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Cohen S, Metcalf E, Brown MJ, Ahmed NH, Nash C, Greaney ML. A closer examination of the "rural mortality penalty": Variability by race, region, and measurement. J Rural Health 2024. [PMID: 39198995 DOI: 10.1111/jrh.12876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 08/13/2024] [Accepted: 08/18/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND Racial health disparities are well documented and pervasive across the United States. Evidence suggests there is a "rural mortality penalty" whereby rural residents experience poorer health outcomes than their urban counterparts. However, whether this penalty is uniform across demographic groups and U.S. regions is unknown. OBJECTIVE To assess how rural-urban differences in mortality differ by race (Black vs. White), U.S. region, poverty status, and how rural-urban status is measured. METHODS Age-standardized mortality rates (ASMRs)/100,000 by U.S. county (2015-2019) were obtained by race (Black/White) from the CDC Wonder National Vital Statistics System (2015-2019) and were merged with county-level social determinants from the US Census Bureau and County Health Rankings. Multivariable generalized linear models assessed the associations between rurality (index of relative rurality [IRR] decile, rural-urban continuum codes, and population density) and race-specific ASMR, overall, and by Census region and poverty level. RESULTS Overall, average ASMR was significantly higher in rural areas than urban areas for both Black (rural ASMR = 949.1 per 100,000 vs. urban ASMR = 857.7 per 100,000) and White (rural ASMR = 903.0 per 100,000 vs. urban ASMR = 791.6 per 100,000) populations. The Black-White difference was substantially higher (p < 0.001) in urban than in rural counties (65.1 per 100,000 vs. 46.1 per 100,000). Black-White differences and patterns in ASMR varied notably by poverty status and U.S. region. CONCLUSION Policies and interventions designed to reduce racial health disparities should consider and address key contextual factors associated with geographic location, including rural-urban status and socioeconomic status.
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Affiliation(s)
- Steven Cohen
- Associate Professor, Department of Public Health, University of Rhode Island, Kingston, Rhode Island, USA
| | - Emily Metcalf
- Research Assistant, Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Monique J Brown
- Associate Professor, Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Neelam H Ahmed
- Research Assistant, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Caitlin Nash
- Associate Teaching Professor, Department of Public Health, University of Rhode Island, Kingston, Rhode Island, USA
| | - Mary L Greaney
- Professor & Chairperson, Department of Public Health, University of Rhode Island, Kingston, Rhode Island, USA
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Sheehan CM, Garcia MA, Chiu CT, Cantu PA. Racial and Ethnic Differences in Sleep Duration Life Expectancies among Men and Women in Mid-to-Late Life. Res Aging 2023; 45:620-629. [PMID: 36548945 DOI: 10.1177/01640275221146478] [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: 12/24/2022]
Abstract
This analysis documents U.S. racial/ethnic and gender differences in life expectancies with different self-reported sleep durations among adults aged 50 and older. We used self-reported sleep duration and linked mortality information from the 2004-2015 National Health Interview Survey (n = 145,015) to calculate Sullivan Method Lifetables for life expectancies with different self-reported sleep duration states: short (≤6 hours), optimal (seven to 8 hours), and long (≥9 hours) sleep duration per-day by race/ethnicity and gender. Non-Hispanic Black men (35.8%, 95% CI: 34.8%-36.8%) and women (36.5%, 95% CI: 35.7%-37.1%) exhibited the highest proportion of years lived with short sleep duration followed by Hispanic men (31.1%, 95% CI: 29.9%-32.3%) and women (34.1%, 95% CI: 33.1%-35.1%) and Non-Hispanic White men (25.8%, 95% CI: 25.4%-26.2%) and women (27.4%, 95% CI: 27.0%-27.7%). These results highlight how race/ethnic inequality in sleep duration and life expectancy are intertwined among older adults in the U.S.
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Affiliation(s)
- Connor M Sheehan
- School of Social and Family Dynamics, Arizona State University, Tempe, AZ, USA
| | - Marc A Garcia
- Department of Sociology, Aging Studies Institute, Center for Aging and Policy Studies, Lerner Center for Public Health Promotion, Syracuse University, Syracuse, New York, USA
| | - Chi-Tsun Chiu
- Institute of European and American Studies, Academia Sinica, Taipei, Taiwan
| | - Phillip A Cantu
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
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Hummer RA. Race and Ethnicity, Racism, and Population Health in the United States: The Straightforward, the Complex, Innovations, and the Future. Demography 2023; 60:633-657. [PMID: 37158783 PMCID: PMC10731781 DOI: 10.1215/00703370-10747542] [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] [Indexed: 05/10/2023]
Abstract
For far too long, U.S. racialized groups have experienced human suffering and loss of life far too often and early. Thus, it is critical that the population sciences community does its part to improve the science, education, and policy in this area of study and help to eliminate ethnoracial disparities in population health. My 2022 PAA Presidential Address focuses on race and ethnicity, racism, and U.S. population health in the United States and is organized into five sections. First, I provide a descriptive overview of ethnoracial disparities in U.S. population health. Second, I emphasize the often overlooked scientific value of such descriptive work and demonstrate how such seemingly straightforward description is complicated by issues of population heterogeneity, time and space, and the complexity of human health. Third, I make the case that the population sciences have generally been far too slow in incorporating the role of racism into explanations for ethnoracial health disparities and lay out a conceptual framework for doing so. Fourth, I discuss how my research team is designing, collecting, and disseminating data for the scientific community that will have potential to, among many other purposes, create a better understanding of ethnoracial health disparities and the role of racism in producing such disparities. Finally, I close by suggesting some policy- and education-related efforts that are needed to address racism and population health within U.S. institutions.
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Affiliation(s)
- Robert A Hummer
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Leopold SS. Editor's Spotlight/Take 5: Postacute Care Readmission and Resource Utilization in Patients From Socioeconomically Distressed Communities After Total Joint Arthroplasty. Clin Orthop Relat Res 2023; 481:198-201. [PMID: 36668695 PMCID: PMC9831188 DOI: 10.1097/corr.0000000000002539] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Seth S Leopold
- Editor-in-Chief, Clinical Orthopaedics and Related Research® , Park Ridge, IL, USA
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Anderson AB. CORR Insights®: Do Community-level Disadvantages Account for Racial Disparities in the Safety of Spine Surgery? A Large Database Study Based on Medicare Claims. Clin Orthop Relat Res 2023; 481:279-280. [PMID: 36125493 PMCID: PMC9831177 DOI: 10.1097/corr.0000000000002417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/30/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Ashley B Anderson
- Assistant Professor of Surgery, Uniformed Services University-Walter Reed Department of Surgery, Bethesda, MD, USA
- Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
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Kalinda C, Phiri M, Chimpinde K, Ishimwe MCS, Simona SJ. Trends and socio-demographic components of modern contraceptive use among sexually active women in Rwanda: a multivariate decomposition analysis. Reprod Health 2022; 19:226. [PMID: 36527042 PMCID: PMC9758849 DOI: 10.1186/s12978-022-01545-0] [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] [Received: 04/10/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The attainment of targets set for modern contraceptive use remains a challenge in sub-Saharan Africa. Rwanda, in its new Family Planning and Adolescent Sexual Reproductive Health/Family Planning (FP/ASRH) Strategic Plan 2018-2024 has set the attainment of a contraceptive prevalence rate (CPR) of 60% by 2024. To achieve this, identifying factors that enhance modern contraceptive use among sexually active women is critical. METHODS We used three Rwanda Demographic Health Surveys (RDHS) datasets collected in 2010, 2015, and 2019/2020 in a multivariable decomposition analysis technique to describe trends and identify factors influencing change in modern contraceptive use among sexually active women aged 15-49 years. Results presented as coefficients and percentages took into consideration the complex survey design weighted using StataSE 17. RESULTS Modern contraceptive use increased from 40% in 2010 to 52.4% in 2020 among sexually active women. About 23.7% of the overall percentage change in modern contraceptive use was attributable to women's characteristics which included women's education levels, number of living children, and being told about family planning at health facilities. Coefficients contributed 76.26% to the change in modern contraceptive use. This change was attributed to modern contraceptive use among young women between the age of 20-24 years, women's education level, the number of living children, changes in family size, and being visited by community health workers. CONCLUSION Rwanda remains on course to archive its 2024 family planning targets. However, there is a need to enhance programs that target sexually active adolescents and young adults, and women from rural areas to sustain the gains made. Furthermore, continuous support of community health workers will be key in exceeding the set targets of modern contraceptive use among sexually active women in Rwanda.
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Affiliation(s)
- Chester Kalinda
- grid.507436.30000 0004 8340 5635Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity, Kigali Heights, Plot 772 KG 7 Ave., P. O. Box 6955, Kigali, Rwanda
| | - Million Phiri
- grid.12984.360000 0000 8914 5257School of Humanities and Social Sciences, University of Zambia, Great East Road Campus, P. O. Box 32379, Lusaka, Zambia ,grid.11951.3d0000 0004 1937 1135School of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kafiswe Chimpinde
- grid.12984.360000 0000 8914 5257School of Humanities and Social Sciences, University of Zambia, Great East Road Campus, P. O. Box 32379, Lusaka, Zambia
| | - Marie C. S. Ishimwe
- grid.507436.30000 0004 8340 5635Institute of Global Health Equity Research (IGHER), University of Global Health Equity, Kigali Heights, Plot 772 KG 7 Ave, P. O. Box 6955, Kigali, Rwanda
| | - Simona J. Simona
- grid.12984.360000 0000 8914 5257School of Humanities and Social Sciences, University of Zambia, Great East Road Campus, P. O. Box 32379, Lusaka, Zambia
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Gupta A. Seasonal variation in infant mortality in India. POPULATION STUDIES 2022; 76:535-552. [PMID: 36106801 DOI: 10.1080/00324728.2022.2112746] [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: 12/25/2022]
Abstract
Investigating seasonal variation in health helps us understand interactions between population, environment, and disease. Using information on birth month and year, survival status within the first year of life, and age at death (if applicable) of more than 330,000 children observed in four rounds of India's Demographic and Health Surveys, I estimate period mortality rates between birth and age one (1m0) by calendar month. Relative to spring months, infant mortality is higher in the summer, monsoon, and winter months. If spring mortality conditions had been prevalent throughout the year, mortality below age one would have been lower by 11.4 deaths per 1,000 in the early 1990s and 3.7 deaths per 1,000 in the mid-2010s. Seasonal variation in infant mortality has declined overall but remains higher among disadvantaged children. The results highlight the multiple environmental health threats that Indian infants face and the short time of year when these threats are less salient.
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Puro N, Kelly RJ, Bodas M, Feyereisen S. Estimating the differences in Caesarean section (C-section) rates between public and privately insured mothers in Florida: A decomposition approach. PLoS One 2022; 17:e0266666. [PMID: 35390095 PMCID: PMC8989242 DOI: 10.1371/journal.pone.0266666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 03/24/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Caesarean section (C-sections) is a medically critical and often life-saving procedure for prevention of childbirth complications. However, there are reports of its overuse, especially in women covered by private insurance as compared to public insurance. This study evaluates the difference in C-Section rates among nulliparous women in Florida hospitals across insurance groups and quantifies the contribution of maternal and hospital factors in explaining the difference in rates. METHODS We used Florida's inpatient data provided by the Florida Agency for HealthCare Administration (FLAHCA) and focused on low-risk births that occurred between January 1, 2010, and September 30, 2015. A Fairlie decomposition method was performed on cross-sectional data to decompose the difference in C-Section rates between insurance groups into the proportion explained versus unexplained by the differences in observable maternal and hospital factors. RESULTS Of the 386,612 NTSV low-risk births, 72,984 were delivered via C-Section (18.87%). Higher prevalence of C-section at maternal level was associated with diabetes, hypertension, and the expectant mother being over 35 years old. Higher prevalence of C-section at the hospital level was associated with lower occupancy rate, presence of neonatal ICU (NICU) unit and higher obstetrics care level in the hospital. Private insurance coverage in expectant mothers is associated with C-section rates that were 4.4 percentage points higher as compared to that of public insurance. Just over 33.7% of the 4.4 percentage point difference in C-section rates between the two insurance groups can be accounted for by maternal and hospital factors. CONCLUSIONS The study identifies that the prevalence of C-sections in expectant mothers covered by private insurance is higher compared to mothers covered by public insurance. Although, majority of the difference in C-Section rates across insurance groups remains unexplained (around 66.3%), the main contributor that explains the other 33.7% is advancing maternal age and socioeconomic status of the expectant mother. Further investigation to explore additional factors that explain the difference needs to be done if United States wants to target specific policies to lower overall C-Section rate.
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Affiliation(s)
- Neeraj Puro
- Department of Management Programs, College of Business, Florida Atlantic University, Boca Raton, Florida, United States of America
| | - Reena J. Kelly
- Department of Health Administration and Policy, School of Health Sciences, University of New Haven, West Haven, CT, United States of America
| | - Mandar Bodas
- Fitzhugh Mullan Institute for Health Workforce Equity, The George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Scott Feyereisen
- Department of Management Programs, College of Business, Florida Atlantic University, Boca Raton, Florida, United States of America
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Social disadvantage, economic inequality, and life expectancy in nine Indian states. Proc Natl Acad Sci U S A 2022; 119:e2109226119. [PMID: 35238635 PMCID: PMC8915795 DOI: 10.1073/pnas.2109226119] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
SignificanceIndia is one of the most hierarchical societies in the world. Because vital statistics are incomplete, mortality disparities are not quantified. Using survey data on more than 20 million individuals from nine Indian states representing about half of India's population, we estimate and decompose life expectancy differences between higher-caste Hindus, comprising other backward classes and high castes, and three marginalized social groups: Adivasis (indigenous peoples), Dalits (oppressed castes), and Muslims. The three marginalized groups experience large disadvantages in life expectancy at birth relative to higher-caste Hindus. Economic status explains less than half of these gaps. These large disparities underscore parallels between diverse systems of discrimination akin to racism. They highlight the global significance of addressing social inequality in India.
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Mingo TM. “When Surviving Jim Crow Is a Preexisting Condition”: The Impact of COVID‐19 on African Americans in Late Adulthood and Their Perceptions of the Medical Field. ADULTSPAN JOURNAL 2021. [PMCID: PMC8652717 DOI: 10.1002/adsp.12112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article examines how the trauma of historical and structural racism affects one's health and well‐being across the life span, specifically for African Americans identified as descendants of Africans enslaved in the United States (DAEUS). Counselors are provided with antiracist strategies to support the intersection of multiple social identities for DAEUS citizens in late adulthood disproportionately affected by COVID‐19.
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Affiliation(s)
- Taryne M. Mingo
- Department of Counseling University of North Carolina at Charlotte
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Baluran DA, Patterson EJ. Examining Ethnic Variation in Life Expectancy Among Asians in the United States, 2012-2016. Demography 2021; 58:1631-1654. [PMID: 34477822 DOI: 10.1215/00703370-9429449] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
As the fastest growing racial group in the United States, understanding the health patterns of Asians is important to addressing health gaps in American society. Most studies have not considered the unique experiences of the ethnic groups contained in the Asian racial group, implying that Asians have a shared story. However, we should expect differences between the ethnic groups given the differences in their timing and place of migration, socioeconomic status, and racialized experiences in the United States. We estimate the life expectancy of the six largest Asian ethnic groups-Chinese, Asian Indians, Filipinos, Vietnamese, Koreans, and Japanese-analyzing data from the Multiple Cause of Death File (2012-2016) and the American Community Survey (2012-2016) in the United States at the national and regional levels. Nationally, Chinese had the highest life expectancy (males e0 = 86.8; females e0 = 91.3), followed by Asian Indians, Koreans, Japanese, Filipinos, and Vietnamese, generally reflecting the pattern expected given their educational attainment, our primary indicator of socioeconomic status. We also found regional differences in life expectancy, where life expectancy for Asians in the West was significantly lower than all other regions. These findings suggest the presence of underlying selection effects associated with settlement patterns among new and traditional destinations. Our results underline the necessity of studying the experiences of the different Asian ethnic groups in the United States, permitting a better assessment of the varying health needs within this diverse racial group.
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Affiliation(s)
- Darwin A Baluran
- Department of Sociology, Vanderbilt University, Nashville, TN, USA
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12
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Doza A, Jensen GA, Tarraf W. Racial/Ethnic Differences in Mortality in Late Midlife: Have They Narrowed in Recent Years? J Gerontol B Psychol Sci Soc Sci 2021; 76:1475-1487. [PMID: 33053179 DOI: 10.1093/geronb/gbaa175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To examine whether racial/ethnic differences in mortality rates have changed in recent years among adults in late midlife, and if so, how. METHODS We analyze Health and Retirement Study data on non-Hispanic Whites (Whites), non-Hispanic Blacks (Blacks), and English- and Spanish-speaking Hispanics (Hispanic-English and Hispanic-Spanish), aged 50-64 from 2 periods: 1998-2004 (Period 1, n = 8,920) and 2004-2010 (Period 2, n = 7,224). Using survey-generalized linear regression techniques, we model death-by-end-of-period as a function of race/ethnicity and sequentially adjust for a series of period-specific baseline risk factors including demographics, health status, health insurance, health behaviors, and social networks. Regression decomposition techniques are used to assess the contribution of these factors to observed racial/ethnic differences in mortality rates. RESULTS The odds ratio for death (ORD) was not statistically different for Blacks (vs. Whites) in Period 1 but was 33% higher in Period 2 (OR = 1.33; 95% confidence interval [CI] = 1.05-1.69). The adjusted ORD among Hispanic-English (vs. Whites) was not statistically different in both periods. The adjusted ORD among Hispanic-Spanish (vs. Whites) was lower (ORD = 0.36; 95% CI = 0.22-0.59) in Period 1 but indistinguishable in Period 2. In Period 1, 50.1% of the disparity in mortality rates among Blacks was explained by baseline health status, 53.1% was explained by financial factors. In Period 2, 55.8% of the disparity in mortality rates was explained by health status, 40.0% by financial factors, and 16.2% by health insurance status. DISCUSSION Mortality rates among Blacks and Hispanic-Spanish have risen since the mid-1990s. Hispanic-Spanish may be losing their advantageous lower risk of mortality, long known as the "Hispanic Paradox."
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Affiliation(s)
- Adit Doza
- Department of Economics and Institute of Gerontology, Wayne State University, Detroit, Michigan
| | - Gail A Jensen
- Institute of Gerontology and Department of Economics, Wayne State University, Detroit, Michigan
| | - Wassim Tarraf
- Institute of Gerontology and Division of Health Sciences, Wayne State University, Detroit, Michigan
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Molina MF, Cash RE, Carreras-Tartak J, Ciccolo G, Petersen J, Mecklai K, Rodriguez G, Castilla-Ojo N, Boms O, Velasquez D, Macias-Konstantopoulos W, Camargo CA, Samuels-Kalow M. Applying crisis standards of care to critically ill patients during the COVID-19 pandemic: Does race/ethnicity affect triage scoring? J Am Coll Emerg Physicians Open 2021; 2:e12502. [PMID: 34278377 PMCID: PMC8275820 DOI: 10.1002/emp2.12502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Given the variability in crisis standards of care (CSC) guidelines during the COVID-19 pandemic, we investigated the racial and ethnic differences in prioritization between 3 different CSC triage policies (New York, Massachusetts, USA), as well as a first come, first served (FCFS) approach, using a single patient population. METHODS We performed a retrospective cohort study of patients with intensive care unit (ICU) needs at a tertiary hospital on its peak COVID-19 ICU census day. We used medical record data to calculate a CSC score under 3 criteria: New York, Massachusetts with full comorbidity list (Massachusetts1), and MA with a modified comorbidity list (Massachusetts2). The CSC scores, as well as FCFS, determined which patients were eligible to receive critical care under 2 scarcity scenarios: 50 versus 100 ICU bed capacity. We assessed the association between race/ethnicity and eligibility for critical care with logistic regression. RESULTS Of 211 patients, 139 (66%) were male, 95 (45%) were Hispanic, 23 (11%) were non-Hispanic Black, and 69 (33%) were non-Hispanic White. Hispanic patients had the fewest comorbidities. Assuming a 50 ICU bed capacity, Hispanic patients had significantly higher odds of receiving critical care services across all CSC guidelines, except FCFS. However, assuming a 100 ICU bed capacity, Hispanic patients had greater odds of receiving critical care services under only the Massachusetts2 guidelines (odds ratio, 2.05; 95% CI, 1.09 to 3.85). CONCLUSION Varying CSC guidelines differentially affect racial and ethnic minority groups with regard to risk stratification. The equity implications of CSC guidelines require thorough investigation before CSC guidelines are implemented.
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Affiliation(s)
- Melanie F Molina
- Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA
| | - Rebecca E Cash
- Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA
- Harvard Medical School Boston Massachusetts USA
| | - Jossie Carreras-Tartak
- Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA
| | - Gia Ciccolo
- Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA
| | | | | | - Giovanni Rodriguez
- Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA
| | | | - Okechi Boms
- Harvard Medical School Boston Massachusetts USA
| | | | - Wendy Macias-Konstantopoulos
- Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA
- Harvard Medical School Boston Massachusetts USA
| | - Carlos A Camargo
- Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA
- Harvard Medical School Boston Massachusetts USA
| | - Margaret Samuels-Kalow
- Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA
- Harvard Medical School Boston Massachusetts USA
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Soled DR, Chatterjee A, Olveczky D, Lindo EG. The Case for Health Reparations. Front Public Health 2021; 9:664783. [PMID: 34336763 PMCID: PMC8323065 DOI: 10.3389/fpubh.2021.664783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 06/10/2021] [Indexed: 11/13/2022] Open
Abstract
The disproportionate impact of COVID-19 on racially marginalized communities has again raised the issue of what justice in healthcare looks like. Indeed, it is impossible to analyze the meaning of the word justice in the medical context without first discussing the central role of racism in the American scientific and healthcare systems. In summary, we argue that physicians and scientists were the architects and imagination of the racial taxonomy and oppressive machinations upon which this country was founded. This oppressive racial taxonomy reinforced and outlined the myth of biological superiority, which laid the foundation for the political, economic, and systemic power of Whiteness. Therefore, in order to achieve universal racial justice, the nation must first address science and medicine's historical role in scaffolding the structure of racism we bear witness of today. To achieve this objective, one of the first steps, we believe, is for there to be health reparations. More specifically, health reparations should be a central part of establishing racial justice in the United States and not relegated to a secondary status. While other scholars have focused on ways to alleviate healthcare inequities, few have addressed the need for health reparations and the forms they might take. This piece offers the ethical grounds for health reparations and various justice-focused solutions.
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Affiliation(s)
- Derek Ross Soled
- Harvard Medical School, Boston, MA, United States
- Harvard Business School, Boston, MA, United States
| | - Avik Chatterjee
- School of Medicine, Boston University, Boston, MA, United States
- Boston Medical Center, Boston, MD, United States
| | - Daniele Olveczky
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Edwin G. Lindo
- School of Medicine, University of Washington, Seattle, WA, United States
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The Roots of Structural Racism in the United States and their Manifestations During the COVID-19 Pandemic. Acad Radiol 2021; 28:893-902. [PMID: 33994077 DOI: 10.1016/j.acra.2021.03.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 02/07/2023]
Abstract
During the COVID-19 pandemic, the disproportionate morbidity and mortality borne by racial minorities, patients of lower socioeconomic status, and patients lacking health insurance reflect pre-existing structural inequities. Structural racism is racial discrimination rooted in history, perpetuated through policies, and manifested in disparities in healthcare, housing, education, employment, and wealth. Although these disparities exert greater impacts on health outcomes than do genetics or behavior, scientists, and policy makers are only beginning to name structural racism as a key determinant of population health and take the necessary steps to dismantle it. In radiology, structural racism impacts how imaging services are utilized. Here we review the history and policies that contribute to structural racism and predispose minority and disadvantaged communities to inferior outcomes during the COVID-19 pandemic in order to identify policy changes that could promote more equitable access to radiologic services.
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Wang S, Hu S, Wang P, Wu Y, Liu Z, Zheng H. Disability-Free Life Expectancy among People Over 60 Years Old by Sex, Urban and Rural Areas in Jiangxi Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094636. [PMID: 33925511 PMCID: PMC8123896 DOI: 10.3390/ijerph18094636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To estimate and compare age trends and the disability-free life expectancy (DFLE) of the population over 60 years old in 2018 in Jiangxi Province, China, by sex and urban-rural areas. METHODS The model life table was employed to estimate the age-specific mortality rate by sex and urban-rural areas, based on the Summary of Health Statistics of Jiangxi Province in 2018 and the Sixth National Health Service survey of Jiangxi Province. DFLE and its ratio to life expectancy (LE) were obtained by the Sullivan method. RESULTS In 2018, the DFLE among people over 60 is 17.157 years for men and is 19.055 years for women, accounting for 89.7% and 86.5% of their LE respectively. The DFLE/LE of men is higher than that of women at all ages. LE and DFLE are higher for the population in urban areas than in rural areas. For women, DFLE/LE is higher in urban areas than in rural areas (except at ages 75 and 80). Urban men have a higher DFLE/LE than rural men (except at age 85). The difference in DFLE between men and women over 60 years is 1.898 years, of which 2.260 years are attributable to the mortality rate, and 0.362 years are due to the disability-free prevalence. In addition, the difference in DFLE between urban-rural elderly over 60 years old is mostly attributed to the mortality rate by gender (male: 0.902/1.637; female: 0.893/1.454), but the impact of the disability-free rate cannot be ignored either (male: 0.735/1.637; female: 0.561/1.454). CONCLUSIONS The increase in DFLE is accompanied by the increase in LE, but with increased age, DFLE/LE gradually decreases. With advancing age, the effect of disability on elderly people becomes more severe. The government administration must implement some preventive actions to improve health awareness and the life quality of the elderly. Rural elderly; rural women in particular, need to be paid more attention and acquire more health care.
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Affiliation(s)
- Shengwei Wang
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China; (S.W.); (S.H.); (Y.W.); (Z.L.)
| | - Songbo Hu
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China; (S.W.); (S.H.); (Y.W.); (Z.L.)
| | - Pei Wang
- Department of Statistics, University of Kentucky, Lexington, KY 40536, USA;
- Department of Statistics, Miami University, Oxford, OH 45056, USA
| | - Yuhang Wu
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China; (S.W.); (S.H.); (Y.W.); (Z.L.)
| | - Zhitao Liu
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China; (S.W.); (S.H.); (Y.W.); (Z.L.)
| | - Huilie Zheng
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China; (S.W.); (S.H.); (Y.W.); (Z.L.)
- Correspondence:
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Reini K, Saarela J. Life Expectancy of the Ethnically Mixed: Register-Based Evidence from Native Finns. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073415. [PMID: 33806110 PMCID: PMC8037163 DOI: 10.3390/ijerph18073415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/09/2021] [Accepted: 03/23/2021] [Indexed: 11/25/2022]
Abstract
As the ethnic composition around the world is becoming more diverse, the need to produce vital statistics for ethnically mixed populations is continuously increasing. Our aim is to provide the first life expectancy estimates for individuals with uniform Finnish, uniform Swedish, and mixed Finnish-Swedish backgrounds, based on individuals in the native population of Finland who can be linked to both their parents. Life expectancy at birth in the period 2005–2015 was calculated from population and mortality numbers at the one-year level based on each person’s sex, year of birth, and the unique ethnolinguistic affiliation of the index person and each parent. Swedish-registered individuals with Swedish-registered parents had the longest life expectancy at birth, or 85.68 years (95% CI: 85.60–85.77) for females and 81.36 for males (95% CI: 81.30–81.42), as compared to 84.76 years (95% CI: 84.72–84.79) and 78.89 years (95% CI: 78.86–78.92) for Finnish-registered females and males with Finnish-registered parents. Persons with mixed backgrounds were found in between those with uniform Finnish and uniform Swedish backgrounds. An individual’s own ethnolinguistic affiliation is nevertheless more important for longevity than parental affiliation. Similar register-based analyses for other countries with mixed populations would be useful.
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Hathi P, Coffey D, Thorat A, Khalid N. When women eat last: Discrimination at home and women's mental health. PLoS One 2021; 16:e0247065. [PMID: 33651820 PMCID: PMC7924788 DOI: 10.1371/journal.pone.0247065] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 02/01/2021] [Indexed: 01/21/2023] Open
Abstract
The 2011 India Human Development Survey found that in about a quarter of Indian households, women are expected to have their meals after men have finished eating. This study investigates whether this form of gender discrimination is associated with worse mental health outcomes for women. Our primary data source is a new, state-representative mobile phone survey of women ages 18-65 in Bihar, Jharkhand, and Maharashtra in 2018. We measure mental health using questions from the World Health Organization's Self-Reporting Questionnaire. We find that, for women in these states, eating last is correlated with worse mental health, even after accounting for differences in socioeconomic status. We discuss two possible mechanisms for this relationship: eating last may be associated with worse mental health because it is associated with worse physical health, or eating last may be associated with poor mental health because it is associated with less autonomy, or both.
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Affiliation(s)
- Payal Hathi
- Departments of Sociology & Demography, University of California, Berkeley, Berkeley, California, United States of America
- r.i.c.e., a Research Institute for Compassionate Economics, India
| | - Diane Coffey
- r.i.c.e., a Research Institute for Compassionate Economics, India
- Population Research Center, University of Texas at Austin, Austin, Texas, United States of America
- Indian Statistical Institute, Delhi Centre, Delhi, India
| | - Amit Thorat
- r.i.c.e., a Research Institute for Compassionate Economics, India
- Centre for the Study of Regional Development, Jawaharlal Nehru University, Delhi, India
| | - Nazar Khalid
- r.i.c.e., a Research Institute for Compassionate Economics, India
- Department of Demography, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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19
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Care Life Expectancy: Gender and Unpaid Work in the Context of Population Aging. POPULATION RESEARCH AND POLICY REVIEW 2021; 41:197-227. [PMID: 33612898 PMCID: PMC7882465 DOI: 10.1007/s11113-021-09640-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 01/23/2021] [Indexed: 11/05/2022]
Abstract
Amid growing concern regarding the potential added burden of care due to population aging, we have very little understanding of what is the burden of care in aging populations. To answer this question, we introduce a novel metric that encompasses demographic complexity and social context to summarize unpaid family care work provided to children, elderly, and other family members across the life cycle at a population level. The measure (Care Life Expectancy), an application of the Sullivan method, estimates the number of years and proportion of adult life that people spend in an unpaid caregiving role. We demonstrate the value of the metric by using it to describe gender differences in unpaid care work in 23 European aging countries. We find that at age 15, women and men are expected to be in an unpaid caregiving role for over half of their remaining life. For women in most of the countries, over half of those years will involve high-level caregiving for a family member. We also find that men lag in caregiving across most countries, even when using the lowest threshold of caregiving. As we show here, demographic techniques can be used to enhance our understanding of the gendered implications of population aging, particularly as they relate to policy research and public debate.
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20
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White DB, Lo B. Mitigating Inequities and Saving Lives with ICU Triage during the COVID-19 Pandemic. Am J Respir Crit Care Med 2021; 203:287-295. [PMID: 33522881 PMCID: PMC7874325 DOI: 10.1164/rccm.202010-3809cp] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023] Open
Abstract
The burdens of the coronavirus disease (COVID-19) pandemic have fallen disproportionately on disadvantaged groups, including the poor and Black, Latinx, and Indigenous communities. There is substantial concern that the use of existing ICU triage protocols to allocate scarce ventilators and critical care resources-most of which are designed to save as many lives as possible-may compound these inequities. As governments and health systems revisit their triage guidelines in the context of impending resource shortages, scholars have advocated a range of alternative allocation strategies, including the use of a random lottery to give all patients in need an equal chance of ICU treatment. However, both the save-the-most-lives approach and random allocation are seriously flawed. In this Perspective, we argue that ICU triage policies should simultaneously promote population health outcomes and mitigate health inequities. These ethical goals are sometimes in conflict, which will require balancing the goals of maximizing the number of lives saved and distributing health benefits equitably across society. We recommend three strategies to mitigate health inequities during ICU triage: introducing a correction factor into patients' triage scores to reduce the impact of baseline structural inequities; giving heightened priority to individuals in essential, high-risk occupations; and rejecting use of longer-term life expectancy and categorical exclusions as allocation criteria. We present a practical triage framework that incorporates these strategies and attends to the twin public health goals of promoting population health and social justice.
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Affiliation(s)
- Douglas B. White
- Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bernard Lo
- Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, California; and
- The Greenwall Foundation, San Francisco, California
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21
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Abstract
Like many fields, bioethics has been constrained to thinking to race in terms of colorblindness, the idea that ideal deliberation would ignore race and hence prevent bias. There are practical and ethically significant problems with colorblind approaches to ethical deliberation, and important reasons why race is ethically relevant. Future discourse needs to understand how and why race is relevant in bioethics.
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22
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Gupta A, Coffey D. Caste, Religion, and Mental Health in India. POPULATION RESEARCH AND POLICY REVIEW 2020; 39:1119-1141. [PMID: 38737137 PMCID: PMC11086696 DOI: 10.1007/s11113-020-09585-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/21/2020] [Indexed: 12/27/2022]
Abstract
The relationship between mental health and social disadvantage in low- and middle-income countries is poorly understood. Our study contributes the first population-level analysis of mental health disparities in India, where the two marginalized groups that we study constitute a population larger than that of the USA. Applying two complementary empirical strategies to data on 10,125 adults interviewed by the World Health Organisation's Survey of Global Ageing and Adult Health (WHO-SAGE), we document and standardize gaps in self-reported mental health between the dominant social group (higher caste Hindus) and two marginalized social groups (Scheduled Castes and Muslims). We find that differences in socioeconomic status cannot fully explain the large disparities in mental health that we document, especially for Muslims. Our results highlight the need for research to understand the causes and consequences of mental health disparities in India, and for policies to move beyond redistribution and address discrimination against Scheduled Castes and Muslims.
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Affiliation(s)
- Aashish Gupta
- Population Studies Center and Department of Sociology, University of Pennsylvania, 239 McNeil Building, 3718 Locust Walk, Philadelphia, PA 19104-6298, USA
| | - Diane Coffey
- Department of Sociology & Population Research Center, UT Austin, Austin, Texas, USA
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23
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Spears D. Exposure to open defecation can account for the Indian enigma of child height. JOURNAL OF DEVELOPMENT ECONOMICS 2020; 146:102277. [PMID: 32904726 PMCID: PMC7457703 DOI: 10.1016/j.jdeveco.2018.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/07/2018] [Accepted: 08/06/2018] [Indexed: 05/05/2023]
Abstract
Physical height is an important measure of human capital. However, differences in average height across developing countries are poorly explained by economic differences. Children in India are shorter than poorer children in Africa, a widely studied puzzle called "the Asian enigma." This paper proposes and quantitatively investigates the hypothesis that differences in sanitation - and especially in the population density of open defecation - can statistically account for an important component of the Asian enigma, India's gap relative to sub-Saharan Africa. The paper's main result computes a demographic projection of the increase in the average height of Indian children, if they were counterfactually exposed to sub-Saharan African sanitation, using a non-parametric reweighting method. India's projected increase in mean height is at least as large as the gap. The analysis also critically reviews evidence from recent estimates in the literature. Two possible mechanisms are effects on children and on their mothers.
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Affiliation(s)
- Dean Spears
- Department of Economics and Population Research Centre, University of Texas at Austin, Austin, TX, USA
- Economics and Planning Unit, Indian Statistical Institute, Delhi, India
- IZA, Germany
- r.i.c.e., USA
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24
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Rogers TN, Rogers CR, VanSant-Webb E, Gu LY, Yan B, Qeadan F. Racial Disparities in COVID-19 Mortality Among Essential Workers in the United States. WORLD MEDICAL & HEALTH POLICY 2020. [PMID: 32837779 DOI: 10.1002/2fwmh3.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Racial disparities are apparent in the impact of coronavirus disease 2019 (COVID-19) in the United States, yet the factors contributing to racial inequities in COVID-19 mortality remain controversial. To better understand these factors, we investigated racial disparities in COVID-19 mortality among America's essential workers. Data from the American Community Survey and Current Population Survey was used to examine the correlation between the prevalence of COVID-19 deaths and occupational differences across racial/ethnic groups and states. COVID-19 mortality was higher among non-Hispanic (NH) Blacks compared with NH Whites, due to more NH Blacks holding essential-worker positions. Vulnerability to coronavirus exposure was increased among NH Blacks, who disproportionately occupied the top nine essential occupations. As COVID-19 death rates continue to rise, existing structural inequalities continue to shape racial disparities in this pandemic. Policies mandating the disaggregation of state-level data by race/ethnicity are vital to ensure equitable and evidence-based response and recovery efforts.
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25
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Rogers TN, Rogers CR, VanSant‐Webb E, Gu LY, Yan B, Qeadan F. Racial Disparities in COVID-19 Mortality Among Essential Workers in the United States. WORLD MEDICAL & HEALTH POLICY 2020; 12:311-327. [PMID: 32837779 PMCID: PMC7436547 DOI: 10.1002/wmh3.358] [Citation(s) in RCA: 180] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/27/2020] [Accepted: 07/06/2020] [Indexed: 11/24/2022]
Abstract
Racial disparities are apparent in the impact of coronavirus disease 2019 (COVID‐19) in the United States, yet the factors contributing to racial inequities in COVID‐19 mortality remain controversial. To better understand these factors, we investigated racial disparities in COVID‐19 mortality among America's essential workers. Data from the American Community Survey and Current Population Survey was used to examine the correlation between the prevalence of COVID‐19 deaths and occupational differences across racial/ethnic groups and states. COVID‐19 mortality was higher among non‐Hispanic (NH) Blacks compared with NH Whites, due to more NH Blacks holding essential‐worker positions. Vulnerability to coronavirus exposure was increased among NH Blacks, who disproportionately occupied the top nine essential occupations. As COVID‐19 death rates continue to rise, existing structural inequalities continue to shape racial disparities in this pandemic. Policies mandating the disaggregation of state‐level data by race/ethnicity are vital to ensure equitable and evidence‐based response and recovery efforts.
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26
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Affiliation(s)
- Emily Cleveland Manchanda
- From the Department of Emergency Medicine, Boston University School of Medicine and Boston Medical Center (E.C.M.), the Departments of Quality and Safety and Diversity, Inclusion, and Experience, Brigham and Women's Hospital (K.S.), and the Institute for Healthcare Improvement (K.S.) - all in Boston; and the Brandon Residential Treatment Center, Natick, MA (C.C.)
| | - Cheri Couillard
- From the Department of Emergency Medicine, Boston University School of Medicine and Boston Medical Center (E.C.M.), the Departments of Quality and Safety and Diversity, Inclusion, and Experience, Brigham and Women's Hospital (K.S.), and the Institute for Healthcare Improvement (K.S.) - all in Boston; and the Brandon Residential Treatment Center, Natick, MA (C.C.)
| | - Karthik Sivashanker
- From the Department of Emergency Medicine, Boston University School of Medicine and Boston Medical Center (E.C.M.), the Departments of Quality and Safety and Diversity, Inclusion, and Experience, Brigham and Women's Hospital (K.S.), and the Institute for Healthcare Improvement (K.S.) - all in Boston; and the Brandon Residential Treatment Center, Natick, MA (C.C.)
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27
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O'Brien R, Neman T, Seltzer N, Evans L, Venkataramani A. Structural racism, economic opportunity and racial health disparities: Evidence from U.S. counties. SSM Popul Health 2020. [PMID: 32195315 DOI: 10.1016/j.ssmph.2020.100564.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In this study, we introduce the 'racial opportunity gap' as a place-based measure of structural racism for use in population health research. We first detail constructing the opportunity gap using race-sex specific estimates of intergenerational economic mobility outcomes for a recent cohort. We then illustrate its utility in examining spatial variation in the racial mortality gap. First we demonstrate a correlation between the racial opportunity gap and the racial mortality gap across U.S. counties; where the gap in the adult earnings of black and white children born to families at the same income level is greater so, too, is the gap in mortality. Second, we show in a multivariable framework that the racial opportunity gap is associated with the racial mortality gap net of differences in the socioeconomic composition of the two groups. In so doing, we aim to provide population health researchers with a new empirical tool and analytic framework for examining the role of structural racism in generating racial health disparities.
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Affiliation(s)
- Rourke O'Brien
- Department of Sociology, Institution for Social and Policy Studies, Yale University, Address: 493 College St. New Haven, CT, 06510, USA
| | - Tiffany Neman
- Department of Sociology, University of Wisconsin-Madison, USA
| | - Nathan Seltzer
- Department of Sociology, University of Wisconsin-Madison, USA
| | - Linnea Evans
- Center for Demography and Ecology, University of Wisconsin-Madison, USA
| | - Atheendar Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, USA
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28
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O'Brien R, Neman T, Seltzer N, Evans L, Venkataramani A. Structural racism, economic opportunity and racial health disparities: Evidence from U.S. counties. SSM Popul Health 2020; 11:100564. [PMID: 32195315 PMCID: PMC7076092 DOI: 10.1016/j.ssmph.2020.100564] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/09/2020] [Accepted: 03/07/2020] [Indexed: 01/13/2023] Open
Abstract
In this study, we introduce the ‘racial opportunity gap’ as a place-based measure of structural racism for use in population health research. We first detail constructing the opportunity gap using race-sex specific estimates of intergenerational economic mobility outcomes for a recent cohort. We then illustrate its utility in examining spatial variation in the racial mortality gap. First we demonstrate a correlation between the racial opportunity gap and the racial mortality gap across U.S. counties; where the gap in the adult earnings of black and white children born to families at the same income level is greater so, too, is the gap in mortality. Second, we show in a multivariable framework that the racial opportunity gap is associated with the racial mortality gap net of differences in the socioeconomic composition of the two groups. In so doing, we aim to provide population health researchers with a new empirical tool and analytic framework for examining the role of structural racism in generating racial health disparities.
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Affiliation(s)
- Rourke O'Brien
- Department of Sociology, Institution for Social and Policy Studies, Yale University, Address: 493 College St. New Haven, CT, 06510, USA
| | - Tiffany Neman
- Department of Sociology, University of Wisconsin-Madison, USA
| | - Nathan Seltzer
- Department of Sociology, University of Wisconsin-Madison, USA
| | - Linnea Evans
- Center for Demography and Ecology, University of Wisconsin-Madison, USA
| | - Atheendar Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, USA
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29
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Schnittker J, Do D. Pharmaceutical Side Effects and Mental Health Paradoxes among Racial-Ethnic Minorities. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2020; 61:4-23. [PMID: 32009468 PMCID: PMC8215684 DOI: 10.1177/0022146519899115] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Sociologists have long struggled to explain the minority mental health paradox: that racial-ethnic minorities often report better mental health than non-Hispanic whites despite social environments that seem less conducive to well-being. Using data from the 2008-2013 Medical Expenditure Panel Survey (MEPS), this study provides a partial explanation for the paradox rooted in a very different disparity. Evidence from MEPS indicates that non-Hispanic whites consume more pharmaceuticals than racial-ethnic minorities for a wide variety of medical conditions. Moreover, non-Hispanic whites consume more pharmaceuticals that although effective in treating their focal indication, include depression or suicide as a side effect. In models that adjust for the use of such medications, the minority advantage in significant distress is reduced, in some instances to statistical nonsignificance. Although a significant black and Hispanic advantage in a continuous measure of distress remains, the magnitude of the difference is reduced considerably. The relationship between the use of medications with suicide as a side effect and significant distress is especially large, exceeding, for instance, the relationship between poverty and significant distress. For some minority groups, the less frequent use of such medications is driven by better health (as in the case of Asians), whereas for others, it reflects a treatment disparity (as in the case of blacks), although the consequences for the mental health paradox are the same. The implications of the results are discussed, especially with respect to the neglect of psychological side effects in the treatment of physical disease as well as the problem of multiple morbidities.
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Affiliation(s)
| | - Duy Do
- University of Pennsylvania, Philadelphia, PA, USA
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30
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Coffey D, Deshpande A, Hammer J, Spears D. Local Social Inequality, Economic Inequality, and Disparities in Child Height in India. Demography 2019; 56:1427-1452. [PMID: 31309449 PMCID: PMC8638789 DOI: 10.1007/s13524-019-00794-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study investigates disparities in child height-an important marker of population-level health-among population groups in rural India. India is an informative context in which to study processes of health disparities because of wide heterogeneity in the degree of local segregation or integration among caste groups. Building on a literature that identifies discrimination by quantifying whether differences in socioeconomic status (SES) can account for differences in health, we decompose height differences between rural children from higher castes and rural children from three disadvantaged groups. We find that socioeconomic differences can explain the height gap for children from Scheduled Tribes (STs), who tend to live in geographically isolated places. However, SES does not fully explain height gaps for children from the Scheduled Castes (SC) and Other Backward Classes (OBCs). Among SC and OBC children, local processes of discrimination also matter: the fraction of households in a child's locality that outrank her household in the caste hierarchy predicts her height. SC and OBC children who are surrounded by other lower-caste households are no shorter than higher-caste children of the same SES. Our results contrast with studies from other populations where segregation or apartheid are negatively associated with health.
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Affiliation(s)
- Diane Coffey
- Department of Sociology, University of Texas, Austin, TX, USA.
- The Population Research Center, University of Texas, Austin, TX, USA.
- Indian Statistical Institute, Delhi, India.
- R.I.C.E., Hyderabad, India.
| | | | - Jeffrey Hammer
- Woodrow Wilson School of Public & International Affairs, Princeton University, Princeton, NJ, USA
| | - Dean Spears
- The Population Research Center, University of Texas, Austin, TX, USA
- Indian Statistical Institute, Delhi, India
- R.I.C.E., Hyderabad, India
- Department of Economics, University of Texas, Austin, TX, USA
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Perera C, Cabrera F, Albizu-Campos JC, Brønnum-Hansen H. Health expectancies among non-white and white populations living in Havana, 2000-2004. Eur J Ageing 2019; 16:17-24. [PMID: 30886557 DOI: 10.1007/s10433-018-0472-5] [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: 10/16/2022] Open
Abstract
This study explored the role of skin color in health expectancies by computing average lifetime in self-rated good health and lifetime without functional limitations in activities of daily living (ADL) among non-white and white 60+ adults living in Havana (Cuba) in 2000-2004. The Sullivan method was used to estimate health expectancies. The contributions from the mortality and health effect to the differences in health expectancies were assessed by decomposition. White males aged 60 were expected to live longer in self-rated good health than non-white males, white and non-white females. Most of the differences among males are attributed to the health effect. No differences were found between white and non-white females in expected lifetime in moderate to full ADL functioning while a difference in ADL functioning of 0.8 years favored white over non-white males. The mortality effect accounted for most difference across the two male groups. From age 80, both non-white groups could expect to live longer than their white counterparts. The results showed that skin color is a risk marker of mortality and morbidity among older adults living in Havana. Although health behaviors vary, the differences were not anticipated due to high social equity and equal health care provision in Cuba. This finding calls for further research on health expectancies by skin color that is representative of the Cuban population and includes information on different diseases and conditions.
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Affiliation(s)
- Camila Perera
- 1Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Fabián Cabrera
- 2Center of Demographic Studies, University of Havana, Havana, Cuba
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Sheehan CM, Hayward MD. Black/white differences in mortality among veteran and non-veteran males. SOCIAL SCIENCE RESEARCH 2019; 79:101-114. [PMID: 30857656 PMCID: PMC6715417 DOI: 10.1016/j.ssresearch.2019.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/07/2019] [Accepted: 02/12/2019] [Indexed: 06/09/2023]
Abstract
U.S. military veterans are a large and racially heterogeneous population. There are reasons to expect that racial disparities in mortality among veterans are smaller than those for non-veterans. For example, blacks are favorably selected into the military, receive relatively equitable treatment within the military, and after service accrue higher socioeconomic status and receive health and other benefits after service. Using the 1997-2009 National Health Interview Survey (N = 99,063) with Linked Mortality Files through the end of 2011 (13,691 deaths), we fit Cox proportional hazard models to estimate whether racial disparities in the risk of death are smaller for veterans than for non-veterans. We find that black/white disparities in mortality are smaller for veterans than for non-veterans, and that this is explained by the elevated socioeconomic resources of black veterans relative to black non-veterans. Leveraging birth cohort differences in military periods, we document that the smaller disparities are concentrated among All-Volunteer era veterans.
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Affiliation(s)
- Connor M Sheehan
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, USA.
| | - Mark D Hayward
- Department of Sociology and Population Research Center, University of Texas at Austin, USA
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Vyas S, Spears D. Sanitation and Religion in South Asia: What Accounts for Differences across Countries? THE JOURNAL OF DEVELOPMENT STUDIES 2018; 54:2119-2135. [PMID: 30363925 PMCID: PMC6183933 DOI: 10.1080/00220388.2018.1469742] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 01/29/2018] [Indexed: 06/08/2023]
Abstract
Exposure to open defecation has serious consequences for child mortality, health, and human capital development. South Asia has the highest rates of open defecation worldwide, and although the incidence declines as household income rises, differences across South Asian countries are not explained by differences in per capita income. The rate of open defecation in sub-national regions of Bangladesh, India and Nepal is highly correlated with the fraction of the population that identifies as Hindu, in part because certain rituals of purity and pollution discourage having latrines in close proximity to one's home. Almost all open defecation occurs in rural areas, and this paper estimates how much the rate could be reduced if rural households in regions that have a higher fraction of Hindus, where open defecation is still common, altered their behaviour to reflect that of non-Hindu households in regions that are predominantly non-Hindu, where the rate of open defecation is much lower. Using nonparametric reweighting methods, this paper projects that rural open defecation in Bangladesh, India, and Nepal could be reduced to rates of between 6 and 8 per cent, compared to the prevailing level of 65 per cent.
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Affiliation(s)
- Sangita Vyas
- Department of Economics, University of Texas at Austin, Austin, USA
| | - Dean Spears
- Department of Economics, University of Texas at Austin, Austin, USA
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Geruso M, Spears D. Neighborhood Sanitation and Infant Mortality. AMERICAN ECONOMIC JOURNAL. APPLIED ECONOMICS 2018; 10:125-162. [PMID: 38213507 PMCID: PMC10782420 DOI: 10.1257/app.20150431] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
In this paper, we shed new light on a long-standing puzzle: in India, Muslim children are substantially more likely than Hindu children to survive to their first birthday, even though Indian Muslims have lower wealth, consumption, educational attainment, and access to state services. Contrary to the prior literature, we show that the observed mortality advantage accrues not to Muslim households themselves but rather to their neighbors, who are also likely to be Muslim. Investigating mechanisms, we provide a collage of evidence suggesting externalities due to poor sanitation are a channel linking the religious composition of neighborhoods to infant mortality.
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Affiliation(s)
- Michael Geruso
- Department of Economics, University of Texas at Austin, 2225 Speedway, Austin, TX 78712 and NBER
| | - Dean Spears
- Department of Economics, University of Texas at Austin, 2225 Speedway, Austin, TX 78712
- Economics and Planning Unit, Indian Statistical Institute, Delhi; and r.i.c.e
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Nowotny KM, Rogers RG, Boardman JD. Racial disparities in health conditions among prisoners compared with the general population. SSM Popul Health 2017; 3:487-496. [PMID: 28824953 PMCID: PMC5558461 DOI: 10.1016/j.ssmph.2017.05.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This paper compares black-white health disparities among prisoners to disparities in the noninstitutionalized community to provide a more complete portrait of the nation’s heath. We use data from the 2004 Survey of Inmates in State and Federal Correctional Facilities and the 2002 and 2004 National Health and Nutrition Examination Survey for incarcerated and noninstitutionalized adult (aged 18–65) men and women, respectively. Health disparities between black and white male prisoners based on self-reported prevalence are similar to disparities in the general population for hypertension and diabetes but significantly reduced for kidney problems and stroke. Health disparities between black and white female prisoners are similar to disparities in the general population for obesity but significantly reduced for hypertension, diabetes, heart problems, kidney problems, and stroke. Our study reveals that prisoners report far worse health profiles than non-prisoners but there is differential health selection into prison for whites and blacks, and population health estimates for adult black men in particular underreport the true health burden for U.S. adults. Our findings highlight the importance of incorporating prison populations in demographic and public health analyses. Inmates have poorer health overall than the noninstitutionalized population, but more so for white women demonstrating a differential health selection into prison. Health problems increase when inmates are included in national health statistics, especially for black men. U.S. health statistics may underestimate the health of the nation with potential consequences for understanding racial health disparities. Properly characterizing population health and health disparities requires the inclusion of incarcerated adults in mainstream epidemiologic studies.
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Affiliation(s)
- Kathryn M. Nowotny
- University of Miami, Department of Sociology 5202 University Drive, Merrick Building, Rm 120, Coral Gables, FL 33146 USA
- Corresponding author.
| | - Richard G. Rogers
- University of Colorado Boulder, Department of Sociology & Institute of Behavioral Science, 1440 15th Street, Boulder, CO 80309-0483 USA
| | - Jason D. Boardman
- University of Colorado Boulder, Department of Sociology & Institute of Behavioral Science, 1440 15th Street, Boulder, CO 80309-0483 USA
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Duh J, Spears D. Health and Hunger: Disease, Energy Needs, and the Indian Calorie Consumption Puzzle. ECONOMIC JOURNAL (LONDON, ENGLAND) 2017; 127:2378-2409. [PMID: 33612850 PMCID: PMC7797625 DOI: 10.1111/ecoj.12417] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 05/08/2019] [Accepted: 08/13/2019] [Indexed: 05/22/2023]
Abstract
India's experience presents a puzzle at odds with a basic fact of household economics: amidst unprecedented economic growth, average per capita daily calorie consumption has declined in recent decades. Does an improving disease environment explain the calorie decline? A diminished burden of infectious disease could lower energy needs by increasing absorption and effective use of calories. We document a robust effect of disease exposure - measured as infant mortality and as poor sanitation - on calorie consumption. Similar effects are found using multiple datasets and empirical strategies. Disease can account for an important fraction (one-fifth or more) of India's calorie decline.
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Affiliation(s)
- Josephine Duh
- University of Texas at Austin, Indian Statistical Institute - Delhi Centre, and r.i.c.e
| | - Dean Spears
- University of Texas at Austin, Indian Statistical Institute - Delhi Centre, and r.i.c.e
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Cichy KE, Leslie M, Rumrill PD, Koch LC. Population aging and disability: Implications for vocational rehabilitation practice. JOURNAL OF VOCATIONAL REHABILITATION 2017. [DOI: 10.3233/jvr-170894] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kelly E. Cichy
- Kent State University, School of Lifespan Development and Educational Sciences, Kent, OH, USA
| | - Mykal Leslie
- Kent State University, School of Lifespan Development and Educational Sciences, Kent, OH, USA
| | - Phillip D. Rumrill
- Kent State University, School of Lifespan Development and Educational Sciences, Kent, OH, USA
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McKetta S, Hatzenbuehler ML, Pratt C, Bates L, Link BG, Keyes KM. Does social selection explain the association between state-level racial animus and racial disparities in self-rated health in the United States? Ann Epidemiol 2017; 27:485-492.e6. [PMID: 28778656 DOI: 10.1016/j.annepidem.2017.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/16/2017] [Accepted: 07/06/2017] [Indexed: 01/22/2023]
Abstract
PURPOSE Racism, whether defined at individual, interpersonal, or structural levels, is associated with poor health among Blacks. This association may arise because exposure to racism causes poor health, but geographic mobility patterns pose an alternative explanation-namely, Black individuals with better health and resources can move away from racist environments. METHODS We examine the evidence for selection effects using nationally representative, longitudinal data (1990-2009) from the Panel Study on Income Dynamics (n = 33,852). We conceptualized state-level racial animus as an ecologic measure of racism and operationalized it as the percent of racially-charged Google search terms in each state. RESULTS Among those who move out of state, Blacks reporting good self-rated health (SRH) are more likely to move to a state with less racial animus than Blacks reporting poor SRH (P = .01), providing evidence for at least some selection into environments with less racial animus. However, among Blacks who moved states, over 80% moved to a state within the same quartile of racial animus, and fewer than 5% resided in states with the lowest level of racial animus. CONCLUSIONS Geographic mobility patterns are therefore likely to explain only a small part of the relationship between racial animus and SRH. These results require replication with alternative measures of racist attitudes and health outcomes.
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Affiliation(s)
- Sarah McKetta
- Department of Epidemiology, Mailman School Public Health, Columbia University, New York City, NY.
| | - Mark L Hatzenbuehler
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York City, NY
| | - Charissa Pratt
- Department of Epidemiology, Mailman School Public Health, Columbia University, New York City, NY
| | - Lisa Bates
- Department of Epidemiology, Mailman School Public Health, Columbia University, New York City, NY
| | - Bruce G Link
- Department of Sociology, University of California Riverside, Riverside
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School Public Health, Columbia University, New York City, NY
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Vyas S, Kov P, Smets S, Spears D. Disease externalities and net nutrition: Evidence from changes in sanitation and child height in Cambodia, 2005-2010. ECONOMICS AND HUMAN BIOLOGY 2016; 23:235-245. [PMID: 27776300 PMCID: PMC5147726 DOI: 10.1016/j.ehb.2016.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 10/07/2016] [Accepted: 10/07/2016] [Indexed: 05/03/2023]
Abstract
Child height is an important indicator of human capital and human development, in large part because early life health and net nutrition shape both child height and adult economic productivity and health. Between 2005 and 2010, the average height of children under 5 in Cambodia significantly increased. What contributed to this improvement? Recent evidence suggests that exposure to poor sanitation - and specifically to widespread open defecation - can pose a critical threat to child growth. We closely analyze the sanitation height gradient in Cambodia in these two years. Decomposition analysis, in the spirit of Blinder-Oaxaca, suggests that the reduction in children's exposure to open defecation can statistically account for much or all of the increase in average child height between 2005 and 2010. In particular, we see evidence of externalities, indicating an important role for public policy: it is the sanitation behavior of a child's neighbors that matters more for child height rather than the household's sanitation behavior by itself. Moving from an area in which 100% of households defecate in the open to an area in which no households defecate in the open is associated with an average increase in height-for-age z-score of between 0.3 and 0.5. Our estimates are quantitatively robust and comparable with other estimates in the literature.
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Affiliation(s)
| | - Phyrum Kov
- World Bank Water and Sanitation Program East Asia and the Pacific, 113 Norodom Blvd, Phnom Penh, Cambodia.
| | - Susanna Smets
- World Bank Water and Sanitation Program East Asia and the Pacific, 113 Norodom Blvd, Phnom Penh, Cambodia.
| | - Dean Spears
- Research Institute for Compassionate Economics; Economics and Planning Unit, Indian Statistical Institute, New Delhi, India; University of Texas, Austin, United States.
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Moses KA, Orom H, Brasel A, Gaddy J, Underwood W. Racial/Ethnic Disparity in Treatment for Prostate Cancer: Does Cancer Severity Matter? Urology 2016; 99:76-83. [PMID: 27667157 DOI: 10.1016/j.urology.2016.07.045] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/07/2016] [Accepted: 07/23/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine if there are variations in the receipt of treatment based on race and disease severity. Treatment variations in men with prostate cancer (PCa) among the various racial groups in the United States exist, which may be a source of potential disparity in outcome. METHODS Utilizing Surveillance, Epidemiology and End Results 17, we identified 327,636 men diagnosed with PCa from 2004 to 2011. Logistic regression analysis was performed to determine the association of receiving definitive treatment and race in the context of disease severity. RESULTS African American (AA) and Hispanic men were less likely to receive treatment compared to White men (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.71, 0.75, and OR 0.95, 95% CI 0.92, 0.98, respectively). AA men had significantly lower OR of receiving definitive treatment within each D'Amico risk classification compared to White men, with decreasing odds of treatment for each increase in risk category (low-risk OR 0.81, 95% CI 0.78, 0.85; intermediate-risk OR 0.74, 95% CI 0.71, 0.77; and high-risk OR 0.62, 95% CI 0.58, 0.66). Hispanic men with intermediate-risk (OR 0.89, 95% CI 0.84, 0.94) or high-risk (OR 0.79, 95% CI 0.72, 0.85) disease had lower odds of receiving treatment compared to White men. Asian men had similar or greater odds of receiving treatment compared to White men within any Gleason or D'Amico classification. CONCLUSION There is a significant disparity in the receipt of treatment for PCa among AA and Hispanic men compared to White men. The variations in receipt of treatment reveal an area of opportunity to develop risk-stratified approaches to treatment regardless of ethnic identity, which may address the poorer PCa-related outcomes in these populations.
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Affiliation(s)
- Kelvin A Moses
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
| | - Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY
| | - Alicia Brasel
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY
| | - Jacquelyne Gaddy
- Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - Willie Underwood
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY; Department of Urology, Roswell Park Cancer Institute, Buffalo, NY
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Variance models of the last age interval and their impact on life expectancy at subnational scales. DEMOGRAPHIC RESEARCH 2016. [DOI: 10.4054/demres.2016.35.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Brick A, Layte R, Nolan A, Turner MJ. Differences in nulliparous caesarean section rates across models of care: a decomposition analysis. BMC Health Serv Res 2016; 16:239. [PMID: 27392410 PMCID: PMC4938942 DOI: 10.1186/s12913-016-1494-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 06/27/2016] [Accepted: 06/29/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND To evaluate the extent of the difference in elective (ELCS) and emergency (EMCS) caesarean section (CS) rates between nulliparous women in public maternity hospitals in Ireland by model of care, and to quantify the contribution of maternal, clinical, and hospital characteristics in explaining the difference in the rates. METHODS Cross-sectional analysis using a combination of two routinely collected administrative databases was performed. A non-linear extension of the Oaxaca-Blinder method is used to decompose the difference between public and private ELCS and EMCS rates into the proportion explained by the differences in observable maternal, clinical, and hospital characteristics and the proportion that remains unexplained. RESULTS Of the 29,870 babies delivered to nulliparous women, 7,792 were delivered via CS (26.1 %), 79.6 % of which were coded as EMCS. Higher prevalence of ELCS was associated with breech presentation, other malpresentation, and the mother being over 40 years old. Higher prevalence of EMCS was associated with placenta praevia or placental abruption, diabetes (pre-existing and gestational), and being over 40 years old. The private model of care is associated with ELCS and EMCS rates 6 percentage points higher compared than the public model of care but this differential is insignificant in the fully adjusted models for EMCS. Just over half (53 %) of the 6 percentage point difference in ELCS rates between the two models of care can be accounted for by maternal, clinical and hospital characteristics. Almost 80 % of the difference for EMCS can be accounted for. CONCLUSIONS The majority of the difference in EMCS rates across models of care can be explained by differing characteristics between the two groups of women. The main contributor to the difference was advancing maternal age. The unexplained component of the difference for ELCS is larger; an excess private effect remains after accounting for maternal, clinical, and hospital characteristics. This requires further investigation and may be mitigated in future with the introduction of clinical guidelines related to CS.
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Affiliation(s)
- Aoife Brick
- />Economic and Social Research Institute, Whitaker Square, Sir John Rogerson`s Quay, Dublin 2, Ireland
- />Trinity College, Dublin, Ireland
| | - Richard Layte
- />Economic and Social Research Institute, Whitaker Square, Sir John Rogerson`s Quay, Dublin 2, Ireland
- />Department of Sociology, Trinity College, Dublin 2, Ireland
| | - Anne Nolan
- />Economic and Social Research Institute, Whitaker Square, Sir John Rogerson`s Quay, Dublin 2, Ireland
- />Trinity College, Dublin, Ireland
| | - Michael J. Turner
- />UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
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Moses KA, Orom H, Brasel A, Gaddy J, Underwood W. Racial/ethnic differences in the relative risk of receipt of specific treatment among men with prostate cancer. Urol Oncol 2016; 34:415.e7-415.e12. [PMID: 27161898 DOI: 10.1016/j.urolonc.2016.04.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/21/2016] [Accepted: 04/05/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE African-American (AA) men have excess mortality from prostate cancer compared with White men, which has remained unchanged over several decades. The purpose of this study is to determine if race/ethnicity is an independent predictor of receipt of any definitive treatment vs. watchful waiting/active surveillance (WW/AS). METHODS AND MATERIALS Men diagnosed with prostate cancer from 2004 to 2011 were identified from the Surveillance, Epidemiology, and End-Results program. Multinomial logistic regression analysis was performed to determine the relative risk ratio (RRR) of receipt of radical prostatectomy (RP), external beam radiation therapy (RT), brachytherapy, cryotherapy, or combination therapy vs. WW/AS. RESULTS Compared with White men, AA men were significantly less likely to receive RP (RRR = 0.53, P<0.001), brachytherapy (RRR = 0.72, P<0.001), cryotherapy (RRR = 0.84, P = 0.001), and combination therapy (RRR = 0.70, P<0.001), and more likely to receive RT (RRR = 1.03, P = 0.041) vs. AS/WW. Hispanic men were significantly less likely to receive RP (RRR = 0.84, P<0.001) and brachytherapy (RRR = 0.77, P<0.001), and more likely to receive RT (RRR = 1.08, P<0.001), and cryotherapy (RRR = 1.19, P = 0.005) vs. AS/WW compared with White men. CONCLUSIONS The disparate risk of receiving definitive treatment among AA and Hispanic men represents a significant public health issue that requires efforts to improve physician education, increase cultural competency, and ensure equitable access.
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Affiliation(s)
- Kelvin A Moses
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
| | - Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY
| | - Alicia Brasel
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY
| | - Jacquelyne Gaddy
- Loyola University Chicago Stritch School of Medicine, Chicago, IL
| | - Willie Underwood
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY; Department of Urology, Roswell Park Cancer Institute, Buffalo, NY
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Howard JT, Sparks PJ. The Effects of Allostatic Load on Racial/Ethnic Mortality Differences in the United States. POPULATION RESEARCH AND POLICY REVIEW 2016. [DOI: 10.1007/s11113-016-9382-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Prepregnancy body mass and weight gain during pregnancy in India and sub-Saharan Africa. Proc Natl Acad Sci U S A 2015; 112:3302-7. [PMID: 25733859 DOI: 10.1073/pnas.1416964112] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Despite being wealthier, Indian children are significantly shorter and smaller than African children. These differences begin very early in life, suggesting that they may in part reflect differences in maternal health. By applying reweighting estimation strategies to the Demographic and Health Surveys, this paper reports, to my knowledge, the first representative estimates of prepregnancy body mass index and weight gain during pregnancy for India and sub-Saharan Africa. I find that 42.2% of prepregnant women in India are underweight compared with 16.5% of prepregnant women in sub-Saharan Africa. Levels of prepregnancy underweight for India are almost seven percentage points higher than the average fraction underweight among women 15-49 y old. This difference in part reflects a previously unquantified relationship among age, fertility, and underweight; childbearing is concentrated in the narrow age range in which Indian women are most likely to be underweight. Further, because weight gain during pregnancy is low, averaging about 7 kg for a full-term pregnancy in both regions, the average woman in India ends pregnancy weighing less than the average woman in sub-Saharan Africa begins pregnancy. Poor maternal health among Indian women is of global significance because India is home to one fifth of the world's births.
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Solé-Auró A, Beltrán-Sánchez H, Crimmins EM. Are Differences in Disability-Free Life Expectancy by Gender, Race, and Education Widening at Older Ages? POPULATION RESEARCH AND POLICY REVIEW 2014; 34:1-18. [PMID: 29681672 PMCID: PMC5906056 DOI: 10.1007/s11113-014-9337-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To examine change from 1991 to 2001 in disability-free life expectancy in the age range 60-90 by gender, race, and education in the United States. Mortality is estimated over two 10-year follow-up periods for persons in the National Health Interview Surveys of 1986/1987 and 1996/1997. Vital status is ascertained through the National Death Index. Disability prevalence is estimated from the National Health and Nutrition Examination Surveys of 1988-1994 and 1999-2002. Disability is defined as ability to perform four activities of daily living without difficulty. Disability-free life expectancy increased only among white men. Disabled life expectancy increased for all groups-black and white men and women. Racial differences in disability-free life expectancy widened among men; gender differences were reduced among whites. Expansion of socioeconomic differentials in disability-free life at older ages occurred among white men and women and black women. The 1990s was a period where the increased years of life between ages 60 and 90 were concentrated in disabled years for most population groups.
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Affiliation(s)
- Aïda Solé-Auró
- Ined- Institut National d'Études Démographiques, 133 boulevard Davout, 75980 Paris cedex 20, France
| | - Hiram Beltrán-Sánchez
- Center for Demography of Health and Aging, University of Wisconsin-Madison, 1180 Observatory Dr, Madison, WI 53706-1393, USA
| | - Eileen M Crimmins
- Ethel Percy Andrus Gerontology Center, University of Southern California, 3715 McClintock Ave, Los Angeles, CA, USA
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Kumar A, Kumari D. Decomposing the Rural-Urban Differentials in Childhood Malnutrition in India, 1992–2006. ASIAN POPULATION STUDIES 2014. [DOI: 10.1080/17441730.2014.902161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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48
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Umberson D, Williams K, Thomas PA, Liu H, Thomeer MB. Race, gender, and chains of disadvantage: childhood adversity, social relationships, and health. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2014; 55:20-38. [PMID: 24578394 PMCID: PMC4193500 DOI: 10.1177/0022146514521426] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
We use a life course approach to guide an investigation of relationships and health at the nexus of race and gender. We consider childhood as a sensitive period in the life course, during which significant adversity may launch chains of disadvantage in relationships throughout the life course that then have cumulative effects on health over time. Data from a nationally representative panel study (Americans' Changing Lives, N = 3,477) reveal substantial disparities between black and white adults, especially pronounced among men, in the quality of close relationships and in the consequences of these relationships for health. Greater childhood adversity helps to explain why black men have worse health than white men, and some of this effect appears to operate through childhood adversity's enduring influence on relationship strain in adulthood. Stress that occurs in adulthood plays a greater role than childhood adversity in explaining racial disparities in health among women.
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Elo IT, Beltrán-Sánchez H, Macinko J. The Contribution of Health Care and Other Interventions to Black-White Disparities in Life Expectancy, 1980-2007. POPULATION RESEARCH AND POLICY REVIEW 2014; 33:97-126. [PMID: 24554793 PMCID: PMC3925638 DOI: 10.1007/s11113-013-9309-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Black-white mortality disparities remain sizable in the United States. In this study, we use the concept of avoidable/amenable mortality to estimate cause-of-death contributions to the difference in life expectancy between whites and blacks by gender in the United States in 1980, 1993, and 2007. We begin with a review of the concept of "avoidable mortality" and results of prior studies using this cause-of-death classification. We then present the results of our empirical analyses. We classified causes of death as amenable to medical care, sensitive to public health policies and health behaviors, ischemic heart disease, suicide, HIV/AIDS, and all other causes combined. We used vital statistics data on deaths and Census Bureau population estimates and standard demographic decomposition techniques. In 2007, causes of death amenable to medical care continued to account for close to 2 years of the racial difference in life expectancy among men (2.08) and women (1.85). Causes amenable to public health interventions made a larger contribution to the racial difference in life expectancy among men (1.17 years) than women (0.08 years). The contribution of HIV/AIDS substantially widened the racial difference among both men (1.08 years) and women (0.42 years) in 1993, but its contribution declined over time. Despite progress observed over the time period studied, a substantial portion of black-white disparities in mortality could be reduced given more equitable access to medical care and health interventions.
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Affiliation(s)
- Irma T. Elo
- Population Studies Center, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104, USA
| | - Hiram Beltrán-Sánchez
- Center for Demography and Ecology, University of Wisconsin, 4329 Sewell Social Science, Madison, WI, USA
| | - James Macinko
- New York University, 411 Lafayette Street 5th Floor, New York, NY 10003, USA
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Kumar A, Singh A. Decomposing the gap in childhood undernutrition between poor and non-poor in urban India, 2005-06. PLoS One 2013; 8:e64972. [PMID: 23734231 PMCID: PMC3666977 DOI: 10.1371/journal.pone.0064972] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 04/23/2013] [Indexed: 11/19/2022] Open
Abstract
Background Despite the growing evidence from other developing countries, intra-urban inequality in childhood undernutrition is poorly researched in India. Additionally, the factors contributing to the poor/non-poor gap in childhood undernutrition have not been explored. This study aims to quantify the contribution of factors that explain the poor/non-poor gap in underweight, stunting, and wasting among children aged less than five years in urban India. Methods We used cross-sectional data from the third round of the National Family Health Survey conducted during 2005–06. Descriptive statistics were used to understand the gap in childhood undernutrition between the urban poor and non-poor, and across the selected covariates. Blinder–Oaxaca decomposition technique was used to explain the factors contributing to the average gap in undernutrition between poor and non-poor children in urban India. Result Considerable proportions of urban children were found to be underweight (33%), stunted (40%), and wasted (17%) in 2005–06. The undernutrition gap between the poor and non-poor was stark in urban India. For all the three indicators, the main contributing factors were underutilization of health care services, poor body mass index of the mothers, and lower level of parental education among those living in poverty. Conclusions The findings indicate that children belonging to poor households are undernourished due to limited use of health care services, poor health of mothers, and poor educational status of their parents. Based on the findings the study suggests that improving the public services such as basic health care and the education level of the mothers among urban poor can ameliorate the negative impact of poverty on childhood undernutrition.
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Affiliation(s)
- Abhishek Kumar
- International Institute for Population Sciences, Deonar, Mumbai, India.
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