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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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Bikomeye JC, Awoyinka I, Kwarteng JL, Beyer AM, Rine S, Beyer KMM. Disparities in Cardiovascular Disease-Related Outcomes Among Cancer Survivors in the United States: A Systematic Review of the Literature. Heart Lung Circ 2024; 33:576-604. [PMID: 38184426 DOI: 10.1016/j.hlc.2023.11.003] [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: 08/11/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Cancer and cardiovascular disease (CVD) are major causes of morbidity and mortality in the United States (US). Cancer survivors have increased risks for CVD and CVD-related mortality due to multiple factors including cancer treatment-related cardiotoxicity. Disparities are rooted in differential exposure to risk factors and social determinants of health (SDOH), including systemic racism. This review aimed to assess SDOH's role in disparities, document CVD-related disparities among US cancer survivors, and identify literature gaps for future research. METHODS Following the Peer Review of Electronic Search Strategies (PRESS) guidelines, MEDLINE, PsycINFO, and Scopus were searched on March 15, 2021, with an update conducted on September 26, 2023. Articles screening was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, a pre-defined Population, Exposure, Comparison, Outcomes, and Settings (PECOS) framework, and the Rayyan platform. A modified version of the Newcastle-Ottawa Scale was used to assess the risk of bias, and RAW Graphs for alluvial charts. This review is registered with PROSPERO under ID #CRD42021236460. RESULTS Out of 7,719 retrieved articles, 24 were included, and discussed diverse SDOH that contribute to CVD-related disparities among cancer survivors. The 24 included studies had a large combined total sample size (n=7,704,645; median=19,707). While various disparities have been investigated, including rural-urban, sex, socioeconomic status, and age, a notable observation is that non-Hispanic Black cancer survivors experience disproportionately adverse CVD outcomes when compared to non-Hispanic White survivors. This underscores historical racism and discrimination against non-Hispanic Black individuals as fundamental drivers of CVD-related disparities. CONCLUSIONS Stakeholders should work to eliminate the root causes of disparities. Clinicians should increase screening for risk factors that exacerbate CVD-related disparities among cancer survivors. Researchers should prioritise the investigation of systemic factors driving disparities in cancer and CVD and develop innovative interventions to mitigate risk in cancer survivors.
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Affiliation(s)
- Jean C Bikomeye
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; PhD Program in Public and Community Health, Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Iwalola Awoyinka
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; PhD Program in Public and Community Health, Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jamila L Kwarteng
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andreas M Beyer
- Department of Medicine and Physiology, Division of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sarah Rine
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; PhD Program in Public and Community Health, Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kirsten M M Beyer
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; PhD Program in Public and Community Health, Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
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Hazlehurst MF, Hajat A, Szpiro AA, Tandon PS, Kaufman JD, Loftus CT, Bush NR, LeWinn KZ, Hare ME, Sathyanarayana S, Karr CJ. Individual and Neighborhood Level Predictors of Children's Exposure to Residential Greenspace. J Urban Health 2024; 101:349-363. [PMID: 38485845 PMCID: PMC11052952 DOI: 10.1007/s11524-024-00829-z] [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] [Accepted: 01/17/2024] [Indexed: 04/28/2024]
Abstract
Inequities in urban greenspace have been identified, though patterns by race and socioeconomic status vary across US settings. We estimated the magnitude of the relationship between a broad mixture of neighborhood-level factors and residential greenspace using weighted quantile sum (WQS) regression, and compared predictive models of greenspace using only neighborhood-level, only individual-level, or multi-level predictors. Greenspace measures included the Normalized Difference Vegetation Index (NDVI), tree canopy, and proximity of the nearest park, for residential locations in Shelby County, Tennessee of children in the CANDLE cohort. Neighborhood measures include socioeconomic and education resources, as well as racial composition and racial residential segregation. In this sample of 1012 mother-child dyads, neighborhood factors were associated with higher NDVI and tree canopy (0.021 unit higher NDVI [95% CI: 0.014, 0.028] per quintile increase in WQS index); homeownership rate, proximity of and enrollment at early childhood education centers, and racial composition, were highly weighted in the WQS index. In models constrained in the opposite direction (0.028 unit lower NDVI [95% CI: - 0.036, - 0.020]), high school graduation rate and teacher experience were highly weighted. In prediction models, adding individual-level predictors to the suite of neighborhood characteristics did not meaningfully improve prediction accuracy for greenspace measures. Our findings highlight disparities in greenspace for families by neighborhood socioeconomic and early education factors, and by race, suggesting several neighborhood indicators for consideration both as potential confounders in studies of greenspace and pediatric health as well as in the development of policies and programs to improve equity in greenspace access.
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Affiliation(s)
- Marnie F Hazlehurst
- Department of Environmental & Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA.
| | - Anjum Hajat
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
| | - Adam A Szpiro
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA
| | - Pooja S Tandon
- Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Joel D Kaufman
- Department of Environmental & Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Christine T Loftus
- Department of Environmental & Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA
| | - Nicole R Bush
- Department of Pediatrics, School of Medicine, University of California, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, CA, USA
| | - Kaja Z LeWinn
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, CA, USA
| | - Marion E Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sheela Sathyanarayana
- Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Catherine J Karr
- Department of Environmental & Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
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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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Nogueira LM, Yabroff KR. Climate change and cancer: the Environmental Justice perspective. J Natl Cancer Inst 2024; 116:15-25. [PMID: 37813679 DOI: 10.1093/jnci/djad185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 10/11/2023] Open
Abstract
Despite advances in cancer control-prevention, screening, diagnosis, treatment, and survivorship-racial disparities in cancer incidence and survival persist and, in some cases, are widening in the United States. Since 2020, there's been growing recognition of the role of structural racism, including structurally racist policies and practices, as the main factor contributing to historical and contemporary disparities. Structurally racist policies and practices have been present since the genesis of the United States and are also at the root of environmental injustices, which result in disproportionately high exposure to environmental hazards among communities targeted for marginalization, increased cancer risk, disruptions in access to care, and worsening health outcomes. In addition to widening cancer disparities, environmental injustices enable the development of polluting infrastructure, which contribute to detrimental health outcomes in the entire population, and to climate change, the most pressing public health challenge of our time. In this commentary, we describe the connections between climate change and cancer through an Environmental Justice perspective (defined as the fair treatment and meaningful involvement of people of all racialized groups, nationalities, or income, in all aspects, including development, implementation, and enforcement, of policies and practices that affect the environment and public health), highlighting how the expertise developed in communities targeted for marginalization is crucial for addressing health disparities, tackling climate change, and advancing cancer control efforts for the entire population.
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Affiliation(s)
- Leticia M Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
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Pham KCT, Chiew KS. The impact of air pollution on neurocognitive development: Adverse effects and health disparities. Dev Psychobiol 2023; 65:e22440. [PMID: 38010305 PMCID: PMC10683861 DOI: 10.1002/dev.22440] [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: 11/01/2022] [Revised: 09/30/2023] [Accepted: 10/21/2023] [Indexed: 11/29/2023]
Abstract
Air pollution is recognized as a major public health concern. The number of deaths related to ambient air pollution has increased in recent years and is projected to continue rising. Additionally, both short- and long-term air pollution exposure has been linked with deleterious effects on neurocognitive function and development. While air pollution poses as a threat to everyone, people of color and individuals of lower socioeconomic status are often exposed to elevated levels of air pollution as a function of systemic racism and classism. Further, given additional disparities in access to healthcare and other compounding stressors, adverse effects of air pollution on neurocognitive health are exacerbated among individuals who hold marginalized identities-making effects both less likely to be detected and treated. This review examines evidence of the effects of air pollution on neurocognitive development across the lifespan and incorporates an environmental justice perspective to highlight disparities in air pollution exposure across race and socioeconomic status. Last, upon the reviewed evidence, limitations of past research and recommendations for policy are discussed.
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Affiliation(s)
- Kim-Chi T Pham
- Department of Psychology, University of Denver, Denver, Colorado, USA
| | - Kimberly S Chiew
- Department of Psychology, University of Denver, Denver, Colorado, USA
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Lansey DG, Ramalingam R, Brawley OW. Health Care Policy and Disparities in Health. Cancer J 2023; 29:287-292. [PMID: 37963360 DOI: 10.1097/ppo.0000000000000680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
ABSTRACT The United States has seen a 33% decline in age-adjusted cancer mortality since 1991. Despite this achievement, the United States has some of the greatest health disparities of any developed nation. US government policies are increasingly directed toward reducing health disparities and promoting health equity. These policies govern the conduct of research, cancer prevention, access, and payment for care. Although implementation of policies has played a significant role in the successes of cancer control, inconsistent implementation of policy has resulted in divergent outcomes; poorly designed or inadequately implemented policies have hindered progress in reducing cancer death rates and, in certain cases, exacerbated existing disparities. Examining policies affecting cancer control in the United States and realizing their unintended consequences are crucial in addressing cancer inequities.
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Affiliation(s)
| | - Rohan Ramalingam
- From the Department of Oncology, Johns Hopkins School of Medicine
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Anderson KF, Wolski C. Racial/Ethnic Residential Segregation, Neighborhood Health Care Provision, and Choice of Pediatric Health Care Provider Across the USA. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01766-4. [PMID: 37624536 DOI: 10.1007/s40615-023-01766-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/31/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
Much research has been conducted that demonstrates a link between racial/ethnic residential segregation and health care outcomes. We suggest that minority segregated neighborhoods may have diminished access to organizations and that this differential access may contribute to differences in health care outcomes across communities. We analyze this specifically using the case of pediatric health care provider choice. To examine this association, we estimate a series of multinomial logistic regression models using restricted data with ZIP code level geoidentifiers from the 2011-2012 National Survey of Children's Health (NSCH). We find that racial/ethnic residential segregation is related to a greater reliance on non-ideal forms of health care, such as clinics, and hospital outpatient departments, instead of pediatric physician's offices. This association is at least partially attenuated by the distribution of health care facilities in the local area, physician's offices, and health care practitioners in particular. Additionally, families express greater dissatisfaction with these other forms of care compared to physician's offices, demonstrating that the lack of adequate health care provision is meaningful for health care outcomes. This study expands the literature by examining how the siting of health organizations has consequences for individuals residing within these areas.
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Affiliation(s)
- Kathryn Freeman Anderson
- Department of Sociology, University of Houston, 3551 Cullen Blvd, PGH Building, Room 450, Houston, TX, 77204-3012, USA.
| | - Caroline Wolski
- Department of Sociology, University of Houston, 3551 Cullen Blvd, PGH Building, Room 450, Houston, TX, 77204-3012, USA
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Bramble K, Blanco MN, Doubleday A, Gassett AJ, Hajat A, Marshall JD, Sheppard L. Exposure Disparities by Income, Race and Ethnicity, and Historic Redlining Grade in the Greater Seattle Area for Ultrafine Particles and Other Air Pollutants. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:77004. [PMID: 37404015 PMCID: PMC10321236 DOI: 10.1289/ehp11662] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 05/15/2023] [Accepted: 06/01/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Growing evidence shows ultrafine particles (UFPs) are detrimental to cardiovascular, cerebrovascular, and respiratory health. Historically, racialized and low-income communities are exposed to higher concentrations of air pollution. OBJECTIVES Our aim was to conduct a descriptive analysis of present-day air pollution exposure disparities in the greater Seattle, Washington, area by income, race, ethnicity, and historical redlining grade. We focused on UFPs (particle number count) and compared with black carbon, nitrogen dioxide, and fine particulate matter (PM 2.5 ) levels. METHODS We obtained race and ethnicity data from the 2010 U.S. Census, median household income data from the 2006-2010 American Community Survey, and Home Owners' Loan Corporation (HOLC) redlining data from the University of Richmond's Mapping Inequality. We predicted pollutant concentrations at block centroids from 2019 mobile monitoring data. The study region encompassed much of urban Seattle, with redlining analyses restricted to a smaller region. To analyze disparities, we calculated population-weighted mean exposures and regression analyses using a generalized estimating equation model to account for spatial correlation. RESULTS Pollutant concentrations and disparities were largest for blocks with median household income of < $ 20,000 , Black residents, HOLC Grade D, and ungraded industrial areas. UFP concentrations were 4% lower than average for non-Hispanic White residents and higher than average for racialized groups (Asian, 3%; Black, 15%; Hispanic, 6%; Native American, 8%; Pacific Islander, 11%). For blocks with median household incomes of < $ 20,000 , UFP concentrations were 40% higher than average, whereas blocks with incomes of > $ 110,000 had UFP concentrations 16% lower than average. UFP concentrations were 28% higher for Grade D and 49% higher for ungraded industrial areas compared with Grade A. Disparities were highest for UFPs and lowest for PM 2.5 exposure levels. DISCUSSION Our study is one of the first to highlight large disparities with UFP exposures compared with multiple pollutants. Higher exposures to multiple air pollutants and their cumulative effects disproportionately impact historically marginalized groups. https://doi.org/10.1289/EHP11662.
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Affiliation(s)
- Kaya Bramble
- Department of Industrial & Systems Engineering, College of Engineering, University of Washington, Seattle, Washington, USA
| | - Magali N. Blanco
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Annie Doubleday
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Amanda J. Gassett
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Julian D. Marshall
- Department of Civil & Environmental Engineering, College of Engineering, University of Washington, Seattle, Washington, USA
| | - Lianne Sheppard
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington, USA
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Bikomeye JC, Zhou Y, McGinley EL, Canales B, Yen TWF, Tarima S, Ponce SB, Beyer KMM. Historical redlining and breast cancer treatment and survival among older women in the United States. J Natl Cancer Inst 2023; 115:652-661. [PMID: 36794919 PMCID: PMC10248836 DOI: 10.1093/jnci/djad034] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/11/2022] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Breast cancer (BC) is the most common cancer among US women, and institutional racism is a critical cause of health disparities. We investigated impacts of historical redlining on BC treatment receipt and survival in the United States. METHODS Home Owners' Loan Corporation (HOLC) boundaries were used to measure historical redlining. Eligible women in the 2010-2017 Surveillance, Epidemiology, and End Results-Medicare BC cohort were assigned a HOLC grade. The independent variable was a dichotomized HOLC grade: A and B (nonredlined) and C and D (redlined). Outcomes of receipt of various cancer treatments, all-cause mortality (ACM), and BC-specific mortality (BCSM) were analyzed using logistic or Cox models. Indirect effects by comorbidity were examined. RESULTS Among 18 119 women, 65.7% resided in historically redlined areas (HRAs), and 32.6% were deceased at a median follow-up of 58 months. A larger proportion of deceased women resided in HRAs (34.5% vs 30.0%). Of all deceased women, 41.6% died of BC; a larger proportion resided in HRAs (43.4% vs 37.8%). Historical redlining is a statistically significant predictor of poorer survival after BC diagnosis (hazard ratio = 1.09, 95% confidence interval [CI] = 1.03 to 1.15 for ACM, and hazard ratio = 1.26, 95% CI = 1.13 to 1.41 for BCSM). Indirect effects via comorbidity were identified. Historical redlining was associated with a lower likelihood of receiving surgery (odds ratio = 0.74, 95% CI = 0.66 to 0.83, and a higher likelihood of receiving palliative care odds ratio = 1.41, 95% CI = 1.04 to 1.91). CONCLUSION Historical redlining is associated with differential treatment receipt and poorer survival for ACM and BCSM. Relevant stakeholders should consider historical contexts when designing and implementing equity-focused interventions to reduce BC disparities. Clinicians should advocate for healthier neighborhoods while providing care.
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Affiliation(s)
- Jean C Bikomeye
- 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
| | - Emily L McGinley
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bethany Canales
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tina W F Yen
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sergey Tarima
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sara Beltrán Ponce
- Division of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kirsten M M Beyer
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
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12
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Purrington KS, Hastert TA, Madhav KC, Nair M, Snider N, Ruterbusch JJ, Schwartz AG, Stoffel EM, Peters ES, Rozek LS. The role of area-level socioeconomic disadvantage in racial disparities in cancer incidence in metropolitan Detroit. Cancer Med 2023. [PMID: 37184135 DOI: 10.1002/cam4.6065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/17/2023] [Accepted: 04/30/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Neighborhood deprivation is associated with both race and cancer incidence, but there is a need to better understand the effect of structural inequities on racial cancer disparities. The goal of this analysis was to evaluate the relationship between a comprehensive measure of neighborhood-level social disadvantage and cancer incidence within the racially diverse population of metropolitan Detroit. METHODS We estimated breast, colorectal, lung, and prostate cancer incidence rates using Metropolitan Detroit Cancer Surveillance System and US decennial census data. Neighborhood socioeconomic disadvantage was measured by the Area Deprivation Index (ADI) using Census Bureau's American Community Survey data at the Public Use Microdata Areas (PUMA) level. Associations between ADI at time of diagnosis and cancer incidence were estimated using Poisson mixed-effects models adjusting for age and sex. Attenuation of race-incidence associations by ADI was quantified using the "mediation" package in R. RESULTS ADI was inversely associated with incidence of breast cancer for both non-Hispanic White (NHW) and non-Hispanic Black (NHB) women (NHW: per-quartile RR = 0.92, 95% CI 0.88-0.96; NHB: per-quartile RR = 0.94, 95% CI 0.91-0.98) and with prostate cancer incidence only for NHW men (per-quartile RR = 0.94, 95% CI 0.90-0.97). ADI was positively associated with incidence of lung cancer for NHWs and NHBs (NHW: per-quartile RR = 1.12, 95% CI 1.04-1.21; NHB: per-quartile RR = 1.37, 95% CI 1.25-1.51) and incidence of colorectal cancer (CRC) only among NHBs (per-quartile RR = 1.11, 95% CI 1.02-1.21). ADI significantly attenuated the relationship between race and hormone receptor positive, HER2-negative breast cancer (proportion attenuated = 8.5%, 95% CI 4.1-16.6%) and CRC cancer (proportion attenuated = 7.3%, 95% CI 3.7 to 12.8%), and there was a significant interaction between race and ADI for lung (interaction RR = 1.22, p < 0.0001) and prostate cancer (interaction RR = 1.09, p = 0.00092). CONCLUSIONS Area-level socioeconomic disadvantage is associated with risk of common cancers in a racially diverse population and plays a role in racial differences in cancer incidence.
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Affiliation(s)
- Kristen S Purrington
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Michigan, Detroit, USA
| | - Theresa A Hastert
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Michigan, Detroit, USA
| | - K C Madhav
- Department of Internal Medicine, Yale School of Medicine, Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Connecticut, New Haven, USA
| | - Mrudula Nair
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
| | - Natalie Snider
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
| | - Julie J Ruterbusch
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Michigan, Detroit, USA
| | - Ann G Schwartz
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Michigan, Detroit, USA
| | - Elena M Stoffel
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System, Michigan, Ann Arbor, USA
| | - Edward S Peters
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Laura S Rozek
- Department of Oncology, Georgetown University School of Medicine, District of Columbia, Washington, USA
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13
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Abstract
Taking stock of environmental justice (EJ) is daunting. It is at once a scholarly field, an ongoing social movement, and an administrative imperative adopted by government agencies and incorporated into legislation. Moreover, within academia, it is multidisciplinary and multimethodological, comprising scholars who do not always speak to one another. Any review of EJ is thus necessarily restrictive. This article explores several facets of EJ activism. One is its coalitional and "inside-outside" orientation. EJ activists are constantly forming alliances with other stakeholders, but these coalitions do not flout the importance of engaging with formal institutions. The review next turns to one set of such institutions-the courts and regulatory agencies-to see how well EJ claims have fared there. I then survey scientific findings that have been influenced by EJ. The review concludes with future directions for activists and scholars to consider: the changing nature of EJ coalitions, fragmentation within EJ and with other fields, the historical roots of environmental injustice, and opportunities for stronger infusion of the EJ lens.
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Affiliation(s)
- Merlin Chowkwanyun
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA;
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14
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Anderson EC, Locke DH, Pickett STA, LaDeau SL. Just street trees? Street trees increase local biodiversity and biomass in higher income, denser neighborhoods. Ecosphere 2023. [DOI: 10.1002/ecs2.4389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Affiliation(s)
- Elsa C. Anderson
- Cary Institute of Ecosystem Studies Millbrook New York USA
- Northwestern University Evanston Illinois USA
| | - Dexter H. Locke
- USDA Forest Service Northern Research Station Baltimore Maryland USA
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15
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Burghardt KT, Avolio ML, Locke DH, Grove JM, Sonti NF, Swan CM. Current street tree communities reflect race-based housing policy and modern attempts to remedy environmental injustice. Ecology 2023; 104:e3881. [PMID: 36196604 PMCID: PMC10078568 DOI: 10.1002/ecy.3881] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/10/2022] [Accepted: 08/05/2022] [Indexed: 02/03/2023]
Abstract
Humans promote and inhibit other species on the urban landscape, shaping biodiversity patterns. Institutional racism may underlie the distribution of urban species by creating disproportionate resources in space and time. Here, we examine whether present-day street tree occupancy, diversity, and composition in Baltimore, MD, USA, neighborhoods reflect their 1937 classification into grades of loan risk-from most desirable (A = green) to least desirable (D = "redlined")-using racially discriminatory criteria. We find that neighborhoods that were redlined have consistently lower street tree α-diversity and are nine times less likely to have large (old) trees occupying a viable planting site. Simultaneously, redlined neighborhoods were locations of recent tree planting activities, with a high occupancy rate of small (young) trees. However, the community composition of these young trees exhibited lower species turnover and reordering across neighborhoods compared to those in higher grades, due to heavy reliance on a single tree species. Overall, while the negative effects of redlining remain detectable in present-day street tree communities, there are clear signs of recent investment. A strategy of planting diverse tree cohorts paired with investments in site rehabilitation and maintenance may be necessary if cities wish to overcome ecological feedbacks associated with legacies of environmental injustice.
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Affiliation(s)
| | - Meghan L Avolio
- Earth and Planetary Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Dexter H Locke
- Northern Research Station, USDA Forest Service, Baltimore, Maryland, USA
| | - J Morgan Grove
- Northern Research Station, USDA Forest Service, Baltimore, Maryland, USA
| | - Nancy F Sonti
- Northern Research Station, USDA Forest Service, Baltimore, Maryland, USA
| | - Christopher M Swan
- Geography and Environmental Systems, University of Maryland, Baltimore, Maryland, USA
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16
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Kamel Boulos MN, Wilson JP. Geospatial techniques for monitoring and mitigating climate change and its effects on human health. Int J Health Geogr 2023; 22:2. [PMID: 36707823 PMCID: PMC9883899 DOI: 10.1186/s12942-023-00324-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 01/28/2023] Open
Abstract
This article begins by briefly examining the multitude of ways in which climate and climate change affect human health and wellbeing. It then proceeds to present a quick overview of how geospatial data, methods and tools are playing key roles in the measurement, analysis and modelling of climate change and its effects on human health. Geospatial techniques are proving indispensable for making more accurate assessments and estimates, predicting future trends more reliably, and devising more optimised climate change adaptation and mitigation plans.
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Affiliation(s)
- Maged N. Kamel Boulos
- Co-Chair, WG III/9 Geospatial Environment and Health Analytics, ISPRS Technical Commission III, 30167 Hannover, Germany ,grid.9983.b0000 0001 2181 4263School of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal
| | - John P. Wilson
- grid.42505.360000 0001 2156 6853Spatial Sciences Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA 90089-0374 USA
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17
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Shkembi A, Smith LM, Neitzel RL. Linking environmental injustices in Detroit, MI to institutional racial segregation through historical federal redlining. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2022:10.1038/s41370-022-00512-y. [PMID: 36544051 DOI: 10.1038/s41370-022-00512-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To identify the most pervasive environmental exposures driving environmental disparities today associated with historical redlining in Detroit. METHODS We overlaid Detroit's 1939 Home Owners' Loan Corporation (HOLC) shapefile from the Mapping Inequality project onto the EPA EJScreen and the DOT National Transportation Noise maps to analyze differences in current demographic and environmental indicators between historically redlined (D-grade) and non-redlined neighborhoods using simple linear regression and a boosted classification tree algorithm. RESULTS Historically redlined neighborhoods in Detroit experienced significantly higher environmental hazards than non-redlined neighborhoods in the form of 12.1% (95% CI: 7.2-17.1%) higher levels of diesel particulate matter (PM), 32.2% (95% CI: 3.3-69.3%) larger traffic volumes, and 65.7% (95% CI: 8.6-152.8%) higher exposure to hazardous road noise (LEQ(24h) >70 dBA). Historically redlined neighborhoods were situated near 1.7-times (95% CI: 1.4-2.1) more hazardous waste sites and twice as many (95% CI: 1.5-2.7) risk management plan (RMP) sites than non-redlined neighborhoods. The lifetime cancer risk from inhalation of air toxics was 4.4% (95% CI: 2.9-6.6%) higher in historically redlined communities, and the risk of adverse respiratory health outcomes from air toxics was 3.9% (95% CI: 2.1-5.6%) higher. All factors considered together, among the environmental hazards considered, the most pervasive hazards in historically redlined communities are proximity to RMP sites, hazardous road noise, diesel PM, and cancer risk from air pollution. CONCLUSIONS Historically redlined neighborhoods may have a disproportionately higher risk of developing cancer and adverse respiratory health outcomes from air toxics. Policies targeting air and noise pollution from transportation sources, particularly from sources of diesel exhaust, in historically redlined neighborhoods may ameliorate some of the impacts of structural environmental racism from historical redlining in Detroit.
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Affiliation(s)
- Abas Shkembi
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA.
| | - Lauren M Smith
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Richard L Neitzel
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA
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18
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Narla S, Heath CR, Alexis A, Silverberg JI. Racial disparities in dermatology. Arch Dermatol Res 2022; 315:1215-1223. [PMID: 36508020 PMCID: PMC9743121 DOI: 10.1007/s00403-022-02507-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Significant racial/ethnic disparities in dermatologic care and their subsequent impact on dermatologic conditions were recently reported. Contributing factors include socioeconomic factors, gaps in educational exposure, and underrepresentation of minority groups in the dermatologic workforce. In 2021, the American Academy of Dermatology (AAD) announced its three-year plan to expand diversity, equity, and inclusion in dermatology. One way to reduce disparities in dermatology is for every dermatologist, regardless of race or ethnicity, to receive adequate education in diseases, treatments, health equity, and tailored approaches to delivering dermatologic care with cultural humility. In addition, a diverse dermatologic workforce-especially at the level of residency program educators and organizational leaders-will contribute to improved cross-cultural understanding, more inclusive research efforts, and improved treatment approaches for conditions that are more prevalent or nuanced in certain racial/ethnic populations. Finally, the dermatology and broader healthcare community needs to acknowledge and educate ourselves on the health impacts of racism.
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Affiliation(s)
- Shanthi Narla
- Department of Dermatology, St. Luke’s University Health Network, Easton, PA 18045 USA
| | - Candrice R. Heath
- Department of Dermatology, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, PA 19140 USA
| | - Andrew Alexis
- Department of Dermatology, Weill Cornell Medicine, New York, NY 10075 USA
| | - Jonathan I. Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Suite 2B-430, 2150 Pennsylvania Avenue, Washington, DC 20037 USA
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19
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Manware M, Dubrow R, Carrión D, Ma Y, Chen K. Residential and Race/Ethnicity Disparities in Heat Vulnerability in the United States. GEOHEALTH 2022; 6:e2022GH000695. [PMID: 36518814 PMCID: PMC9744626 DOI: 10.1029/2022gh000695] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/03/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Adverse health outcomes caused by extreme heat represent the most direct human health threat associated with the warming of the Earth's climate. Socioeconomic, demographic, health, land cover, and temperature determinants contribute to heat vulnerability; however, nationwide patterns of residential and race/ethnicity disparities in heat vulnerability in the United States are poorly understood. This study aimed to develop a Heat Vulnerability Index (HVI) for the United States; to assess differences in heat vulnerability across geographies that have experienced historical and/or contemporary forms of marginalization; and to quantify HVI by race/ethnicity. Principal component analysis was used to calculate census tract level HVI scores based on the 2019 population characteristics of the United States. Differences in HVI scores were analyzed across the Home Owners' Loan Corporation (HOLC) "redlining" grades, the Climate and Economic Justice Screening Tool (CEJST) disadvantaged versus non-disadvantaged communities, and race/ethnicity groups. HVI scores were calculated for 55,267 U.S. census tracts. Mean HVI scores were 17.56, 18.61, 19.45, and 19.93 for HOLC grades "A"-"D," respectively. CEJST-defined disadvantaged census tracts had a significantly higher mean HVI score (19.13) than non-disadvantaged tracts (16.68). The non-Hispanic African American or Black race/ethnicity group had the highest HVI score (18.51), followed by Hispanic or Latino (18.19). Historically redlined and contemporary CEJST disadvantaged census tracts and communities of color were found to be associated with increased vulnerability to heat. These findings can help promote equitable climate change adaptation policies by informing policymakers about the national distribution of place- and race/ethnicity-based disparities in heat vulnerability.
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Affiliation(s)
- Mitchell Manware
- Department of Social and Behavioral SciencesYale School of Public HealthNew HavenCTUSA
- Yale Center on Climate Change and HealthYale School of Public HealthNew HavenCTUSA
| | - Robert Dubrow
- Yale Center on Climate Change and HealthYale School of Public HealthNew HavenCTUSA
- Department of Environmental Health SciencesYale School of Public HealthNew HavenCTUSA
| | - Daniel Carrión
- Yale Center on Climate Change and HealthYale School of Public HealthNew HavenCTUSA
- Department of Environmental Health SciencesYale School of Public HealthNew HavenCTUSA
| | - Yiqun Ma
- Yale Center on Climate Change and HealthYale School of Public HealthNew HavenCTUSA
- Department of Environmental Health SciencesYale School of Public HealthNew HavenCTUSA
| | - Kai Chen
- Yale Center on Climate Change and HealthYale School of Public HealthNew HavenCTUSA
- Department of Environmental Health SciencesYale School of Public HealthNew HavenCTUSA
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20
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The Relationship of Historical Redlining with Present-Day Neighborhood Environmental and Health Outcomes: A Scoping Review and Conceptual Model. J Urban Health 2022; 99:959-983. [PMID: 35915192 PMCID: PMC9342590 DOI: 10.1007/s11524-022-00665-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 12/31/2022]
Abstract
Following the Great Depression and related home foreclosures, the federal government established new agencies to facilitate access to affordable home mortgages, including the Home Owners' Loan Corporation (HOLC) and Federal Housing Administration (FHA). HOLC and FHA directed widespread neighborhood appraisals to determine investment risk, referred to as "redlining," which took into account residents' race. Redlining thereby contributed to segregation, disinvestment, and racial inequities in opportunities for homeownership and wealth accumulation. Recent research examines associations between historical redlining and subsequent environmental determinants of health and health-related outcomes. In this scoping review, we assess the extent of the current body of evidence, the range of outcomes studied, and key study characteristics, examining the direction and strength of the relationship between redlining, neighborhood environments, and health as well as different methodological approaches. Overall, studies nearly universally report evidence of an association between redlining and health-relevant outcomes, although heterogeneity in study design precludes direct comparison of results. We critically consider evidence regarding HOLC's causality and offer a conceptual framework for the relationship between redlining and present-day health. Finally, we point to key directions for future research to improve and broaden understanding of redlining's enduring impact and translate findings into public health and planning practice.
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21
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Yu AG, Hall M, Agharokh L, Lee BC, Zaniletti I, Wilson KM, Williams DJ. Hospital-Level Neighborhood Opportunity and Rehospitalization for Common Diagnoses at US Children's Hospitals. Acad Pediatr 2022; 22:1459-1467. [PMID: 35728729 DOI: 10.1016/j.acap.2022.05.008] [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: 12/13/2021] [Revised: 04/27/2022] [Accepted: 05/10/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Neighborhood conditions influence child health outcomes, but data examining association between local factors and hospital utilization are lacking. We determined if hospitals' mix of patients by neighborhood opportunity correlates with rehospitalization for common diagnoses at US children's hospitals. METHODS We analyzed all discharges in 2018 for children ≤18 years at 47 children's hospitals for 14 common diagnoses. The exposure was hospital-level mean neighborhood opportunity - measured by Child Opportunity Index (COI) - for each diagnosis. The outcome was same-cause rehospitalization within 365 days. We measured association via Pearson correlation coefficient. For diagnoses with significant associations, we also examined shorter rehospitalization time windows and compared unadjusted and COI-adjusted rehospitalization rates. RESULTS There were 256,871 discharges included. Hospital-level COI ranged from 17th to 70th percentile nationally. Hospitals serving lower COI neighborhoods had more frequent rehospitalization for asthma (ρ -0.34 [95% confidence interval -0.57, -0.06]) and diabetes (ρ -0.33 [-0.56, -0.04]), but fewer primary mental health rehospitalizations (ρ 0.47 [0.21, 0.67]). There was no association for 11 other diagnoses. Secondary timepoint analysis revealed increasing correlation over time, with differences by diagnosis. Adjustment for hospital-level COI resulted in 26%, 32%, and 45% of hospitals changing >1 decile in rehospitalization rank order for diabetes, asthma, and mental health diagnoses, respectively. CONCLUSIONS Children's hospitals vary widely in their mix of neighborhoods served. Asthma, diabetes, and mental health rehospitalization rates correlate with COI, suggesting that neighborhood factors may influence outcome disparities for these conditions. Hospital outcomes may be affected by neighborhood opportunity, which has implications for benchmarking.
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Affiliation(s)
- Andrew G Yu
- Division of Hospital Medicine, Department of Pediatrics (AG Yu, L Agharokh and BC Lee), University of Texas Southwestern Medical Center and Children's Health, Dallas, Tex.
| | - Matt Hall
- Children's Hospital Association (M Hall and I Zaniletti), Lenexa, Kans
| | - Ladan Agharokh
- Division of Hospital Medicine, Department of Pediatrics (AG Yu, L Agharokh and BC Lee), University of Texas Southwestern Medical Center and Children's Health, Dallas, Tex
| | - Benjamin C Lee
- Division of Hospital Medicine, Department of Pediatrics (AG Yu, L Agharokh and BC Lee), University of Texas Southwestern Medical Center and Children's Health, Dallas, Tex
| | | | - Karen M Wilson
- Department of Pediatrics (KM Wilson), University of Rochester Medical Center, Rochester, NY
| | - Derek J Williams
- Division of Hospital Medicine, Department of Pediatrics (DJ Williams), Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn
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22
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Hoffmann JA, Alegría M, Alvarez K, Anosike A, Shah PP, Simon KM, Lee LK. Disparities in Pediatric Mental and Behavioral Health Conditions. Pediatrics 2022; 150:e2022058227. [PMID: 36106466 PMCID: PMC9800023 DOI: 10.1542/peds.2022-058227] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 12/31/2022] Open
Abstract
Mental and behavioral health conditions are common among children and adolescents in the United States. The purpose of this state-of the-art review article is to describe inequities in mental and behavioral health care access and outcomes for children and adolescents, characterize mechanisms behind the inequities, and discuss strategies to decrease them. Understanding the mechanisms underlying these inequities is essential to inform strategies to mitigate these health disparities. Half of United States children with a treatable mental health disorder do not receive treatment from a mental health professional. Children and adolescents in racial, ethnic, sexual, sex, and other minority groups experience inequities in access to care and disparities in outcomes for mental and behavioral health conditions. Suicide rates are nearly twice as high in Black compared to White boys 5 to 11 years old and have been increasing disproportionately among adolescent Black girls 12 to 17 years old. Children identifying as a sexual minority have >3 times increased odds of attempting suicide compared to heterosexual peers. Adverse experiences of children living as part of a minority group, including racism and discrimination, have immediate and lasting effects on mental health. Poverty and an uneven geographic distribution of resources also contribute to inequities in access and disparities in outcomes for mental and behavioral health conditions. Strategies to address inequities in mental and behavioral health among United States children include investing in a diverse workforce of mental health professionals, improving access to school-based services, ensuring equitable access to telehealth, and conducting quality improvement with rigorous attention to equity.
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Affiliation(s)
- Jennifer A. Hoffmann
- . Division of Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Margarita Alegría
- . Disparities Research Unit, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Kiara Alvarez
- . Disparities Research Unit, Massachusetts General Hospital, Department of Medicine, Harvard Medical School, Boston, MA
| | - Amara Anosike
- . Office of Government Relations, Boston Children’s Hospital, Boston, MA
| | | | - Kevin M. Simon
- . Adolescent Substance use and Addiction Program, Boston Children’s Hospital, Boston, Massachusetts; Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts; Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Boston, MA, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lois K. Lee
- . Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA
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23
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Bose S, Madrigano J, Hansel NN. When Health Disparities Hit Home: Redlining Practices, Air Pollution, and Asthma. Am J Respir Crit Care Med 2022; 206:803-804. [PMID: 35696342 PMCID: PMC9799277 DOI: 10.1164/rccm.202206-1063ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Sonali Bose
- Division of Pulmonary, Critical Care, and Sleep MedicineIcahn School of Medicine at Mount SinaiNew York, New York,Division of Pulmonary and Critical Care MedicineJohns Hopkins University School of MedicineBaltimore, Maryland
| | - Jaime Madrigano
- Department of Environmental Health and EngineeringJohns Hopkins Bloomberg School of Public HealthBaltimore, Maryland
| | - Nadia N. Hansel
- Division of Pulmonary and Critical Care MedicineJohns Hopkins University School of MedicineBaltimore, Maryland,Department of Environmental Health and EngineeringJohns Hopkins Bloomberg School of Public HealthBaltimore, Maryland
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Schuyler AJ, Wenzel SE. Historical Redlining Impacts Contemporary Environmental and Asthma-related Outcomes in Black Adults. Am J Respir Crit Care Med 2022; 206:824-837. [PMID: 35612914 PMCID: PMC9799280 DOI: 10.1164/rccm.202112-2707oc] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/25/2022] [Indexed: 01/02/2023] Open
Abstract
Rationale: Environmental threats and poorly controlled asthma disproportionately burden Black people. Some have attributed this to socioeconomic or biologic factors; however, racism, specifically historical redlining, a U.S. discriminatory mortgage lending practice in existence between the 1930s and the 1970s, may have actuated and then perpetuated poor asthma-related outcomes. Objectives: To link historical redlining (institutional racism) to contemporary environmental quality- and lung health-related racial inequity. Methods: Leveraging a broadly recruited asthma registry, we geocoded 1,034 registry participants from Pittsburgh/Allegheny County, Pennsylvania, to neighborhoods subjected to historical redlining, as defined by a 1930s Home Owners' Loan Corporation (HOLC) map. Individual-level clinical/physiologic data, residential air pollution, demographics, and socioeconomic factors provided detailed characterization. We determined the prevalence of uncontrolled and/or severe asthma and other asthma-related outcomes by HOLC (neighborhood) grade (A-D). We performed a stratified analysis by self-identified race to assess the distribution of environmental and asthma risk within each HOLC grade. Measurements and Main Results: The registry sampling overall reflected Allegheny County neighborhood populations. The emissions of carbon monoxide, filterable particulate matter <2.5 μm, sulfur dioxide, and volatile organic compounds increased across HOLC grades (all P ⩽ 0.004), with grade D neighborhoods encumbered by the highest levels. The persistent, dispersive socioenvironmental burden peripherally extending from grade D neighborhoods, including racialized access to healthy environments (structural racism), supported a long-term impact of historical/HOLC redlining. The worst asthma-related outcomes, including uncontrolled and/or severe asthma (P < 0.001; Z = 3.81), and evidence for delivery of suboptimal asthma care occurred among registry participants from grade D neighborhoods. Furthermore, elevated exposure to filterable particulate matter <2.5 μm, sulfur dioxide, and volatile organic compound emissions (all P < 0.050) and risk of uncontrolled and/or severe asthma (relative risk [95% confidence interval], 2.30 [1.19, 4.43]; P = 0.009) demonstrated inequitable distributions within grade D neighborhood boundaries, disproportionately burdening Black registry participants. Conclusions: The racist practice of historical/HOLC redlining profoundly contributes to long-term environmental and asthma-related inequities in Black adults. Acknowledging the role racism has in these outcomes should empower more specific and novel interventions targeted at reversing these structural issues.
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Affiliation(s)
- Alexander J. Schuyler
- University of Pittsburgh Asthma and Environmental Lung Health Institute@UPMC and
- Department of Environmental & Occupational Health, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sally E. Wenzel
- University of Pittsburgh Asthma and Environmental Lung Health Institute@UPMC and
- Department of Environmental & Occupational Health, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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25
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Johnson DP. Population-Based Disparities in U.S. Urban Heat Exposure from 2003 to 2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12314. [PMID: 36231614 PMCID: PMC9566334 DOI: 10.3390/ijerph191912314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
Previous studies have shown, in the United States (U.S.), that communities of color are exposed to significantly higher temperatures in urban environments than complementary White populations. Studies highlighting this disparity have generally been cross-sectional and are therefore "snapshots" in time. Using surface urban heat island (SUHI) intensity data, U.S. Census 2020 population counts, and a measure of residential segregation, this study performs a comparative analysis between census tracts identified as prevalent for White, Black, Hispanic and Asian populations and their thermal exposure from 2003 to 2018. The analysis concentrates on the top 200 most populous U.S. cities. SUHI intensity is shown to be increasing on average through time for the examined tracts. However, based on raw observations the increase is only statistically significant for White and Black prevalent census tracts. There is a 1.25 K to ~2.00 K higher degree of thermal exposure on average for communities of color relative to White prevalent areas. When examined on an inter-city basis, White and Black prevalent tracts had the largest disparity, as measured by SUHI intensity, in New Orleans, LA, by <6.00 K. Hispanic (>7.00 K) and Asian (<6.75 K) prevalent tracts were greatest in intensity in San Jose, CA. To further explore temporal patterns, two models were developed using a Bayesian hierarchical spatial temporal framework. One models the effect of varying the percentages of each population group relative to SUHI intensity within all examined tracts. Increases in percentages of Black, Hispanic, and Asian populations contributed to statistically significant increases in SUHI intensity. White increases in population percentage witnessed a lowering of SUHI intensity. Throughout all modeled tracts, there is a statistically significant 0.01 K per year average increase in SUHI intensity. A second model tests the effect of residential segregation on thermal inequity across all examined cities. Residential segregation, indeed, has a statistically significant positive association with SUHI intensity based on this portion of the analysis. Similarly, there is a statistically significant 0.01 K increase in average SUHI intensity per year for all cities. Results from this study can be used to guide and prioritize intervention strategies and further urgency related to social, climatic, and environmental justice concerns.
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Affiliation(s)
- Daniel P Johnson
- Department of Geography, Indiana University-Purdue University at Indianapolis, Indianapolis, IN 46202, USA
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26
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Neighborhood disadvantage and lung cancer risk in a national cohort of never smoking Black women. Lung Cancer 2022; 173:21-27. [PMID: 36108579 PMCID: PMC9588723 DOI: 10.1016/j.lungcan.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Compared to women of other races who have never smoked, Black women have a higher risk of lung cancer. Whether neighborhood disadvantage, which Black women experience at higher rates than other women, is linked to never-smoking lung cancer risk remains unclear. This study investigates the association of neighborhood disadvantage and lung cancer risk in Black never-smoking women. METHODS AND MATERIALS This research utilized data from the Black Women's Health Study, a prospective cohort of 59,000 Black women recruited from across the US in 1995 and followed by biennial questionnaires. Associations of lung cancer incidence with neighborhood-level factors (including two composite variables derived from Census Bureau data: neighborhood socioeconomic status and neighborhood concentrated disadvantage), secondhand smoke exposure, and PM2.5 were estimated using Fine-Gray subdistribution hazard models. RESULTS Among 37,650 never-smokers, 77 were diagnosed with lung cancer during follow-up from 1995 to 2018. The adjusted subdistribution hazard ratio (sHR) of lung cancer incidence with ten unit increase in neighborhood concentrated disadvantage index was 1.30 (95 % CI: 1.04, 1.63, p = 0.023). Exposure to secondhand smoke at work was associated with increased risk (sHR = 1.93, 95 % CI: 1.21, 3.10, p = 0.006), but exposure to secondhand smoke at home and PM2.5 was not. CONCLUSION Worse neighborhood concentrated disadvantage was associated with increased lung cancer risk in Black women who never smoked. These findings suggest that non-tobacco-related factors in disadvantaged neighborhoods may be linked to lung cancer risk in Black women and that these factors must be understood and targeted to achieve health equity.
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27
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Balan N, Petrie BA, Chen KT. Racial Disparities in Colorectal Cancer Care for Black Patients: Barriers and Solutions. Am Surg 2022; 88:2823-2830. [PMID: 35757937 DOI: 10.1177/00031348221111513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Racial disparities in colorectal cancer for Black patients have led to a significant mortality difference when compared to White patients, a gap which has remained to this day. These differences have been linked to poorer quality insurance and socioeconomic status in addition to lower access to high-quality health care resources, which are emblematic of systemic racial inequities. Disparities impact nearly every point along the colorectal cancer care continuum and include barriers to screening, surgical care, oncologic care, and surveillance. These critical faults are the driving forces behind the mortality difference Black patients face. Health care systems should strive to correct these disparities through both cultural competency at the provider level and public policy change at the national level.
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Affiliation(s)
- Naveen Balan
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Beverley A Petrie
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Kathryn T Chen
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
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28
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Noelke C, Outrich M, Baek M, Reece J, Osypuk TL, McArdle N, Ressler RW, Acevedo-Garcia D. Connecting past to present: Examining different approaches to linking historical redlining to present day health inequities. PLoS One 2022; 17:e0267606. [PMID: 35587478 PMCID: PMC9119533 DOI: 10.1371/journal.pone.0267606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/12/2022] [Indexed: 11/18/2022] Open
Abstract
In the 1930’s, the Home Owner Loan Corporation (HOLC) drafted maps to quantify variation in real estate credit risk across US city neighborhoods. The letter grades and associated risk ratings assigned to neighborhoods discriminated against those with black, lower class, or immigrant residents and benefitted affluent white neighborhoods. An emerging literature has begun linking current individual and community health effects to government redlining, but each study faces the same measurement problem: HOLC graded area boundaries and neighborhood boundaries in present-day health datasets do not match. Previous studies have taken different approaches to classify present day neighborhoods (census tracts) in terms of historical HOLC grades. This study reviews these approaches, examines empirically how different classifications fare in terms of predictive validity, and derives a predictively optimal present-day neighborhood redlining classification for neighborhood and health research.
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Affiliation(s)
- Clemens Noelke
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States of America
- * E-mail:
| | - Michael Outrich
- Kirwan Institute for the Study of Race and Ethnicity, Ohio State University, Columbus, OH, United States of America
| | - Mikyung Baek
- Kirwan Institute for the Study of Race and Ethnicity, Ohio State University, Columbus, OH, United States of America
| | - Jason Reece
- Knowlton School of Architecture, Ohio State University, Columbus, OH, United States of America
| | - Theresa L. Osypuk
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Nancy McArdle
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States of America
| | - Robert W. Ressler
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States of America
| | - Dolores Acevedo-Garcia
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States of America
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29
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Lane H, Morello-Frosch R, Marshall JD, Apte JS. Historical Redlining Is Associated with Present-Day Air Pollution Disparities in U.S. Cities. ENVIRONMENTAL SCIENCE & TECHNOLOGY LETTERS 2022; 9:345-350. [PMID: 35434171 PMCID: PMC9009174 DOI: 10.1021/acs.estlett.1c01012] [Citation(s) in RCA: 105] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 05/02/2023]
Abstract
Communities of color in the United States are systematically exposed to higher levels of air pollution. We explore here how redlining, a discriminatory mortgage appraisal practice from the 1930s by the federal Home Owners' Loan Corporation (HOLC), relates to present-day intraurban air pollution disparities in 202 U.S. cities. In each city, we integrated three sources of data: (1) detailed HOLC security maps of investment risk grades [A ("best"), B, C, and D ("hazardous", i.e., redlined)], (2) year-2010 estimates of NO2 and PM2.5 air pollution levels, and (3) demographic information from the 2010 U.S. census. We find that pollution levels have a consistent and nearly monotonic association with HOLC grade, with especially pronounced (>50%) increments in NO2 levels between the most (grade A) and least (grade D) preferentially graded neighborhoods. On a national basis, intraurban disparities for NO2 and PM2.5 are substantially larger by historical HOLC grade than they are by race and ethnicity. However, within each HOLC grade, racial and ethnic air pollution exposure disparities persist, indicating that redlining was only one of the many racially discriminatory policies that impacted communities. Our findings illustrate how redlining, a nearly 80-year-old racially discriminatory policy, continues to shape systemic environmental exposure disparities in the United States.
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Affiliation(s)
- Haley
M. Lane
- Department
of Civil and Environmental Engineering, University of California, Berkeley, California 94720, United States
| | - Rachel Morello-Frosch
- School
of Public Health, University of California, Berkeley, California 94720, United States
- Department
of Environmental Science, Policy, and Management, University of California, Berkeley, California 94720, United States
| | - Julian D. Marshall
- Department
of Civil and Environmental Engineering, University of Washington, Seattle, Washington 98195, United States
| | - Joshua S. Apte
- Department
of Civil and Environmental Engineering, University of California, Berkeley, California 94720, United States
- School
of Public Health, University of California, Berkeley, California 94720, United States
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30
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Lane HM, Morello-Frosch R, Marshall JD, Apte JS. Historical Redlining Is Associated with Present-Day Air Pollution Disparities in U.S. Cities. ENVIRONMENTAL SCIENCE & TECHNOLOGY LETTERS 2022; 9:345-350. [PMID: 35434171 DOI: 10.6084/m9.figshare.19193243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 05/17/2023]
Abstract
Communities of color in the United States are systematically exposed to higher levels of air pollution. We explore here how redlining, a discriminatory mortgage appraisal practice from the 1930s by the federal Home Owners' Loan Corporation (HOLC), relates to present-day intraurban air pollution disparities in 202 U.S. cities. In each city, we integrated three sources of data: (1) detailed HOLC security maps of investment risk grades [A ("best"), B, C, and D ("hazardous", i.e., redlined)], (2) year-2010 estimates of NO2 and PM2.5 air pollution levels, and (3) demographic information from the 2010 U.S. census. We find that pollution levels have a consistent and nearly monotonic association with HOLC grade, with especially pronounced (>50%) increments in NO2 levels between the most (grade A) and least (grade D) preferentially graded neighborhoods. On a national basis, intraurban disparities for NO2 and PM2.5 are substantially larger by historical HOLC grade than they are by race and ethnicity. However, within each HOLC grade, racial and ethnic air pollution exposure disparities persist, indicating that redlining was only one of the many racially discriminatory policies that impacted communities. Our findings illustrate how redlining, a nearly 80-year-old racially discriminatory policy, continues to shape systemic environmental exposure disparities in the United States.
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Affiliation(s)
- Haley M Lane
- Department of Civil and Environmental Engineering, University of California, Berkeley, California 94720, United States
| | - Rachel Morello-Frosch
- School of Public Health, University of California, Berkeley, California 94720, United States
- Department of Environmental Science, Policy, and Management, University of California, Berkeley, California 94720, United States
| | - Julian D Marshall
- Department of Civil and Environmental Engineering, University of Washington, Seattle, Washington 98195, United States
| | - Joshua S Apte
- Department of Civil and Environmental Engineering, University of California, Berkeley, California 94720, United States
- School of Public Health, University of California, Berkeley, California 94720, United States
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31
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Climate Change, Environmental Disasters, and Health Inequities: The Underlying Role of Structural Inequalities. Curr Environ Health Rep 2022; 9:80-89. [PMID: 35338470 DOI: 10.1007/s40572-022-00336-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW We review and analyze recent literature in public health, urban planning, and disaster management to better understand the relationships between climate change, natural disasters, and root causes of health disparities in the USA. RECENT FINDINGS Existing scholarship establishes clear linkages between climate change and increasing occurrences and severity of natural disasters across the USA. The frequency and types of disasters vary by region and impact both short and long-term health outcomes. Current research highlights health inequities affecting lower income and minoritized communities disproportionately, but data-driven studies critically examining the role of structural inequalities in climate-induced health disparities are sparse. Adding to the body of knowledge, our conceptual framework maps how long-standing structural inequalities in policy, practice, and funding shape vulnerability of lower-income, racially and ethnically marginalized individuals. Vulnerability follows three common pathways: disparities in "exposure", "sensitivity", and "resiliency" before, during, and after a climate disaster. We recommend that future research, policy, and practice shift towards solutions that unearth and address the structural biases that cause environmental disaster and health inequities.
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32
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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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Huang SJ, Sehgal NJ. Association of historic redlining and present-day health in Baltimore. PLoS One 2022; 17:e0261028. [PMID: 35045092 PMCID: PMC8769359 DOI: 10.1371/journal.pone.0261028] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background In the 1930s, the Home Owners’ Loan Corporation categorized neighborhoods by investment grade along racially discriminatory lines, a process known as redlining. Although other authors have found associations between Home Owners’ Loan Corporation categories and current impacts on racial segregation, analysis of current health impacts rarely use these maps. Objective To study whether historical redlining in Baltimore is associated with health impacts today. Approach Fifty-four present-day planning board-defined community statistical areas are assigned historical Home Owners’ Loan Corporation categories by area predominance. Categories are red (“hazardous”), yellow (”definitely declining”) with blue/green (“still desirable”/”best”) as the reference category. Community statistical area life expectancy is regressed against Home Owners’ Loan Corporation category, controlling for median household income and proportion of African American residents. Conclusion Red categorization is associated with 4.01 year reduction (95% CI: 1.47, 6.55) and yellow categorization is associated with 5.36 year reduction (95% CI: 3.02, 7.69) in community statistical area life expectancy at baseline. When controlling for median household income and proportion of African American residents, red is associated with 5.23 year reduction (95% CI: 3.49, 6.98) and yellow with 4.93 year reduction (95% CI: 3.22, 6.23). Results add support that historical redlining is associated with health today.
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Affiliation(s)
- Shuo Jim Huang
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, Maryland, United States of America
- * E-mail:
| | - Neil Jay Sehgal
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, Maryland, United States of America
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Eneanya ND, Tiako MJN, Novick TK, Norton JM, Cervantes L. Disparities in Mental Health and Well-Being Among Black and Latinx Patients With Kidney Disease. Semin Nephrol 2022; 41:563-573. [PMID: 34973700 DOI: 10.1016/j.semnephrol.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Black and Latinx individuals in the United States are afflicted disproportionately with kidney disease. Because of structural racism, social risk factors drive disparities in disease prevalence and result in worse outcomes among these patient groups. The impact of social and economic oppression is pervasive in physical and emotional aspects of health. In this review, we describe the history of race and ethnicity among black and Latinx individuals in the United States and discuss how these politicosocial constructs impact disparities in well-being and mental health. Lastly, we outline future research, clinical considerations, and policy considerations to eliminate racial and ethnic disparities in well-being among black and Latinx individuals with kidney disease.
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Affiliation(s)
- Nwamaka D Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | | | - Tessa K Novick
- Division of Nephrology, Department of Internal Medicine, University of Texas, Austin Dell Medical School, Austin, TX
| | - Jenna M Norton
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Lilia Cervantes
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO
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Ashing KT, Jones V, Bedell F, Phillips T, Erhunmwunsee L. Calling Attention to the Role of Race-Driven Societal Determinants of Health on Aggressive Tumor Biology: A Focus on Black Americans. JCO Oncol Pract 2022; 18:15-22. [PMID: 34255546 PMCID: PMC8758120 DOI: 10.1200/op.21.00297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Blacks have the highest incidence and mortality from most cancers. The reasons for these disparities remain unclear. Blacks are exposed to adverse social determinants because of historic and contemporary racist polices; however, how these determinants affect the disparities that Blacks experience is understudied. As a result of discriminatory community policies, like redlining, Blacks have higher exposure to air pollution and neighborhood deprivation. Studies investigating how these factors affect tumor biology are emerging. We highlight the literature that connects racism-related community exposure to the tumor biology in breast, lung, prostate, and colorectal cancer. Further investigations that clarify the link between adverse social determinants that result from systemic racism and aggressive tumor biology are required if health equity is to be achieved. Without recognition that racism is a public health risk with carcinogenic impact, health care delivery and cancer care will never achieve excellence. In response, health systems ought to establish corrective actions to improve Black population health and bring medical justice to marginalized racialized groups.
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Affiliation(s)
- Kimlin T. Ashing
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA,African-Caribbean Cancer Consortium, Fox Chase Cancer Center, Philadelphia, PA,Kimlin T. Ashing, PhD, CCARE—Department of Population Sciences, City of Hope Comprehensive Cancer Center, 1500 E Duarte Rd, Duarte, CA 91010-3000; e-mail:
| | - Veronica Jones
- African-Caribbean Cancer Consortium, Fox Chase Cancer Center, Philadelphia, PA
| | - Fornati Bedell
- Division of Urology and Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Tanyanika Phillips
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Loretta Erhunmwunsee
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA,Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA
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Wright E, Waterman PD, Testa C, Chen JT, Krieger N. OUP accepted manuscript. JNCI Cancer Spectr 2022; 6:6531976. [PMID: 35603845 PMCID: PMC8953461 DOI: 10.1093/jncics/pkac016] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/02/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Emily Wright
- Correspondence to: Emily Wright, BA, PhD(c), Department of Social and Behavioral Sciences, Kresge 7th floor, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA (e-mail: )
| | | | - Christian Testa
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jarvis T Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Chesney ML, Duderstadt K. Children's Rights, Environmental Justice, and Environmental Health Policy in the United States. J Pediatr Health Care 2022; 36:3-11. [PMID: 34922676 DOI: 10.1016/j.pedhc.2021.08.006] [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: 05/05/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 10/19/2022]
Abstract
Environmentalists have forewarned that our planet is in peril because of serious degradation and pollution of the earth's land, air, water, and food sources. Climate change is present and worsening at an alarming rate. Gaping disparities exist between high-income and low-income countries and high-income and low-income zip codes in the United States, resulting in marginalized and vulnerable populations bearing the greatest burden from the ill effects of pollution and environmental toxins. Infants and children carry the greatest risk for pollution-related diseases and exposure to chemical toxins as their bodies are rapidly developing. This review article provides a historical overview of children's rights to protection from environmental health risks, effects of environmental injustice, and U.S. statutory and regulatory policies responsible for protecting food, air, and water quality. The authors advocate for policy and clinical strategies to support children's health and the right to environmental protection.
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Lee EK, Donley G, Ciesielski TH, Gill I, Yamoah O, Roche A, Martinez R, Freedman DA. Health outcomes in redlined versus non-redlined neighborhoods: A systematic review and meta-analysis. Soc Sci Med 2021; 294:114696. [PMID: 34995988 DOI: 10.1016/j.socscimed.2021.114696] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Redlining was a racialized zoning practice in the U.S. that blocked fair access to home loans during the 1930s, and recent research is illuminating health problems in the current residents of these historically redlined areas. However, this work has not yet been holistically summarized. Here, we present the first systematic review and meta-analysis comparing health outcomes in redlined versus non-redlined neighborhoods in U.S. cities. METHODS We extracted relevant articles in PubMed, Web of Science, Cochrane and Science Direct databases published from January 2010 to September 2021. RESULTS The search revealed 12 studies on preterm births (n = 3), gunshot-related injuries (n = 2), cancer (n = 1), asthma (n = 1), self-rated health (n = 1), multiple health outcomes (n = 2), heat-related outcomes (n = 1) and COVID-19 incidence and mortality (n = 1). A meta-analysis of three studies found the odds of having preterm birth was significantly higher (OR = 1.41, 95% CI: 1.05, 1.88; p = 0.02) among women living in redlined areas compared to those in non-redlined areas. Review of other outcomes revealed that gunshot-related injuries, asthma, heat-related outcomes, and multiple chronic conditions were worse in redlined areas, while associations with cancer varied by cancer type. In terms of cause-specific mortality, one study revealed no link between residential redlining and infant mortality rate, while one study on COVID-19 outcomes was inconclusive. CONCLUSIONS Overall, this review presents evidence that living in historically redlined areas is associated with increased risk of multiple serious adverse health outcomes. Further research on mechanisms, remediation, and neighborhood-level interventions is needed to strengthen the understanding of the impacts of redlining on health.
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Affiliation(s)
- Eun Kyung Lee
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, 11000 Cedar Avenue, Cleveland, OH, 44106, USA.
| | - Gwendolyn Donley
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, 11000 Cedar Avenue, Cleveland, OH, 44106, USA.
| | - Timothy H Ciesielski
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, 11000 Cedar Avenue, Cleveland, OH, 44106, USA
| | - India Gill
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, 11000 Cedar Avenue, Cleveland, OH, 44106, USA
| | - Owusua Yamoah
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, 11000 Cedar Avenue, Cleveland, OH, 44106, USA
| | - Abigail Roche
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, 11000 Cedar Avenue, Cleveland, OH, 44106, USA
| | - Roberto Martinez
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, 11000 Cedar Avenue, Cleveland, OH, 44106, USA
| | - Darcy A Freedman
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, 11000 Cedar Avenue, Cleveland, OH, 44106, USA
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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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McDonald RI, Biswas T, Sachar C, Housman I, Boucher TM, Balk D, Nowak D, Spotswood E, Stanley CK, Leyk S. The tree cover and temperature disparity in US urbanized areas: Quantifying the association with income across 5,723 communities. PLoS One 2021; 16:e0249715. [PMID: 33909628 PMCID: PMC8081227 DOI: 10.1371/journal.pone.0249715] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 03/23/2021] [Indexed: 01/21/2023] Open
Abstract
Urban tree cover provides benefits to human health and well-being, but previous studies suggest that tree cover is often inequitably distributed. Here, we use National Agriculture Imagery Program digital ortho photographs to survey the tree cover inequality for Census blocks in US large urbanized areas, home to 167 million people across 5,723 municipalities and other Census-designated places. We compared tree cover to summer land surface temperature, as measured using Landsat imagery. In 92% of the urbanized areas surveyed, low-income blocks have less tree cover than high-income blocks. On average, low-income blocks have 15.2% less tree cover and are 1.5⁰C hotter than high-income blocks. The greatest difference between low- and high-income blocks was found in urbanized areas in the Northeast of the United States, where low-income blocks in some urbanized areas have 30% less tree cover and are 4.0⁰C hotter. Even after controlling for population density and built-up intensity, the positive association between income and tree cover is significant, as is the positive association between proportion non-Hispanic white and tree cover. We estimate, after controlling for population density, that low-income blocks have 62 million fewer trees than high-income blocks, equal to a compensatory value of $56 billion ($1,349/person). An investment in tree planting and natural regeneration of $17.6 billion would be needed to close the tree cover disparity, benefitting 42 million people in low-income blocks.
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Affiliation(s)
- Robert I. McDonald
- Center for Sustainability Science, The Nature Conservancy, Arlington, Virginia, United States of America
- * E-mail:
| | - Tanushree Biswas
- California Program, The Nature Conservancy, Sacramento, California, United States of America
| | - Cedilla Sachar
- CUNY Institute for Demographic Research and CUNY Graduate Center, City University of New York, New York, NY, United States of America
| | - Ian Housman
- Independent Researcher, Salt Lake City, Utah, United States of America
| | - Timothy M. Boucher
- Global Science Program, The Nature Conservancy, Arlington, Virginia, United States of America
| | - Deborah Balk
- CUNY Institute for Demographic Research and Marxe School of International and Public Affairs, Baruch College, City University of New York, New York, New York, United States of America
| | - David Nowak
- Northern Research Station, USDA Forest Service, Syracuse, New York, United States of America
| | - Erica Spotswood
- San Francisco Estuary Institute, Richmond, California, United States of America
| | - Charlotte K. Stanley
- California Program, The Nature Conservancy, Sacramento, California, United States of America
| | - Stefan Leyk
- Geography Department, University of Colorado-Boulder, Boulder, Colorado, United States of America
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, Colorado, United States of America
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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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Barlow P, Stuckler D. Globalization and health policy space: Introducing the WTOhealth dataset of trade challenges to national health regulations at World Trade Organization, 1995–2016. Soc Sci Med 2021; 275:113807. [DOI: 10.1016/j.socscimed.2021.113807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/14/2021] [Accepted: 02/26/2021] [Indexed: 01/02/2023]
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Bailey ZD, Feldman JM, Bassett MT. How Structural Racism Works - Racist Policies as a Root Cause of U.S. Racial Health Inequities. N Engl J Med 2021; 384:768-773. [PMID: 33326717 DOI: 10.1056/nejmms2025396] [Citation(s) in RCA: 751] [Impact Index Per Article: 250.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Zinzi D Bailey
- From the University of Miami Miller School of Medicine, Miami (Z.D.B.); and the FXB Center for Health and Human Rights, Harvard University, Boston (J.M.F., M.T.B.)
| | - Justin M Feldman
- From the University of Miami Miller School of Medicine, Miami (Z.D.B.); and the FXB Center for Health and Human Rights, Harvard University, Boston (J.M.F., M.T.B.)
| | - Mary T Bassett
- From the University of Miami Miller School of Medicine, Miami (Z.D.B.); and the FXB Center for Health and Human Rights, Harvard University, Boston (J.M.F., M.T.B.)
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Nardone A, Rudolph KE, Morello-Frosch R, Casey JA. Redlines and Greenspace: The Relationship between Historical Redlining and 2010 Greenspace across the United States. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:17006. [PMID: 33502254 PMCID: PMC7839347 DOI: 10.1289/ehp7495] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Redlining, a racist mortgage appraisal practice of the 1930s, established and exacerbated racial residential segregation boundaries in the United States. Investment risk grades assigned >80y ago through security maps from the Home Owners' Loan Corporation (HOLC) are associated with current sociodemographics and adverse health outcomes. We assessed whether historical HOLC investment grades are associated with 2010 greenspace, a health-promoting neighborhood resource. OBJECTIVES We compared 2010 normalized difference vegetation index (NDVI) across previous HOLC neighborhood grades using propensity score restriction and matching. METHODS Security map shapefiles were downloaded from the Mapping Inequality Project. Neighborhood investment risk grades included A (best, green), B (blue), C (yellow), and D (hazardous, red, i.e., redlined). We used 2010 satellite imagery to calculate the average NDVI for each HOLC neighborhood. Our main outcomes were 2010 annual average NDVI and summer NDVI. We assigned areal-apportioned 1940 census measures to each HOLC neighborhood. We used propensity score restriction, matching, and targeted maximum likelihood estimation to limit model extrapolation, reduce confounding, and estimate the association between HOLC grade and NDVI for the following comparisons: Grades B vs. A, C vs. B, and D vs. C. RESULTS Across 102 urban areas (4,141 HOLC polygons), annual average ±standard deviation (SD) 2010 NDVI was 0.47 (±0.09), 0.43 (±0.09), 0.39 (±0.09), and 0.36 (±0.10) in Grades A-D, respectively. In analyses adjusted for current ecoregion and census region, 1940s census measures, and 1940s population density, annual average NDVI values in 2010 were estimated at -0.039 (95% CI: -0.045, -0.034), -0.024 (95% CI: -0.030, -0.018), and -0.026 (95% CI: -0.037, -0.015) for Grades B vs. A, C vs. B, and D vs. C, respectively, in the 1930s. DISCUSSION Estimates adjusted for historical characteristics indicate that neighborhoods assigned worse HOLC grades in the 1930s are associated with reduced present-day greenspace. https://doi.org/10.1289/EHP7495.
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Affiliation(s)
- Anthony Nardone
- University of California (UC) Berkeley–UC San Francisco (UCSF) Joint Medical Program, UC Berkeley School of Public Health and UCSF School of Medicine, Berkeley and San Francisco, California, USA
| | - Kara E. Rudolph
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Rachel Morello-Frosch
- School of Public Health and Department of Environmental Science, Policy and Management, UC Berkeley, Berkeley, California, USA
| | - Joan A. Casey
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
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Characterization of Urban Greening in a District of Lecce (Southern Italy) for the Analysis of CO2 Storage and Air Pollutant Dispersion. ATMOSPHERE 2020. [DOI: 10.3390/atmos11090967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This paper is devoted to the assessment of urban greening effects on two important ecosystem services, i.e., air quality and CO2 storage, including the corresponding economic impacts in a real urban area, i.e., a district located in the Mediterranean city of Lecce (southern Italy). Two tools were employed, i-Tree Canopy and the computational fluid dynamics (CFD) microclimate model ENVI-met. i-Tree Canopy allowed fully determining the land-cover percentage on the basis of different ground cover classes and obtaining an estimate of annual values of CO2 storage, air pollutant removal, and economic benefits in the presence of urban greening. The estimate in i-Tree Canopy considered only the amount of greening; therefore, air pollutant removal estimates were only potential. As the vegetation was located in street canyons, its interaction with local meteorology and urban geometry strictly affected the dispersion of nitrogen oxides (NOx) (taken here as an example) as obtained from ENVI-met simulations. In ENVI-met, both deposition/absorption and aerodynamic effects were considered, and local increases in concentration were found in the district. The analysis of results obtained from different tools (one complex (CFD model) and the other simple (i-Tree model)) showed the error associated with the simple model in the computation of impacts if the interaction among the vegetation characteristics, the meteorological conditions, and the urban geometry was neglected; however, it also uncovers a novel approach for comprehensively characterizing a given area in terms of its vegetation cover, CO2 storage, and economic benefits, as well as local effects on air quality. This study is set in a broader context aimed at assessing the air quality in urban canopies of Mediterranean areas characterized by the presence of narrow street canyons where pollutants can accumulate due to ineffective air exchange with the above atmosphere.
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Nardone AL, Casey JA, Rudolph KE, Karasek D, Mujahid M, Morello-Frosch R. Associations between historical redlining and birth outcomes from 2006 through 2015 in California. PLoS One 2020; 15:e0237241. [PMID: 32764800 PMCID: PMC7413562 DOI: 10.1371/journal.pone.0237241] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/22/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Despite being one of the wealthiest nations, disparities in adverse birth outcomes persist across racial and ethnic lines in the United States. We studied the association between historical redlining and preterm birth, low birth weight (LBW), small-for-gestational age (SGA), and perinatal mortality over a ten-year period (2006-2015) in Los Angeles, Oakland, and San Francisco, California. METHODS We used birth outcomes data from the California Office of Statewide Health Planning and Development between January 1, 2006 and December 31, 2015. Home Owners' Loan Corporation (HOLC) Security Maps developed in the 1930s assigned neighborhoods one of four grades that pertained to perceived investment risk of borrowers from that neighborhood: green (grade A) were considered "Best", blue (grade B) "Still Desirable", yellow (grade C) "Definitely Declining", and red (grade D, hence the term "redlining") "Hazardous". Geocoded residential addresses at the time of birth were superimposed on HOLC Security Maps to assign each birth a HOLC grade. We adjusted for potential confounders present at the time of Security Map creation by assigning HOLC polygons areal-weighted 1940s Census measures. We then employed propensity score matching methods to estimate the association of historical HOLC grades on current birth outcomes. Because tracts graded A had almost no propensity of receiving grade C or D and because grade B tracts had low propensity of receiving grade D, we examined birth outcomes in the three following comparisons: B vs. A, C vs. B, and D vs. C. RESULTS The prevalence of preterm birth, SGA and mortality tended to be higher in worse HOLC grades, while the prevalence of LBW varied across grades. Overall odds of mortality and preterm birth increased as HOLC grade worsened. Propensity score matching balanced 1940s census measures across contrasting groups. Logistic regression models revealed significantly elevated odds of preterm birth (odds ratio (OR): 1.02, 95% confidence interval (CI): 1.00-1.05), and SGA (OR: 1.03, 95% CI: 1.00-1.05) in the C vs. B comparison and significantly reduced odds of preterm birth (OR: 0.93, 95% CI: 0.91-0.95), LBW (OR: 0.94-95% CI: 0.92-0.97), and SGA (OR: 0.94, 95% CI: 0.92-0.96) in the D vs. C comparison. Results differed by metropolitan area and maternal race. CONCLUSION Similar to prior studies on redlining, we found that worsening HOLC grade was associated with adverse birth outcomes, although this relationship was less clear after propensity score matching and stratifying by metropolitan area. Higher odds of preterm birth and SGA in grade C versus grade B neighborhoods may be caused by higher-stress environments, racial segregation, and lack of access to resources, while lower odds of preterm birth, SGA, and LBW in grade D versus grade C neighborhoods may due to population shifts in those neighborhoods related to gentrification.
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Affiliation(s)
- Anthony L. Nardone
- University of California, Berkeley-University of California San Francisco Joint Medical Program, Berkeley, California, United States of America
| | - Joan A. Casey
- Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Kara E. Rudolph
- Department of Epidemiology, Columbia University, New York, New York, United States of America
| | - Deborah Karasek
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Mahasin Mujahid
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Rachel Morello-Frosch
- School of Public Health, University of California, Berkeley, California, United States of America
- Department of Environmental Science, Policy and Management, University of California, Berkeley, California, United States of America
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