed. Methodological considerations included unmeasured confounding and trade-offs between generalizability, self-censorship, and specificity of measurement. CONCLUSIONS Future research should continue to develop the conceptual and methodological rigor of this work and test hypotheses to inform evidence-based interventions to advance population health and reduce racial health inequities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Eli K. Michaels
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Christine Board
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Mahasin S. Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Corinne A. Riddell
- Division of Epidemiology, School of Public Health, University of California, Berkeley
- Division of Biostatistics, School of Public Health, University of California, Berkeley
| | - David H. Chae
- Department of Global Community Health & Behavioral Sciences, Tulane School of Public Health and Tropical Medicine
| | | | - Amani M. Allen
- Division of Epidemiology, School of Public Health, University of California, Berkeley
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley
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26
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McCullough LE. The Long Red Line: Breast Cancer Incidence at the Intersection of Unjust Structural Policies and Their Contemporary Manifestations. JNCI Cancer Spectr 2022; 6:6531977. [PMID: 35603846 PMCID: PMC8953441 DOI: 10.1093/jncics/pkac018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
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27
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Michaels EK, Canchola AJ, Beyer KMM, Zhou Y, Shariff-Marco S, Gomez SL. Home mortgage discrimination and incidence of triple-negative and Luminal A breast cancer among non-Hispanic Black and non-Hispanic White females in California, 2006-2015. Cancer Causes Control 2022; 33:727-735. [PMID: 35113296 PMCID: PMC9010391 DOI: 10.1007/s10552-022-01557-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/24/2022] [Indexed: 11/24/2022]
Abstract
Purpose In the United States, Black females are burdened by more aggressive subtypes and increased mortality from breast cancer compared to non-Hispanic (NH) White females. Institutional racism may contribute to these inequities. We aimed to characterize the association between home mortgage discrimination, a novel measure of institutional racism, and incidence of Luminal A and triple-negative breast cancer (TNBC) subtypes among NH Black and NH White females in California metropolitan areas. Methods We merged data from the California Cancer Registry on females aged 20 + diagnosed with primary invasive breast cancer between 2006 and 2015 with a census tract-level index of home mortgage lending bias measuring the odds of mortgage loan denial for Black versus White applicants, generated from the 2007–2013 Home Mortgage Disclosure Act database. Poisson regression estimated cross-sectional associations of census tract-level racial bias in mortgage lending with race/ethnicity- and Luminal A and TNBC-specific incidence rate ratios, adjusting for neighborhood confounders. Results We identified n = 102,853 cases of Luminal A and n = 15,528 cases of TNBC over the study period. Compared to NH Whites, NH Black females had higher rates of TNBC, lower rates of Luminal A breast cancer, and lived in census tracts with less racial bias in home mortgage lending. There was no evidence of association between neighborhood racial bias in mortgage lending at the time of diagnosis and either subtype among either racial/ethnic group. Conclusion Future research should incorporate residential history data with measures of institutional racism to improve estimation and inform policy interventions.
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Affiliation(s)
- Eli K Michaels
- Division of Epidemiology, Berkeley School of Public Health, University of California, 2121 Berkeley Way #5302, Berkeley, CA, 94720-7360, USA.
| | - Alison J Canchola
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,Greater Bay Area Cancer Registry, San Francisco, CA, USA
| | - Kirsten M M Beyer
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Yuhong Zhou
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,Greater Bay Area Cancer Registry, San Francisco, CA, USA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,Greater Bay Area Cancer Registry, San Francisco, CA, USA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
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28
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MacIver L, London J, Sampson N, Gordon M, Grow R, Eady V. West Oakland's Experience in Building Community Power to Confront Environmental Injustice Through California's Assembly Bill 617. Am J Public Health 2022; 112:262-270. [PMID: 35080948 PMCID: PMC8802607 DOI: 10.2105/ajph.2021.306592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 02/03/2023]
Abstract
We explored how air quality management processes associated with Assembly Bill 617 (AB 617) in West Oakland, California, represent a shift in power relationships between government agencies and communities toward the goal of addressing legacies of environmental injustice. We drew from a statewide assessment of community engagement in AB 617's first year, and an analysis of the West Oakland AB 617 process. The first comprised 2 statewide surveys (n = 102 and n = 106), 70 key informant interviews, observation of all AB 617 first-year sites, and analysis of related planning documents. The second comprised 2 rounds of interviews (n = 22 and n = 23, with a total of 19 individuals) and extensive participant observation. Several factors are necessary for pursuing environmental justice: (1) invest in community partnerships and collaborations, (2) honor community knowledge and data, (3) ensure that community constituents share power in environmental governance, and (4) adopt explicit racial justice frameworks. Although still a work in progress, AB 617 offers important lessons for community and policy organizations nationwide engaged in environmental justice. (Am J Public Health. 2022;112(2):262-270. https://doi.org/10.2105/AJPH.2021.306592).
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Affiliation(s)
- Lily MacIver
- At the time of this writing, Lily MacIver was with the Department of City and Regional Planning, University of California, Berkeley. Jonathan London is with the Department of Human Ecology, University of California, Davis. Natalie Sampson is with the Department of Health and Human Services, University of Michigan-Dearborn. Margaret Gordon is with the West Oakland Environmental Indicators Project, Oakland, CA. Richard Grow is retired from US Environmental Protection Agency Region 9, San Francisco, CA. Veronica Eady is with the Bay Area Air Quality Management District, San Francisco, CA
| | - Jonathan London
- At the time of this writing, Lily MacIver was with the Department of City and Regional Planning, University of California, Berkeley. Jonathan London is with the Department of Human Ecology, University of California, Davis. Natalie Sampson is with the Department of Health and Human Services, University of Michigan-Dearborn. Margaret Gordon is with the West Oakland Environmental Indicators Project, Oakland, CA. Richard Grow is retired from US Environmental Protection Agency Region 9, San Francisco, CA. Veronica Eady is with the Bay Area Air Quality Management District, San Francisco, CA
| | - Natalie Sampson
- At the time of this writing, Lily MacIver was with the Department of City and Regional Planning, University of California, Berkeley. Jonathan London is with the Department of Human Ecology, University of California, Davis. Natalie Sampson is with the Department of Health and Human Services, University of Michigan-Dearborn. Margaret Gordon is with the West Oakland Environmental Indicators Project, Oakland, CA. Richard Grow is retired from US Environmental Protection Agency Region 9, San Francisco, CA. Veronica Eady is with the Bay Area Air Quality Management District, San Francisco, CA
| | - Margaret Gordon
- At the time of this writing, Lily MacIver was with the Department of City and Regional Planning, University of California, Berkeley. Jonathan London is with the Department of Human Ecology, University of California, Davis. Natalie Sampson is with the Department of Health and Human Services, University of Michigan-Dearborn. Margaret Gordon is with the West Oakland Environmental Indicators Project, Oakland, CA. Richard Grow is retired from US Environmental Protection Agency Region 9, San Francisco, CA. Veronica Eady is with the Bay Area Air Quality Management District, San Francisco, CA
| | - Richard Grow
- At the time of this writing, Lily MacIver was with the Department of City and Regional Planning, University of California, Berkeley. Jonathan London is with the Department of Human Ecology, University of California, Davis. Natalie Sampson is with the Department of Health and Human Services, University of Michigan-Dearborn. Margaret Gordon is with the West Oakland Environmental Indicators Project, Oakland, CA. Richard Grow is retired from US Environmental Protection Agency Region 9, San Francisco, CA. Veronica Eady is with the Bay Area Air Quality Management District, San Francisco, CA
| | - Veronica Eady
- At the time of this writing, Lily MacIver was with the Department of City and Regional Planning, University of California, Berkeley. Jonathan London is with the Department of Human Ecology, University of California, Davis. Natalie Sampson is with the Department of Health and Human Services, University of Michigan-Dearborn. Margaret Gordon is with the West Oakland Environmental Indicators Project, Oakland, CA. Richard Grow is retired from US Environmental Protection Agency Region 9, San Francisco, CA. Veronica Eady is with the Bay Area Air Quality Management District, San Francisco, CA
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29
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Namin S, Zhou Y, Xu W, McGinley E, Jankowski C, Laud P, Beyer K. Persistence of mortgage lending bias in the United States: 80 years after the Home Owners' Loan Corporation security maps. JOURNAL OF RACE, ETHNICITY AND THE CITY 2022; 3:70-94. [PMID: 35992214 PMCID: PMC9387904 DOI: 10.1080/26884674.2021.2019568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Housing discrimination and racial segregation have a long history in the United States. The 1930's Home Owners' Loan Corporation (HOLC) "residential security maps," recently digitized, have become a popular visualization of Depression era mortgage lending risk patterns across American cities. Numerous housing policies have since been instituted, including the Home Mortgage Disclosure Act (HMDA), but mortgage lending bias persists. The degree to which detailed spatial patterns of bias have persisted or changed along with urban change is not well understood. We compare historic HOLC grades and contemporary levels of mortgage lending bias using spatially detailed HMDA data. We further examine the relationship between HOLC risk grades and contemporary racial and ethnic settlement patterns. Results suggest that historical mortgage lending risk categorizations and settlement patterns are associated with contemporary mortgage lending bias and racial and ethnic settlement patterns. Concerted and deliberate efforts will be needed to change these patterns.
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Affiliation(s)
| | | | - Wei Xu
- University of Wisconsin-Madison
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Siegel SD, Brooks MM, Lynch SM, Sims-Mourtada J, Schug ZT, Curriero FC. Racial disparities in triple negative breast cancer: toward a causal architecture approach. Breast Cancer Res 2022; 24:37. [PMID: 35650633 PMCID: PMC9158353 DOI: 10.1186/s13058-022-01533-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/23/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Triple negative breast cancer (TNBC) is an aggressive subtype of invasive breast cancer that disproportionately affects Black women and contributes to racial disparities in breast cancer mortality. Prior research has suggested that neighborhood effects may contribute to this disparity beyond individual risk factors. METHODS The sample included a cohort of 3316 breast cancer cases diagnosed between 2012 and 2020 in New Castle County, Delaware, a geographic region of the US with elevated rates of TNBC. Multilevel methods and geospatial mapping evaluated whether the race, income, and race/income versions of the neighborhood Index of Concentration at the Extremes (ICE) metric could efficiently identify census tracts (CT) with higher odds of TNBC relative to other forms of invasive breast cancer. Odds ratios (OR) and 95% confidence intervals (CI) were reported; p-values < 0.05 were significant. Additional analyses examined area-level differences in exposure to metabolic risk factors, including unhealthy alcohol use and obesity. RESULTS The ICE-Race, -Income-, and Race/Income metrics were each associated with greater census tract odds of TNBC on a bivariate basis. However, only ICE-Race was significantly associated with higher odds of TNBC after adjustment for patient-level age and race (most disadvantaged CT: OR = 2.09; 95% CI 1.40-3.13), providing support for neighborhood effects. Higher counts of alcohol and fast-food retailers, and correspondingly higher rates of unhealthy alcohol use and obesity, were observed in CTs that were classified into the most disadvantaged ICE-Race quintile and had the highest odds of TNBC. CONCLUSION The use of ICE can facilitate the monitoring of cancer inequities and advance the study of racial disparities in breast cancer.
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Affiliation(s)
- Scott D. Siegel
- grid.414316.50000 0004 0444 1241Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, 4701 Ogletown-Stanton Road, Newark, DE 19713 USA ,grid.414316.50000 0004 0444 1241Institute for Research on Equity and Community Health, Christiana Care Health System, Newark, USA
| | - Madeline M. Brooks
- grid.414316.50000 0004 0444 1241Institute for Research on Equity and Community Health, Christiana Care Health System, Newark, USA
| | - Shannon M. Lynch
- grid.249335.a0000 0001 2218 7820Fox Chase Cancer Center, Philadelphia, USA
| | - Jennifer Sims-Mourtada
- grid.414316.50000 0004 0444 1241Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, 4701 Ogletown-Stanton Road, Newark, DE 19713 USA
| | - Zachary T. Schug
- grid.251075.40000 0001 1956 6678The Wistar Institute Cancer Center, Philadelphia, USA
| | - Frank C. Curriero
- grid.21107.350000 0001 2171 9311Department of Epidemiology, Johns Hopkins Spatial Science for Public Health Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Richard-Eaglin A, Muirhead L, Webb M, Randolph SD. A syndemic effect: Interrelationships between systemic racism, health disparities, and COVID-19. Nursing 2022; 52:38-43. [PMID: 34979013 DOI: 10.1097/01.nurse.0000803424.08667.c6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
ABSTRACT This article discusses the interconnection between the syndemic effect of racial inequities and disparities as well as the impact of the COVID-19 pandemic on Black Americans. It also highlights meaningful reforms and priorities to achieve health equity in Black communities.
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Affiliation(s)
- Angela Richard-Eaglin
- Angela Richard-Eaglin is the associate dean for Equity and an associate professor at Yale University in Orange, Conn. Lisa Muirhead is an associate professor and the assistant dean for Diversity, Equity, and Inclusion at Emory University's Nell Hodgson Woodruff School of Nursing. Michelle Webb is an assistant professor at Duke University School of Nursing. Schenita D. Randolph is an associate professor at Duke University School of Nursing and a co-director of the Duke Center for REsearch to AdvanCe Healthcare Equity (REACH Equity) Community Engagement Core
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Cuevas AG, Boen C. Tip of the iceberg: Measuring racial discrimination in studies of health. Stress Health 2021; 37:1043-1050. [PMID: 33739613 PMCID: PMC8449795 DOI: 10.1002/smi.3047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 03/05/2021] [Accepted: 03/12/2021] [Indexed: 11/09/2022]
Abstract
There is compelling evidence that racial discrimination is a risk factor for illness and disease. But what are health scientists measuring-and what do they think they are measuring-when they include measures of racial discrimination in health research? We synthesize theoretical conceptualizations of racial discrimination in health research and critically assess whether and how these concepts correspond (or not) to widely used measures of racial discrimination. In doing so, we show that while researchers often use terms such as 'self-reported discrimination', 'perceptions of discrimination', and 'exposure to discrimination' interchangeably, these concepts are indeed unique, with each holding a distinct epistemological position and theoretical and methodological capacity to uncover the impact of racial discrimination on health and health disparities. Importantly, we argue that commonly used measures of self-reported or perceived racial discrimination are just the 'tip of the iceberg' in terms of revealing the ways in which discrimination shapes health inequities. Scientists and practitioners must be cognizant of and intentional in their measurement choices and language, as the framing of these processes will inform policy and intervention efforts aimed at eliminating discrimination.
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Affiliation(s)
- Adolfo G. Cuevas
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
| | - Courtney Boen
- Department of Sociology, Population Studies Center, & Population Aging Research Center, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Walker RJ, Walker RE, Mosley-Johnson E, Egede LE. Exploring the Lived Experience of Food Insecure African Americans with Type 2 Diabetes Living in the Inner City. Ethn Dis 2021; 31:527-536. [PMID: 34720556 PMCID: PMC8545483 DOI: 10.18865/ed.31.4.527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose Despite evidence that food insecure African Americans with type 2 diabetes are at particularly high risk for poor health outcomes, there is currently a lack of information on their lived experience. This qualitative study aimed to identify challenges, facilitators, and barriers to effective diabetes care for food insecure African Americans with type 2 diabetes residing in an inner city. Methods In fall 2018, we conducted two focus groups attended by a total of 16 food insecure adults with type 2 diabetes residing in the inner city of Milwaukee, Wisconsin. A standardized moderator guide included questions to explore the role of food insecurity in managing diabetes, and facilitators that improve diabetes management within the context of food insecurity. Focus groups were audio recorded and recordings were transcribed by a professional transcription service. A grounded theory approach was used for analysis. Results Six major challenges existed at the individual level (diet/nutrition, exercise, diabetes knowledge and skills, complications from diabetes, a family history of diabetes, and a preoccupation with food). Five major barriers and facilitators existed both internally and externally to the individuals (access to food, medications, stress, cost of health-related needs and religion/spirituality). Conclusions This study identified multiple challenges, barriers, and facilitators to effective care for food insecure African American adults with type 2 diabetes. It is imperative to incorporate this understanding in future work by using an ecological approach to investigate strategies to address food insecurity beyond a singular focus on access to food.
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Affiliation(s)
- Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, WI.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Renee E Walker
- Zilber School of Public Health, University of Wisconsin at Milwaukee, Milwaukee, WI
| | - Elise Mosley-Johnson
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, WI.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, WI.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
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What Are the Relationships between Psychosocial Community Characteristics and Dietary Behaviors in a Racially/Ethnically Diverse Urban Population in Los Angeles County? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189868. [PMID: 34574791 PMCID: PMC8468734 DOI: 10.3390/ijerph18189868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/22/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022]
Abstract
To address existing gaps in public health practice, we used data from a 2014 internet panel survey of 954 Los Angeles County adults to investigate the relationships between psychosocial community characteristics (PCCs) and two key chronic disease-related dietary behaviors: fruit and vegetable (F+V) and soda consumption. Negative binomial regression models estimated the associations between 'neighborhood risks and resources' and 'sense of community' factors for each dietary outcome of interest. While high perceived neighborhood violence (p < 0.001) and perceived community-level collective efficacy (p < 0.001) were associated with higher F+V consumption, no PCCs were directly associated with soda consumption overall. However, moderation analyses by race/ethnicity showed a more varied pattern. High perceived violence was associated with lower F+V consumption among White and Asian/Native Hawaiian/Other Pacific Islander (ANHOPI) groups (p < 0.01). Inadequate park access and walking as the primary mode of transportation to the grocery store were associated with higher soda consumption among the ANHOPI group only (p < 0.05). Study findings suggest that current and future chronic disease prevention efforts should consider how social and psychological dynamics of communities influence dietary behaviors, especially among racially/ethnically diverse groups in urban settings. Intervention design and implementation planning could benefit from and be optimized based on these considerations.
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Ecological Study of Variability in the Relationship between Liver Cancer Mortality and Racial Residential Segregation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189732. [PMID: 34574655 PMCID: PMC8465489 DOI: 10.3390/ijerph18189732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 01/16/2023]
Abstract
Racial segregation has been identified as a predictor for the burden of cancer in several different metropolitan areas across the United States. This ecological study tested relationships between racial segregation and liver cancer mortality across several different metropolitan statistical areas in Wisconsin. Tract-level liver cancer mortality rates were calculated using cases from 2003-2012. Hotspot analysis was conducted and segregation scores in high, low, and baseline mortality tracts were compared using ANOVA. Spatial regression analysis was done, controlling for socioeconomic advantage and rurality. Black isolation scores were significantly higher in high-mortality tracts compared to baseline and low-mortality tracts, but stratification by metropolitan areas found this relationship was driven by two of the five metropolitan areas. Hispanic isolation was predictive for higher mortality in regression analysis, but this effect was not found across all metropolitan areas. This study showed associations between liver cancer mortality and racial segregation but also found that this relationship was not generalizable to all metropolitan areas in the study area.
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Beyer KMM, Zhou Y, Laud PW, McGinley EL, Yen TWF, Jankowski C, Rademacher N, Namin S, Kwarteng J, Beltrán Ponce S, Nattinger AB. Mortgage Lending Bias and Breast Cancer Survival Among Older Women in the United States. J Clin Oncol 2021; 39:2749-2757. [PMID: 34129388 PMCID: PMC8407650 DOI: 10.1200/jco.21.00112] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/23/2021] [Accepted: 04/30/2021] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The objective was to examine the relationship between contemporary redlining (mortgage lending bias on the basis of property location) and survival among older women with breast cancer in the United States. METHODS A redlining index using Home Mortgage Disclosure Act data (2007-2013) was linked by census tract with a SEER-Medicare cohort of 27,516 women age 66-90 years with an initial diagnosis of stage I-IV breast cancer in 2007-2009 and follow-up through 2015. Cox proportional hazards models were used to examine the relationship between redlining and both all-cause and breast cancer-specific mortality, accounting for covariates. RESULTS Overall, 34% of non-Hispanic White, 57% of Hispanic, and 79% of non-Hispanic Black individuals lived in redlined tracts. As the redlining index increased, women experienced poorer survival. This effect was strongest for women with no comorbid conditions, who comprised 54% of the sample. For redlining index values of 1 (low), 2 (moderate), and 3 (high), as compared with 0.5 (least), hazard ratios (HRs) (and 95% CIs) for all-cause mortality were HR = 1.10 (1.06 to 1.14), HR = 1.27 (1.17 to 1.38), and HR = 1.39 (1.25 to 1.55), respectively, among women with no comorbidities. A similar pattern was found for breast cancer-specific mortality. CONCLUSION Contemporary redlining is associated with poorer breast cancer survival. The impact of this bias is emphasized by the pronounced effect even among women with health insurance (Medicare) and no comorbid conditions. The magnitude of this neighborhood level effect demands an increased focus on upstream determinants of health to support comprehensive patient care. The housing sector actively reveals structural racism and economic disinvestment and is an actionable policy target to mitigate adverse upstream health determinants for the benefit of patients with cancer.
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Affiliation(s)
- Kirsten M. M. Beyer
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI
| | - Yuhong Zhou
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Purushottam W. Laud
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI
| | - Emily L. McGinley
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Tina W. F. Yen
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Courtney Jankowski
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI
| | | | - Sima Namin
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Jamila Kwarteng
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI
- MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI
| | - Sara Beltrán Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Ann B. Nattinger
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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37
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Shiman LJ, Freeman K, Bedell J, Bassett MT. Making Injustice Visible: How a Health Department Can Demonstrate the Connection Between Structural Racism and the Health of Whole Neighborhoods. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:442-448. [PMID: 32956297 DOI: 10.1097/phh.0000000000001259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) has built a presence in Tremont, a historically redlined neighborhood located in Bronx, NYC. As part of an agency-wide commitment to explicitly name racism as a threat to healthy communities, DOHMH has sought opportunities to educate and engage in discussion about historical and current structural racism. PROGRAM Between January and September 2018, DOHMH exhibited Undesign the Redline, a pictorial timeline and historical analysis of redlining, in its Tremont office. The exhibit exposed neglected history, making concrete the concept of structural racism. IMPLEMENTATION DOHMH staff led 101 tours for 950 visitors, including employees, community partners, and residents. Tours were given in English and Spanish in three 2-month cycles over 8 months. Tour guides also facilitated interactive workshops with youth groups, community-based organizations, and teams from city agencies to engage participants in the design and ownership of new systems intended to "undesign" the consequences of redlining. EVALUATION Immediate feedback was requested from all participants at the conclusion of each tour and was collected on a bulletin board. Longer-term impact was assessed through an electronic survey sent to all participants who provided valid contact information to better understand ways that the exhibit impacted personal and professional actions. Participants reported talking with family, friends, and coworkers, seeking more information, and applying an equity lens to professional projects after experiencing the exhibit. DISCUSSION Hosting the exhibit in a local health department building offered a concrete opportunity to learn about and discuss structural racism. Exhibit tours had immediate- and long-term impacts on participants and contributed to sustainable changes internal to DOHMH work. This work presents a concrete practice to make injustice visible and engage in open conversation about structural racism to build community trust.
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Affiliation(s)
- Lauren J Shiman
- Bureau of Bronx Neighborhood Health, Center for Health Equity and Community Wellness, NYC Department of Health and Mental Hygiene, New York City, New York (Mss Shiman and Freeman and Drs Bedell and Bassett). Dr Bassett is now at François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, Massachusetts
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Gabriel E, Brockman TA, Albertie M, Balls-Berry J. Neighborhood-Level Redlining and Lending Bias Are Associated with Breast Cancer Mortality in a Large and Diverse Metropolitan Area-Letter. Cancer Epidemiol Biomarkers Prev 2021; 30:799. [PMID: 33811167 DOI: 10.1158/1055-9965.epi-20-1763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/06/2021] [Accepted: 01/15/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Emmanuel Gabriel
- Department of Surgery, Section of Surgical Oncology, Mayo Clinic Florida, Jacksonville, Florida.
| | | | - Monica Albertie
- Department of Health Care Administration, Mayo Clinic Rochester, Rochester, Minnesota
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Mendez DD, Scott J, Adodoadji L, Toval C, McNeil M, Sindhu M. Racism as Public Health Crisis: Assessment and Review of Municipal Declarations and Resolutions Across the United States. Front Public Health 2021; 9:686807. [PMID: 34458221 PMCID: PMC8385329 DOI: 10.3389/fpubh.2021.686807] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/14/2021] [Indexed: 11/30/2022] Open
Abstract
Racism in the United States has been cited as a key driver of racial health inequities. Racism as a public health crisis has been in the forefront, particularly with respect to state and municipal governments that have developed legislation, resolutions, and declarations. This policy brief includes a review of resolutions and declarations across the US related to Racism as a Public Health Crisis through the end of September 2020. There were 125 resolutions reviewed for content related to the history of racism, reference to racial health equity data, content related to action steps or implementation, and any accompanying funding or resources. We found that the majority of policies name racism as critical in addressing racial inequities in health with limited details about specific actions, funding, or resources.
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Affiliation(s)
- Dara D. Mendez
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jewel Scott
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Linda Adodoadji
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Christina Toval
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Monica McNeil
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Mahima Sindhu
- Departments of Communication and Statistics, Dietrich School of Arts and Sciences, University of Pittsburgh, Pittsburgh, PA, United States
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Bikomeye JC, Namin S, Anyanwu C, Rublee CS, Ferschinger J, Leinbach K, Lindquist P, Hoppe A, Hoffman L, Hegarty J, Sperber D, Beyer KMM. Resilience and Equity in a Time of Crises: Investing in Public Urban Greenspace Is Now More Essential Than Ever in the US and Beyond. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8420. [PMID: 34444169 PMCID: PMC8392137 DOI: 10.3390/ijerph18168420] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/31/2021] [Accepted: 08/01/2021] [Indexed: 01/14/2023]
Abstract
The intersecting negative effects of structural racism, COVID-19, climate change, and chronic diseases disproportionately affect racial and ethnic minorities in the US and around the world. Urban populations of color are concentrated in historically redlined, segregated, disinvested, and marginalized neighborhoods with inadequate quality housing and limited access to resources, including quality greenspaces designed to support natural ecosystems and healthy outdoor activities while mitigating urban environmental challenges such as air pollution, heat island effects, combined sewer overflows and poor water quality. Disinvested urban environments thus contribute to health inequity via physical and social environmental exposures, resulting in disparities across numerous health outcomes, including COVID-19 and chronic diseases such as cancer and cardiovascular diseases (CVD). In this paper, we build off an existing conceptual framework and propose another conceptual framework for the role of greenspace in contributing to resilience and health equity in the US and beyond. We argue that strategic investments in public greenspaces in urban neighborhoods impacted by long term economic disinvestment are critically needed to adapt and build resilience in communities of color, with urgency due to immediate health threats of climate change, COVID-19, and endemic disparities in chronic diseases. We suggest that equity-focused investments in public urban greenspaces are needed to reduce social inequalities, expand economic opportunities with diversity in workforce initiatives, build resilient urban ecosystems, and improve health equity. We recommend key strategies and considerations to guide this investment, drawing upon a robust compilation of scientific literature along with decades of community-based work, using strategic partnerships from multiple efforts in Milwaukee Wisconsin as examples of success.
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Affiliation(s)
- Jean C. Bikomeye
- Institute for Health & Equity, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA; (J.C.B.); (S.N.); (C.A.)
| | - Sima Namin
- Institute for Health & Equity, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA; (J.C.B.); (S.N.); (C.A.)
| | - Chima Anyanwu
- Institute for Health & Equity, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA; (J.C.B.); (S.N.); (C.A.)
| | - Caitlin S. Rublee
- Department of Emergency Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA;
| | - Jamie Ferschinger
- Sixteenth Street Community Health Centers, Environmental Health & Community Wellness, 1337 S Cesar Chavez Drive, Milwaukee, WI 53204, USA;
| | - Ken Leinbach
- The Urban Ecology Center, 1500 E. Park Place, Milwaukee, WI 53211, USA;
| | - Patricia Lindquist
- Wisconsin Department of Natural Resources, Division of Forestry, 101 S. Webster Street, P.O. Box 7921, Madison, WI 53707, USA;
| | - August Hoppe
- The Urban Wood Lab, Hoppe Tree Service, 1813 S. 73rd Street, West Allis, WI 53214, USA;
| | - Lawrence Hoffman
- Department of GIS, Groundwork Milwaukee, 227 West Pleasant Street, Milwaukee, WI 53212, USA;
| | - Justin Hegarty
- Reflo—Sustainable Water Solutions, 1100 S 5th Street, Milwaukee, WI 53204, USA;
| | - Dwayne Sperber
- Wudeward Urban Forest Products, N11W31868 Phyllis Parkway, Delafield, WI 53018, USA;
| | - Kirsten M. M. Beyer
- Institute for Health & Equity, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA; (J.C.B.); (S.N.); (C.A.)
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Azriful A, Mallapiang F, Kurniati Y. Literature Review: Social Determinant of Health in Breast Cancer Patients Survival. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Social determinants have an important role in the survival of breast cancer patients.
AIM: This article aims to reviews the social determinants that affect the survival of breast cancer patient.
METHODS: We searched PubMed and Google Scholar for identifying studies related to this review using free-text terms and Medical Subject Headings terms. Both experimental and observational studies on social determinants of breast cancer patient survival which were published in the English language have been included in this review except expert opinions, commentaries, editorials, and review articles. Ten studies were eligible to be included in review.
RESULTS: Social health determinants that play a role in the survival of breast cancer patients are education level, place of residence, socioeconomic status, social environment, racial discrimination, and access to health services.
CONCLUSION: Social determinants have an influence on the survival of breast cancer patients, so it is important to pay attention to these factors.
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Islami F, Fedewa SA, Thomson B, Nogueira L, Yabroff KR, Jemal A. Association between disparities in intergenerational economic mobility and cause-specific mortality among Black and White persons in the United States. Cancer Epidemiol 2021; 74:101998. [PMID: 34364819 DOI: 10.1016/j.canep.2021.101998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/16/2021] [Accepted: 07/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evidence about the association between structural racism and mortality in the United States is limited. We examined the association between ongoing structural racism, measured as inequalities in adulthood income between White and Black children with similar parental household income (economic mobility gap) in a recent birth cohort, and Black-White disparities in death rates (mortality gap) overall and for major causes. METHODS Sex-, race/ethnicity-, and county-specific data were used to examine sex-specific associations between economic mobility and mortality gaps for all causes combined, heart diseases, cerebrovascular diseases, chronic obstructive pulmonary disease (COPD), injury/violence, all malignant cancers, and 14 cancer types. Economic mobility data for 1978-1983 birth cohorts and death rates during 2011-2018 were obtained from the Opportunity Atlas and National Center for Health Statistics, respectively. Data from 471 counties were included in analyses of all-cause mortality at ages 30-39 years during 2011-2018 (corresponding to partially overlapping 1978-1983 birth cohorts); and from 1,572 and 1,248 counties in analyses of all-cause and cause-specific mortality in all ages combined, respectively. RESULTS In ages 30-39 years, a one percentile increase in the economic mobility gap was associated with a 6.8 % (95 % confidence interval 1.8 %-11.8 %) increase in the Black-White mortality gap among males and a 13.5 % (8.9 %-18.1 %) increase among females, based on data from 471 counties. In all ages combined, the corresponding percentages based on data from 1,572 counties were 10.2 % (7.2 %-13.2 %) among males and 14.8 % (11.4 %-18.2 %) among females, equivalent to an increase of 18.4 and 14.0 deaths per 100,000 in the mortality gap, respectively. Similarly, strong associations between economic mobility gap and mortality gap in all ages were found for major causes of death, notably for potentially preventable conditions, including COPD, injury/violence, and cancers of the lung, liver, and cervix. CONCLUSIONS Economic mobility gap conditional on parental income in a recent birth cohort as a marker of ongoing structural racism is strongly associated with Black-White disparities in all-cause mortality and mortality from several causes.
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Affiliation(s)
- Farhad Islami
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, United States.
| | - Stacey A Fedewa
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, United States
| | - Blake Thomson
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, United States
| | - Leticia Nogueira
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, United States
| | - K Robin Yabroff
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, United States
| | - Ahmedin Jemal
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, United States
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Namin S, Zhou Y, Neuner J, Beyer K. Neighborhood Characteristics and Cancer Survivorship: An Overview of the Current Literature on Neighborhood Landscapes and Cancer Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7192. [PMID: 34281129 PMCID: PMC8297243 DOI: 10.3390/ijerph18137192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/21/2021] [Accepted: 07/02/2021] [Indexed: 12/18/2022]
Abstract
There is a growing literature on the association between neighborhood contexts and cancer survivorship. To understand the current trends and the gaps in the literature, we aimed to answer the following questions: To what degree, and how, has cancer survivorship research accounted for neighborhood-level effects? What neighborhood metrics have been used to operationalize neighborhood factors? To what degree do the neighborhood level metrics considered in cancer research reflect neighborhood development as identified in the Leadership for Energy and Environmental Design for Neighborhood Development (LEED-ND) guidelines? We first conducted a review guided by PRISMA extension for scoping review of the extant literature on neighborhood effects and cancer survivorship outcomes from January 2000 to January 2021. Second, we categorized the studied neighborhood metrics under six main themes. Third, we assessed the findings based on the LEED-ND guidelines to identify the most relevant neighborhood metrics in association with areas of focus in cancer survivorship care and research. The search results were scoped to 291 relevant peer-reviewed journal articles. Results show that survivorship disparities, primary care, and weight management are the main themes in the literature. Additionally, most articles rely on neighborhood SES as the primary (or only) examined neighborhood level metric. We argue that the expansion of interdisciplinary research to include neighborhood metrics endorsed by current paradigms in salutogenic urban design can enhance the understanding of the role of socioecological context in survivorship care and outcomes.
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Affiliation(s)
- Sima Namin
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (Y.Z.); (K.B.)
| | - Yuhong Zhou
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (Y.Z.); (K.B.)
| | - Joan Neuner
- General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Kirsten Beyer
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (Y.Z.); (K.B.)
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A more practical guide to incorporating health equity domains in implementation determinant frameworks. Implement Sci Commun 2021; 2:61. [PMID: 34090524 PMCID: PMC8178842 DOI: 10.1186/s43058-021-00146-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 04/07/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Due to striking disparities in the implementation of healthcare innovations, it is imperative that researchers and practitioners can meaningfully use implementation determinant frameworks to understand why disparities exist in access, receipt, use, quality, or outcomes of healthcare. Our prior work documented and piloted the first published adaptation of an existing implementation determinant framework with health equity domains to create the Health Equity Implementation Framework. We recommended integrating these three health equity domains to existing implementation determinant frameworks: (1) culturally relevant factors of recipients, (2) clinical encounter or patient-provider interaction, and (3) societal context (including but not limited to social determinants of health). This framework was developed for healthcare and clinical practice settings. Some implementation teams have begun using the Health Equity Implementation Framework in their evaluations and asked for more guidance. METHODS We completed a consensus process with our authorship team to clarify steps to incorporate a health equity lens into an implementation determinant framework. RESULTS We describe steps to integrate health equity domains into implementation determinant frameworks for implementation research and practice. For each step, we compiled examples or practical tools to assist implementation researchers and practitioners in applying those steps. For each domain, we compiled definitions with supporting literature, showcased an illustrative example, and suggested sample quantitative and qualitative measures. CONCLUSION Incorporating health equity domains within implementation determinant frameworks may optimize the scientific yield and equity of implementation efforts by assessing and ideally addressing implementation and equity barriers simultaneously. These practical guidance and tools provided can assist implementation researchers and practitioners to concretely capture and understand barriers and facilitators to implementation disparities.
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Sewell AA. Political Economies of Acute Childhood Illnesses: Measuring Structural Racism as Mesolevel Mortgage Market Risks. Ethn Dis 2021; 31:319-332. [PMID: 34045834 PMCID: PMC8143851 DOI: 10.18865/ed.31.s1.319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives Health studies of structural racism/discrimination have been animated through the deployment of neighborhood effects frameworks that engage institutionalist concerns about sociopolitical resources and mobility structures. This study highlights the acute illness risks of place-based inequalities and neighborhood-varying race-based inequalities by focusing on access to and the regulation of mortgage markets. Design By merging neighborhood data on lending processes from the Home Mortgage Disclosure Act with individual health from the Project on Human Development in Chicago Neighborhoods, this article evaluates the acute childhood illness risks of four mutually inclusive, political economies using multilevel generalized linear models. Setting Chicago, IL, USA. Participants Youth aged 0 to 17 years. Main Outcome Measures The prevalence of 11 acute illnesses (cold/flu, sinus trouble, sore throat/tonsils, headache, upset stomach, bronchitis, skin infection, pneumonia, urinary tract infections, fungal disease, mononucleosis) and the past-year frequencies of 6 acute illnesses (cold/flu, sinus trouble, sore throat/tonsils, headache, upset stomach, bronchitis) are evaluated. Methods Multilevel logistic regression. Results The most theoretically consistent predictor of illness is a measure identifying neighborhoods with above-city-median levels of racial disparities in the regulation of loans - a mesolevel measure of structural racism. In areas with high levels of minority-White differences in less-regulated credit, youth are more likely to have a range of acute illnesses and experience them at more frequent intervals in the past year. Conclusions This article highlights the substantive and methodological importance of focusing on multidimensional representations of institutionalized political economic inequalities circumscribed and traversed by the power relations established by institutions and the state.
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Martini R, Newman L, Davis M. Breast cancer disparities in outcomes; unmasking biological determinants associated with racial and genetic diversity. Clin Exp Metastasis 2021; 39:7-14. [PMID: 33950410 DOI: 10.1007/s10585-021-10087-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/20/2021] [Indexed: 12/28/2022]
Abstract
Breast cancer (BC) remains a leading cause of death among women today, and mortality among African American women in the US remains 40% higher than that of their White counterparts, despite reporting a similar incidence of disease over recent years. Previous meta-analyses and studies of BC mortality highlight that tumor characteristics, rather than socio-economic factors, drive excess mortality among African American women with BC. This is further complicated by the heterogeneity of BC, where BC can more appropriately be defined as a collection of diseases rather than a single disease. Molecular phenotyping and gene expression profiling distinguish subtypes of BC, and these subtypes have distinct prognostic outcomes. Racial disparities transcend these subtype-specific outcomes, where African American women suffer higher mortality rates among all BC subtypes. The most striking differences are observed among the most aggressive molecular subtype, triple-negative BC (TNBC), where incidence and mortality are significantly higher among African American women compared to all other race/ethnicity groups. We and others have shown that this predisposition for triple-negative disease may be linked to shared west African ancestry, where the highest rates of TNBC are observed among west African nations, and these high frequencies follow into the African diaspora. Genetic and molecular characterization of breast tumors among subtypes and racial/ethnic groups have begun to identify targets with future therapeutic potential, but more work needs to be done to identify targeted treatment options for all women who suffer from BC.
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Affiliation(s)
- Rachel Martini
- Department of Surgery, Weill Cornell Medical College, 420 E 70th Street, New York City, NY, 10065, USA.,Department of Genetics, University of Georgia, Athens, GA, USA
| | - Lisa Newman
- Department of Surgery, Weill Cornell Medical College, 420 E 70th Street, New York City, NY, 10065, USA
| | - Melissa Davis
- Department of Surgery, Weill Cornell Medical College, 420 E 70th Street, New York City, NY, 10065, USA.
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Lynch EE, Malcoe LH, Laurent SE, Richardson J, Mitchell BC, Meier HCS. The legacy of structural racism: Associations between historic redlining, current mortgage lending, and health. SSM Popul Health 2021; 14:100793. [PMID: 33997243 PMCID: PMC8099638 DOI: 10.1016/j.ssmph.2021.100793] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/16/2021] [Accepted: 04/02/2021] [Indexed: 11/02/2022] Open
Abstract
Structural racism, which is embedded in past and present operations of the U.S. housing market, is a fundamental cause of racial health inequities. We conducted an ecologic study to 1) examine historic redlining in relation to current neighborhood lending discrimination and three key indicators of societal health (mental health, physical health, and infant mortality rate (IMR)) and 2) investigate sustained lending disinvestment as a determinant of current neighborhood health in one of the most hypersegregated metropolitan areas in the United States, Milwaukee, Wisconsin. We calculated weighted historic redlining scores from the proportion of 1930s Home Owners' Loan Corporation residential security grades contained within 2010 census tract boundaries. We combined two lending indicators from 2018 Home Mortgage Disclosure Act data to capture current neighborhood lending discrimination: low lending occurrence and high cost loans (measured via loan rate spread). Using historic redlining score and current lending discrimination, we created a 4-level hierarchical measure of lending trajectory. In Milwaukee neighborhoods, greater historic redlining was associated with current lending discrimination (OR = 1.73, 95%CI: 1.16, 2.58) and increased prevalence of poor physical health (β = 1.34, 95%CI: 0.40, 2.28) and poor mental health (β = 1.26, 95%CI: 0.51, 2.01). Historic redlining was not associated with neighborhood IMR (β = -0.48, 95%CI: -2.12, 1.15). A graded association was observed between lending trajectory and health: neighborhoods with high sustained disinvestment had worse physical and mental health than neighborhoods with high investment (poor physical health: β = 5.33, 95%CI: 3.05, 7.61; poor mental health: β = 4.32, 95%CI: 2.44, 6.20). IMR was highest in 'disinvested' neighborhoods (β = 5.87, 95%CI: 0.52, 11.22). Our findings illustrate ongoing legacies of government sponsored historic redlining. Structural racism, as manifested in historic and current forms of lending disinvestment, predicts poor health in Milwaukee's hypersegregated neighborhoods. We endorse equity focused policies that dismantle and repair the ways racism is entrenched in America's social fabric.
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Affiliation(s)
- Emily E Lynch
- Joseph J. Zilber School of Public Health, University of Wisconsin - Milwaukee, Milwaukee, WI, USA
| | - Lorraine Halinka Malcoe
- Joseph J. Zilber School of Public Health, University of Wisconsin - Milwaukee, Milwaukee, WI, USA
| | - Sarah E Laurent
- Joseph J. Zilber School of Public Health, University of Wisconsin - Milwaukee, Milwaukee, WI, USA
| | | | | | - Helen C S Meier
- Population, Neurodevelopment, and Genetics Program, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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Formica MK. An Eye on Disparities, Health Equity, and Racism-The Case of Firearm Injuries in Urban Youth in the United States and Globally. Pediatr Clin North Am 2021; 68:389-399. [PMID: 33678293 DOI: 10.1016/j.pcl.2020.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Firearm violence is a significant public health problem, particularly among youth in the United States. Regardless of the data source or setting, young Black men have consistently been found to be disproportionately affected by firearm injuries and deaths. Public health research indicates that racial segregation likely increases racial disparities in firearm violence. To minimize deaths and injuries due to firearms and their cascading health consequences and to ultimately achieve health equity, preventive efforts will need to address the social determinants of health, including racism.
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Affiliation(s)
- Margaret K Formica
- Department of Public Health and Preventive Medicine, State University of New York Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA.
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Schwartz E, Onnen N, Craigmile PF, Roberts ME. The legacy of redlining: Associations between historical neighborhood mapping and contemporary tobacco retailer density in Ohio. Health Place 2021; 68:102529. [PMID: 33631601 PMCID: PMC8651150 DOI: 10.1016/j.healthplace.2021.102529] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
In the 1930s United States, urban neighborhoods were graded on their desirability for investment (often based on race), a process known as "redlining." This study examined how historical redlining relates to current disparities in an important health determinant: tobacco retailer density. Analyses were conducted for thirteen Ohio cities using negative binomial models that accounted for retailer spatial dependence and controlled for present-day sociodemographic characteristics. Findings indicated that as grades increased from "Best" to "Still Desirable" to "Definitely Declining" and "Hazardous," retailer density increased monotonically. These results highlight the persisting impacts of redlining and how disparities, once intentionally created, can be perpetuated over time.
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Affiliation(s)
- Elli Schwartz
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Nathaniel Onnen
- Department of Statistics, The Ohio State University, Columbus, OH, USA
| | - Peter F Craigmile
- Department of Statistics, The Ohio State University, Columbus, OH, USA
| | - Megan E Roberts
- College of Public Health, The Ohio State University, Columbus, OH, USA.
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Alson JG, Robinson WR, Pittman L, Doll KM. Incorporating Measures of Structural Racism into Population Studies of Reproductive Health in the United States: A Narrative Review. Health Equity 2021; 5:49-58. [PMID: 33681689 PMCID: PMC7929921 DOI: 10.1089/heq.2020.0081] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose: Black women in the United States face poor outcomes across reproductive health measures-from pregnancy outcomes to gynecologic cancers. Racial health inequities are attributable to systemic racism, but few population studies of reproductive health outcomes integrate upstream measures of systemic racism, and those who do are limited to maternal and infant health outcomes. Advances in understanding and intervening on the pathway from racism to reproductive health outcomes are limited by a paucity of methodological guidance toward this end. We aim to fill this gap by identifying quantitative measures of systemic racism that are salient across reproductive health outcomes. Methods: We conducted a review of literature from 2000 to 2019 to identify studies that use quantitative measures of exposure to systemic racism in population reproductive health studies. We analyzed the catalog of literature to identify cohesive domains and measures that integrate data across domains. For each domain, we contextualize its use within population health research, describe metrics currently in use, and present opportunities for their application to reproductive health research. Results: We identified four domains of systemic racism that may affect reproductive health outcomes: (1) civil rights laws and legal racial discrimination, (2) residential segregation and housing discrimination, (3) police violence, and (4) mass incarceration. Multiple quantitative measures are available for each domain. In addition, a multidimensional measure exists and additional domains of systemic racism are salient for future development into distinct measures. Conclusion: There are quantitative measures of systemic racism available for incorporation into population studies of reproductive health that investigate hypotheses, including and beyond those related to maternal and infant health. There are also promising areas for future measure development, such as the child welfare system and intersectionality. Incorporating such measures is critical for appropriate assessment of and intervention in racial inequities in reproductive health outcomes.
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Affiliation(s)
- Julianna G. Alson
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Whitney R. Robinson
- Department of Epidemiology, UNC Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - LaShawnDa Pittman
- Department of American Ethnic Studies, University of Washington, Seattle, Washington, USA
| | - Kemi M. Doll
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington, USA
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