1
|
Wong DWS, Das Gupta D. Empirical evidence supporting the inclusion of multi-axes segregation in assessing US county health. Soc Sci Med 2023; 339:116404. [PMID: 38006796 DOI: 10.1016/j.socscimed.2023.116404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/06/2023] [Accepted: 11/06/2023] [Indexed: 11/27/2023]
Abstract
To facilitate community action toward health equity, the County Health Rankings & Roadmaps program (CHR&R) assigns health rankings to US counties. The CHR&R conceptual model considers White-Black and White-non-White dissimilarity values to represent residential segregation as part of the family and social support subcomponent. As the US is greying and becoming more multi-racial-ethnic, the two-group White-centered segregation measures are inadequate to capture segregation among population subgroups in the US. Thus, we evaluate the relevancy of segregation measures that consider multiple racial, ethnic, and age groups in assessing US county health. Besides using the two-group dissimilarity index to measure White-centered racial segregation as conceptualized by CHR&R, the study also uses the multi-group generalized dissimilarity index to measure racial-ethnic-age segregation by counties, employing both aspatial and spatial versions of these measures. These indices are computed for counties using the 2015-2019 American Community Survey data at the census tract level. Descriptive statistics and regressions controlling for sociodemographic factors and healthcare access are used to assess the contributions of individual segregation measures to mortality (life expectancy, years of potential life lost and premature mortality) and morbidity (frequent mental distress, frequent physical distress, and low birth weight) indicators representing county health. Overall, correlations between these indicators and most segregation measures are significant but weak. Regression results show that many segregation measures are not significantly related to mortality indicators, but most are significantly associated with morbidity indicators, with the magnitudes of these associations higher for the multi-group racial-ethnic-age segregation index and its spatial version. Results provide evidence that racial-ethnic-age segregation is associated with county-level morbidity and that spatial measures capturing segregation of multiple population axes should be considered for ranking county health.
Collapse
Affiliation(s)
- David W S Wong
- Geography & Geoinformation Science, George Mason University, 2400, Exploratory Hall, 4400 University Drive, Fairfax, VA, 22030, USA.
| | - Debasree Das Gupta
- Department of Kinesiology and Health Science, Utah State University, 7000 Old Main Hill, Logan, UT, 84322, USA.
| |
Collapse
|
2
|
Jiang L, Tang K, Magee LA, von Dadelszen P, Ekeroma A, Li X, Zhang E, Bhutta ZA. A global view of hypertensive disorders and diabetes mellitus during pregnancy. Nat Rev Endocrinol 2022; 18:760-775. [PMID: 36109676 PMCID: PMC9483536 DOI: 10.1038/s41574-022-00734-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/23/2022]
Abstract
Two important maternal cardiometabolic disorders (CMDs), hypertensive disorders in pregnancy (HDP) (including pre-eclampsia) and gestational diabetes mellitus (GDM), result in a large disease burden for pregnant individuals worldwide. A global consensus has not been reached about the diagnostic criteria for HDP and GDM, making it challenging to assess differences in their disease burden between countries and areas. However, both diseases show an unevenly distributed disease burden for regions with a low income or middle income, or low-income and middle-income countries (LMICs), or regions with lower sociodemographic and human development indexes. In addition to many common clinical, demographic and behavioural risk factors, the development and clinical consequences of maternal CMDs are substantially influenced by the social determinants of health, such as systemic marginalization. Although progress has been occurring in the early screening and management of HDP and GDM, the accuracy and long-term effects of such screening and management programmes are still under investigation. In addition to pharmacological therapies and lifestyle modifications at the individual level, a multilevel approach in conjunction with multisector partnership should be adopted to tackle the public health issues and health inequity resulting from maternal CMDs. The current COVID-19 pandemic has disrupted health service delivery, with women with maternal CMDs being particularly vulnerable to this public health crisis.
Collapse
Affiliation(s)
- Li Jiang
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Kun Tang
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Alec Ekeroma
- Department of Obstetrics and Gynecology, Wellington School of Medicine, University of Otago, Wellington, New Zealand
- National University of Samoa, Apia, Samoa
| | - Xuan Li
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Enyao Zhang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada.
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan.
- Institute for Global Health & Development, the Aga Khan University, Karachi, Pakistan.
| |
Collapse
|
3
|
Hailu EM, Maddali SR, Snowden JM, Carmichael SL, Mujahid MS. Structural racism and adverse maternal health outcomes: A systematic review. Health Place 2022; 78:102923. [PMID: 36401939 PMCID: PMC11216026 DOI: 10.1016/j.healthplace.2022.102923] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/19/2022] [Accepted: 09/22/2022] [Indexed: 11/18/2022]
Abstract
In the United States, racial disparities in adverse maternal health outcomes remain a pressing issue, with Black women experiencing a 3-4 times higher risk of maternal mortality and a 2-3 times higher risk of severe maternal morbidity. Despite recent encouraging efforts, fundamental determinants of these alarming inequities (e.g. structural racism) remain understudied. Approaches that address these structural drivers are needed to then intervene upon root causes of adverse maternal outcomes and their disparities and to ultimately improve maternal health across the U.S. In this paper, we offer a conceptual framework for studies of structural racism and maternal health disparities and systematically synthesize the current empirical epidemiologic literature on the links between structural racism measures and adverse maternal health outcomes. For the systematic review, we searched electronic databases (Pubmed, Web of Science, and EMBASE) to identify peer-reviewed U.S. based quantitative articles published between 1990 and 2021 that assessed the link between measures of structural racism and indicators of maternal morbidity/mortality. Our search yielded 2394 studies and after removing duplicates, 1408 were included in the title and abstract screening, of which 18 were included in the full text screening. Only 6 studies met all the specified inclusion criteria for this review. Results revealed that depending on population sub-group analyzed, measures used, and covariates considered, there was evidence that structural racism may increase the risk of adverse maternal health outcomes. This review also highlighted several areas for methodological and theoretical development in this body of work. Future work should more comprehensively assess structural racism in a way that informs policy and interventions, which can ameliorate its negative consequences on racial/ethnic disparities in maternal morbidity/mortality.
Collapse
Affiliation(s)
- Elleni M Hailu
- Division of Epidemiology, School of Public Health, University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Sai Ramya Maddali
- Interdisciplinary Division, School of Public Health, University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA
| | - Jonathan M Snowden
- School of Public Health, Oregon Health & Science University-Portland State University, 1805 SW 4th Ave #623T, Portland, OR, 97201, USA
| | - Suzan L Carmichael
- Division of Neonatal & Developmental Medicine, Department of Pediatrics, Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, 3145 Porter Drive #A103, Palo Alto, CA, 94304, USA
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA
| |
Collapse
|
4
|
A Critical Review on the Complex Interplay between Social Determinants of Health and Maternal and Infant Mortality. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030394. [PMID: 35327766 PMCID: PMC8947729 DOI: 10.3390/children9030394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 12/21/2022]
Abstract
Background: U.S. maternal and infant mortality rates constitute an important public health problem, because these rates surpass those in developed countries and are characterized by stark disparities for racial/ethnic minorities, rural residents, and individuals with less privileged socioeconomic status due to social determinants of health (SDoH). Methods: A critical review of the maternal and infant mortality literature was performed to determine multilevel SDoH factors leading to mortality disparities with a life course lens. Results: Black mothers and infants fared the worst in terms of mortality rates, likely due to the accumulation of SDoH experienced as a result of structural racism across the life course. Upstream SDoH are important contributors to disparities in maternal and infant mortality. More research is needed on the effectiveness of continuous quality improvement initiatives for the maternal–infant dyad, and expanding programs such as paid maternity leave, quality, stable and affordable housing, and social safety-nets (Medicaid, CHIP, WIC), in reducing maternal and infant mortality. Finally, it is important to address research gaps in individual, interpersonal, community, and societal factors, because they affect maternal and infant mortality and related disparities. Conclusion: Key SDoH at multiple levels affect maternal and infant health. These SDoH shape and perpetuate disparities across the lifespan and are implicated in maternal and infant mortality disparities.
Collapse
|
5
|
Cordes J, Castro MC. Spatial analysis of COVID-19 clusters and contextual factors in New York City. Spat Spatiotemporal Epidemiol 2020; 34:100355. [PMID: 32807400 PMCID: PMC7306208 DOI: 10.1016/j.sste.2020.100355] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/01/2020] [Accepted: 06/18/2020] [Indexed: 11/17/2022]
Abstract
Proportion positive tests were positively associated with marginalized statuses. Low testing and high positivity were associated with public transportation use. We recommend testing and health care resources be directed to eastern Brooklyn.
Identifying areas with low access to testing and high case burden is necessary to understand risk and allocate resources in the COVID-19 pandemic. Using zip code level data for New York City, we analyzed testing rates, positivity rates, and proportion positive. A spatial scan statistic identified clusters of high and low testing rates, high positivity rates, and high proportion positive. Boxplots and Pearson correlations determined associations between outcomes, clusters, and contextual factors. Clusters with less testing and low proportion positive tests had higher income, education, and white population, whereas clusters with high testing rates and high proportion positive tests were disproportionately black and without health insurance. Correlations showed inverse associations of white race, education, and income with proportion positive tests, and positive associations with black race, Hispanic ethnicity, and poverty. We recommend testing and health care resources be directed to eastern Brooklyn, which has low testing and high proportion positives.
Collapse
Affiliation(s)
- Jack Cordes
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston 02115, MA, USA.
| | - Marcia C Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston 02115, MA, USA.
| |
Collapse
|
6
|
Gibbons J, Yang TC, Brault E, Barton M. Evaluating Residential Segregation's Relation to the Clustering of Poor Health across American Cities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3910. [PMID: 32492811 PMCID: PMC7312480 DOI: 10.3390/ijerph17113910] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 12/11/2022]
Abstract
Residential segregation by race/ethnicity is widely recognized as a leading source of health disparities. Not clear from past research, however, is the overall health burden cities face due to clustering brought about by segregation. This study builds on previous research by directly measuring how spatially unequal health outcomes are within segregated cities. Utilizing Census-tract data from the Center for Disease Control and Prevention's 500 Cities project, we examine how different dimensions of spatial segregation are associated with the clustering of poor self-rated health in cities. We make novel usage of the Global Moran's I statistic to measure the spatial clustering of poor health within cities. We find spatial segregation is associated with poor health clustering, however the race/ethnicity and dimension of segregation matter. Our study contributes to existing research on segregation and health by unpacking the localized associations of residential segregation with poor health clustering in U.S. cities.
Collapse
Affiliation(s)
- Joseph Gibbons
- Department of Sociology, San Diego State University, San Diego, CA 92182, USA
| | - Tse-Chuan Yang
- Department of Sociology, University at Albany, SUNY, Albany, NY 12222, USA;
| | - Elizabeth Brault
- Department of Sociology, Louisiana State University, Baton Rouge, LA 70802, USA; (E.B.); (M.B.)
| | - Michael Barton
- Department of Sociology, Louisiana State University, Baton Rouge, LA 70802, USA; (E.B.); (M.B.)
| |
Collapse
|
7
|
Yang TC, Park K, Matthews SA. Racial/ethnic segregation and health disparities: Future directions and opportunities. SOCIOLOGY COMPASS 2020; 14:e12794. [PMID: 32655686 PMCID: PMC7351362 DOI: 10.1111/soc4.12794] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/08/2020] [Indexed: 05/10/2023]
Abstract
Health researchers have investigated the association between racial segregation and racial health disparities with multilevel approaches. This study systematically reviews these multilevel studies and identifies broad trends and potential directions for future research on racial segregation and health disparities in the US. After searching databases including CINAHL and MEDLINE, we identified and systematically reviewed 66 articles published between 2003 and 2019 and found four major gaps in racial/ethnic segregation and health disparities: (a) the concept of segregation was rarely operationalized at the neighborhood level, (b) except for the evenness and exposure dimension, other dimensions of segregation are overlooked, (c) little attention was paid to the segregation between whites and non-black minorities, particularly Hispanics and Asians, and (d) mental health outcomes were largely absent. Future directions and opportunities include: First, other segregation dimensions should be explored. Second, the spatial scales for segregation measures should be clarified. Third, the theoretical frameworks for black and non-black minorities should be tested. Fourth, mental health, substance use, and the use of mental health care should be examined. Fifth, the long-term health effect of segregation has to be investigated, and finally, other competing explanations for why segregation matters at the neighborhood level should be answered.
Collapse
Affiliation(s)
- Tse-Chuan Yang
- Department of Sociology, University at Albany, State University of New York, 315 AS, 1400 Washington Avenue, Albany, NY 12222
| | - Kiwoong Park
- Department of Sociology & Criminology, University of Arkansas, 211 Old Main, University of Arkansas Fayetteville, AR 72701
| | - Stephen A Matthews
- Department of Sociology & Criminology, Pennsylvania State University, 211 Oswald Tower, University Park, PA 16802
| |
Collapse
|
8
|
Shrimali BP, Pearl M, Karasek D, Reid C, Abrams B, Mujahid M. Neighborhood Privilege, Preterm Delivery, and Related Racial/Ethnic Disparities: An Intergenerational Application of the Index of Concentration at the Extremes. Am J Epidemiol 2020; 189:412-421. [PMID: 31909419 DOI: 10.1093/aje/kwz279] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 11/13/2022] Open
Abstract
We assessed whether early childhood and adulthood experiences of neighborhood privilege, measured by the Index of Concentration at the Extremes (ICE), were associated with preterm delivery and related racial/ethnic disparities using intergenerationally linked birth records of 379,794 California-born primiparous mothers (born 1982-1997) and their infants (born 1997-2011). ICE measures during early childhood and adulthood approximated racial/ethnic and economic dimensions of neighborhood privilege and disadvantage separately (ICE-income, ICE-race/ethnicity) and in combination (ICE-income + race/ethnicity). Results of our generalized estimating equation models with robust standard errors showed associations for ICE-income and ICE-income + race/ethnicity. For example, ICE-income + race/ethnicity was associated with preterm delivery in both early childhood (relative risk (RR) = 1.12, 95% confidence interval (CI): 1.08, 1.17) and adulthood (RR = 1.07, 95% CI: 1.03, 1.11). Non-Hispanic black and Hispanic women had higher risk of preterm delivery than white women (RR = 1.32, 95% CI: 1.28, 1.37; and RR = 1.11, 95% CI: 1.08, 1.14, respectively, adjusting for individual-level confounders). Adjustment for ICE-income + race/ethnicity at both time periods yielded the greatest declines in disparities (for non-Hispanic black women, RR = 1.23, 95% CI: 1.18, 1.28; for Hispanic women, RR = 1.05, 95% CI: 1.02, 1.09). Findings support independent effects of early childhood and adulthood neighborhood privilege on preterm delivery and related disparities.
Collapse
|
9
|
Mehra R, Keene DE, Kershaw TS, Ickovics JR, Warren JL. Racial and ethnic disparities in adverse birth outcomes: Differences by racial residential segregation. SSM Popul Health 2019; 8:100417. [PMID: 31193960 PMCID: PMC6545386 DOI: 10.1016/j.ssmph.2019.100417] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 11/26/2022] Open
Abstract
Racial and ethnic disparities in adverse birth outcomes have persistently been wide and may be explained by individual and area-level factors. Our primary objective was to determine if county-level black-white segregation modified the association between maternal race/ethnicity and adverse birth outcomes using birth records from the National Center for Health Statistics (2012). Based on maternal residence at birth, county-level black-white racial residential segregation was calculated along five dimensions of segregation: evenness, exposure, concentration, centralization, and clustering. We conducted a two-stage analysis: (1) county-specific logistic regression to determine whether maternal race and ethnicity were associated with preterm birth and term low birth weight; and (2) Bayesian meta-analyses to determine if segregation moderated these associations. We found greater black-white and Hispanic-white disparities in preterm birth in racially isolated counties (exposure) relative to non-isolated counties. We found reduced Hispanic-white disparities in term low birth weight in racially concentrated and centralized counties relative to non-segregated counties. Area-level poverty explained most of the moderating effect of segregation on disparities in adverse birth outcomes, suggesting that area-level poverty is a mediator of these associations. Segregation appears to modify racial/ethnic disparities in adverse birth outcomes. Therefore, policy interventions that reduce black-white racial isolation, or buffer the poor social and economic correlates of segregation, may help to reduce disparities in preterm birth and term low birth weight.
Collapse
Affiliation(s)
- Renee Mehra
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Danya E. Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Trace S. Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Jeannette R. Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Joshua L. Warren
- Department of Biostatistics, Yale School of Public Health, 60 College St, New Haven, CT, 06510, United States
| |
Collapse
|
10
|
Spatial Analytics Based on Confidential Data for Strategic Planning in Urban Health Departments. URBAN SCIENCE 2019. [DOI: 10.3390/urbansci3030075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Spatial data analytics can detect patterns of clustering of events in small geographies across an urban region. This study presents and demonstrates a robust research design to study the longitudinal stability of spatial clustering with small case numbers per census tract and assess the clustering changes over time across the urban environment to better inform public health policy making at the community level. We argue this analysis enables the greater efficiency of public health departments, while leveraging existing data and preserving citizen personal privacy. Analysis at the census tract level is conducted in Mecklenburg County, North Carolina, on hypertension during pregnancy compiled from 2011–2014 birth certificates. Data were derived from per year and per multi-year moving counts by aggregating spatially to census tracts and then assessed for clustering using global Moran’s I. With evidence of clustering, local indicators of spatial association are calculated to pinpoint hot spots, while time series data identified hot spot changes. Knowledge regarding the geographical distribution of diseases is essential in public health to define strategies that improve the health of populations and quality of life. Our findings support that spatial aggregation at the census tract level contributes to identifying the location of at-risk “hot spot” communities to refine health programs, while temporal windowing reduces random noise effects on spatial clustering patterns. With tight state budgets limiting health departments’ funds, using geographic analytics provides for a targeted and efficient approach to health resource planning.
Collapse
|
11
|
A Bayesian spatio-temporal analysis on racial disparities in hypertensive disorders of pregnancy in Florida, 2005-2014. Spat Spatiotemporal Epidemiol 2019; 29:43-50. [PMID: 31128630 PMCID: PMC6631343 DOI: 10.1016/j.sste.2019.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/21/2019] [Accepted: 03/12/2019] [Indexed: 11/21/2022]
Abstract
Disparities in hypertensive disorders of pregnancy (HDP) exist among racial and ethnic groups in the US. However, little is known about spatio-temporal variations in HDP disparities. We used a Bayesian hierarchical regression approach to investigate spatio-temporal variations in HDP disparities from 2005 to 2014. County-level variation was firstly examined, followed by census tract-level variation assessment in counties where high HDP disparities were observed. A significant disadvantage in HDP was revealed for African Americans in Florida overall (Odds Ratio: 1.27, 95% Confidence Interval: 1.25, 1.29), with significant spatial variations. The greatest HDP disparities between African Americans and non-African Americans occurred in North Central Florida counties (the Big Bend region of Florida), with consistent patterns from 2005 to 2014. Analyses at census tract-level further revealed significant neighborhood disparities within these counties. Findings from this study provide important information for public health agencies and policymakers to reduce HDP disparities at the population level.
Collapse
|
12
|
Mayne SL, Yellayi D, Pool LR, Grobman WA, Kershaw KN. Racial Residential Segregation and Hypertensive Disorder of Pregnancy Among Women in Chicago: Analysis of Electronic Health Record Data. Am J Hypertens 2018; 31:1221-1227. [PMID: 30010764 DOI: 10.1093/ajh/hpy112] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/11/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Racial residential segregation is associated with higher rates of chronic hypertension, as well as greater risk of preterm birth and low birthweight. However, few studies have examined associations between segregation and hypertensive disorder of pregnancy (HDP). METHODS Electronic health records from 4,748 singleton births among non-Hispanic black women at Prentice Women's Hospital in Chicago, IL (2009-2013) were geocoded to the census tract level. Residential segregation was measured using the Gi* statistic, a z-score measuring the extent to which each individual's neighborhood composition deviates from the composition of the larger surrounding area. Segregation was categorized as low (z < 0), medium (z = 0-1.96) or high (z > 1.96). We estimated cross-sectional associations of segregation with HDP using multilevel logistic regression models with census tract random intercepts. Models adjusted for neighborhood poverty and maternal characteristics. We also examined effect modification by neighborhood poverty. RESULTS Overall, 27.2% of women lived in high segregation, high-poverty neighborhoods. Racial residential segregation was not associated as a main effect with HDP in models adjusting for neighborhood poverty and maternal characteristics. However, at higher levels of neighborhood poverty (>20%), women living in high- and medium-segregated neighborhoods had greater odds of HDP relative to those in low-segregation neighborhoods (P interaction: 0.002). CONCLUSIONS In this sample of non-Hispanic black women in Chicago, racial residential segregation was associated with greater prevalence of HDP among those living in higher poverty neighborhoods. Understanding sources of heterogeneity in the relationship between segregation and health will help refine targeted intervention efforts to reduce disparities.
Collapse
Affiliation(s)
- Stephanie L Mayne
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Disha Yellayi
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lindsay R Pool
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - William A Grobman
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kiarri N Kershaw
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
13
|
Salow AD, Pool LR, Grobman WA, Kershaw KN. Associations of neighborhood-level racial residential segregation with adverse pregnancy outcomes. Am J Obstet Gynecol 2018; 218:351.e1-351.e7. [PMID: 29421603 DOI: 10.1016/j.ajog.2018.01.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/10/2018] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Previous analyses utilizing birth certificate data have shown environmental factors such as racial residential segregation may contribute to disparities in adverse pregnancy outcomes. However, birth certificate data are ill equipped to reliably differentiate among small for gestational age, spontaneous preterm birth, and medically indicated preterm birth. OBJECTIVE We sought to utilize data from electronic medical records to determine whether residential segregation among Black women is associated with an increased risk of adverse pregnancy outcomes. STUDY DESIGN The study population was composed of 4770 non-Hispanic Black women who delivered during the years 2009 through 2013 at a single urban medical center. Addresses were geocoded at the level of census tract, and this tract was used to determine the degree of residential segregation for an individual's neighborhood. Residential segregation was measured using the Gi* statistic, a z-score that measures the extent to which the neighborhood racial composition deviates from the composition of the larger surrounding area. The Gi* statistic z-scores were categorized as follows: low (z < 0), medium (z = 0-1.96), and high (z > 1.96). Adverse pregnancy outcomes included overall preterm birth, spontaneous preterm birth, medically indicated preterm birth, and small for gestational age. Hierarchical logistic regression models accounting for clustering by census tract and repeated births among mothers were used to estimate odds ratios of adverse pregnancy outcomes associated with segregation. RESULTS In high segregation areas, the prevalence of overall preterm birth was significantly higher than that in low segregation areas (15.5% vs 10.7%, respectively; P < .001). Likewise, the prevalence of spontaneous preterm birth and medically indicated preterm birth were higher in high (9.5% and 6.0%) vs low (6.2% and 4.6%) segregation neighborhoods (P < .001 and P = .046, respectively). The associations of high segregation with overall preterm birth (odds ratio, 1.31; 95% confidence interval, 1.02-1.69) and spontaneous preterm birth (odds ratio, 1.37; 95% confidence interval, 1.02-1.85) remained significant with adjustment for neighborhood poverty, insurance status, parity, and maternal medical conditions. CONCLUSION Among non-Hispanic Black women in an urban area, high levels of segregation were independently associated with the higher odds of spontaneous preterm birth. These findings highlight one aspect of social determinants (ie, segregation) through which adverse pregnancy outcomes may be influenced and points to a potential target for intervention.
Collapse
|
14
|
Abstract
BACKGROUND Racial residential segregation in the United States has been linked to racial differences in birth outcomes, with studies reporting associations between segregation and birth weight. However, this relationship is likely confounded, and many individual and neighborhood-level covariates included in previous models are likely mediators, potentially obscuring any causal impact of segregation on birth weight. METHODS We compiled a record of non-Hispanic black and white singleton births to US-born/resident mothers in 2000, linked to segregation indices at the metropolitan statistical area (MSA) level in the non-Southern US. Segregation was measured via the dissimilarity index. The outcomes were individual-level birth weight and the metropolitan statistical area-level black/white gap in birth weight. We instrumented for segregation using the railroad division index. We compared race-stratified ordinary least squares models to two-stage least squares models, with cluster robust standard errors. RESULTS We estimated a 1.2 g decrease in black birth weight for every one-percentage point increase in segregation (95% confidence interval [CI]: -1.9, -0.50) via ordinary least squares but a 2.8 g decrease (95% CI: -6.0, 0.48) using two-stage least squares. For white infants, our ordinary least squares estimate was 0.53 (95% CI: -0.23, 1.3), and our two-stage least squares estimate was in the opposite direction (-0.68, 95% CI: -3.5, 2.1). CONCLUSIONS Ordinary least squares estimates may understate the effect of segregation on birth weight in blacks. Evidence from instrumental variable models was consistent with a causal impact of segregation on black birth outcomes, but estimates were imprecise and may be affected by weak instrument bias.
Collapse
|
15
|
Chambers BD, Erausquin JT, Tanner AE, Nichols TR, Brown-Jeffy S. Testing the Association Between Traditional and Novel Indicators of County-Level Structural Racism and Birth Outcomes among Black and White Women. J Racial Ethn Health Disparities 2017; 5:966-977. [PMID: 29218496 DOI: 10.1007/s40615-017-0444-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/21/2017] [Accepted: 10/30/2017] [Indexed: 11/26/2022]
Abstract
Despite decreases in infants born premature and at low birth weight in the United States (U.S.), racial disparities between Black and White women continue. In response, the purpose of this analysis was to examine associations between both traditional and novel indicators of county-level structural racism and birth outcomes among Black and White women. We merged individual-level data from the California Birth Statistical Master Files 2009-2013 with county-level data from the United States (U.S.) Census American Community Survey. We used hierarchical linear modeling to examine Black-White differences among 531,170 primiparous women across 33 California counties. Traditional (e.g., dissimilarity index) and novel indicators (e.g., Black to White ratio in elected office) were associated with earlier gestational age and lower birth weight among Black and White women. A traditional indicator was more strongly associated with earlier gestational age for Black women than for White women. This was the first study to empirically demonstrate that structural racism, measured by both traditional and novel indicators, is associated with poor health and wellbeing of infants born to Black and White women. However, findings indicate traditional indicators of structural racism, rather than novel indicators, better explain racial disparities in birth outcomes. Results also suggest the need to develop more innovative approaches to: (1) measure structural racism at the county-level and (2) reform public policies to increase integration and access to resources.
Collapse
Affiliation(s)
- Brittany D Chambers
- UCSF Preterm Birth Initiative- California, University of California, San Francisco, San Francisco, CA, USA.
| | - Jennifer Toller Erausquin
- Department of Public Health Education, University of North Carolina, Greensboro, Greensboro, NC, USA
| | - Amanda E Tanner
- Department of Public Health Education, University of North Carolina, Greensboro, Greensboro, NC, USA
| | - Tracy R Nichols
- Department of Public Health Education, University of North Carolina, Greensboro, Greensboro, NC, USA
| | - Shelly Brown-Jeffy
- Department of Sociology, University of North Carolina, Greensboro, Greensboro, NC, USA
| |
Collapse
|
16
|
Mehra R, Boyd LM, Ickovics JR. Racial residential segregation and adverse birth outcomes: A systematic review and meta-analysis. Soc Sci Med 2017; 191:237-250. [PMID: 28942206 DOI: 10.1016/j.socscimed.2017.09.018] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 08/25/2017] [Accepted: 09/08/2017] [Indexed: 11/30/2022]
Abstract
RATIONALE Persistent racial disparities in adverse birth outcomes are not fully explained by individual-level risk factors. Racial residential segregation-degree to which two or more groups live apart from one another-may contribute to the etiology of these birth outcome disparities. Our aim was to assess associations between segregation and adverse birth outcomes by race. This review focused on formal measures of segregation, using Massey and Denton's framework (1998) that identifies five distinct operationalizations of segregation, in addition to proxy measures of segregation such as racial composition, in order to gain a deeper understanding of the operationalizations of segregation most salient for birth outcomes. METHOD Review and meta-analyses were conducted using PubMed, PsycINFO and Web of Science and included articles from inception through April 30, 2017. RESULTS Forty-two articles examined associations between segregation and adverse birth outcomes among Black and White mothers separately. Meta-analyses showed that among Black mothers, exposure was associated with increased risk of preterm birth (OR = 1.17, 95% CI = 1.10, 1.26), and low birth weight (OR = 1.13, 95% CI=1.06, 1.21), and Black racial composition was associated with increased risk of preterm birth (OR = 1.20, 95% CI=1.05, 1.37), among those living in most- compared to least-segregated neighborhoods. Few studies were conducted among White mothers and only exposure was associated with increased risk of preterm birth and low birth weight. Qualitative analyses indicated that among Black mothers, exposure and hypersegregation were associated with multiple adverse birth outcomes; findings were mixed for evenness and clustering. CONCLUSIONS AND FUTURE DIRECTIONS Associations between segregation and adverse birth outcomes differ by race. Methodological heterogeneity between studies may obscure true associations. Research can be advanced through use of multilevel frameworks and by examining mechanistic pathways between segregation and adverse birth outcomes. Elucidation of pathways may provide opportunities to intervene to reduce seemingly intractable racial disparities in adverse birth outcomes.
Collapse
|
17
|
Kershaw KN, Robinson WR, Gordon-Larsen P, Hicken MT, Goff DC, Carnethon MR, Kiefe CI, Sidney S, Diez Roux AV. Association of Changes in Neighborhood-Level Racial Residential Segregation With Changes in Blood Pressure Among Black Adults: The CARDIA Study. JAMA Intern Med 2017; 177:996-1002. [PMID: 28505341 PMCID: PMC5710452 DOI: 10.1001/jamainternmed.2017.1226] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/26/2017] [Indexed: 01/20/2023]
Abstract
Importance Despite cross-sectional evidence linking racial residential segregation to hypertension prevalence among non-Hispanic blacks, it remains unclear how changes in exposure to neighborhood segregation may be associated with changes in blood pressure. Objective To examine the association of changes in neighborhood-level racial residential segregation with changes in systolic and diastolic blood pressure over a 25-year period. Design, Setting, and Participants This observational study examined longitudinal data of 2280 black participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a prospective investigation of adults aged 18 to 30 years who underwent baseline examinations in field centers in 4 US locations from March 25, 1985, to June 7, 1986, and then were re-examined for the next 25 years. Racial residential segregation was assessed using the Getis-Ord Gi* statistic, a measure of SD between the neighborhood's racial composition (ie, percentage of black residents) and the surrounding area's racial composition. Segregation was categorized as high (Gi* >1.96), medium (Gi* 0-1.96), and low (Gi* <0). Fixed-effects linear regression modeling was used to estimate the associations of within-person change in exposure to segregation and within-person change in blood pressure while tightly controlling for time-invariant confounders. Data analyses were performed between August 4, 2016, and February 9, 2017. Main Outcomes and Measures Within-person changes in systolic and diastolic blood pressure across 6 examinations over 25 years. Results Of the 2280 participants at baseline, 974 (42.7%) were men and 1306 (57.3%) were women. Of these, 1861 (81.6%) were living in a high-segregation neighborhood; 278 (12.2%), a medium-segregation neighborhood; and 141 (6.2%), a low-segregation neighborhood. Systolic blood pressure increased by a mean of 0.16 (95% CI, 0.06-0.26) mm Hg with each 1-SD increase in segregation score after adjusting for interactions of time with age, sex, and field center. Of the 1861 participants (81.6%) who lived in high-segregation neighborhoods at baseline, reductions in exposure to segregation were associated with reductions in systolic blood pressure. Mean differences in systolic blood pressure were -1.33 (95% CI, -2.26 to -0.40) mm Hg when comparing high-segregation with medium-segregation neighborhoods and -1.19 (95% CI, -2.08 to -0.31) mm Hg when comparing high-segregation with low-segregation neighborhoods after adjustment for time and interactions of time with baseline age, sex, and field center. Changes in segregation were not associated with changes in diastolic blood pressure. Conclusions and Relevance Decreases in exposure to racial residential segregation are associated with reductions in systolic blood pressure. This study adds to the small but growing body of evidence that policies that reduce segregation may have meaningful health benefits.
Collapse
Affiliation(s)
- Kiarri N. Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Whitney R. Robinson
- Department of Epidemiology, University of North Carolina Gillings School of Public Health, Chapel Hill
| | - Penny Gordon-Larsen
- Department of Nutrition, University of North Carolina Gillings School of Public Health, Chapel Hill
| | | | - David C. Goff
- Department of Epidemiology, Colorado School of Public Health, Aurora
| | - Mercedes R. Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Catarina I. Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Ana V. Diez Roux
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| |
Collapse
|
18
|
Abstract
Persistent racial/ethnic disparities in obesity and type 2 diabetes mellitus seen in the US are likely due to a combination of social, biological, and environmental factors. A growing number of studies have examined the role of racial/ethnic residential segregation with respect to these outcomes because this macro-level process is believed to be a fundamental cause of many of the factors that contribute to these disparities. This review provides an overview of findings from studies of racial/ethnic residential segregation with obesity and diabetes published between 2013 and 2015. Findings for obesity varied by geographic scale of the segregation measure, gender, ethnicity, and racial identity (among Hispanics/Latinos). Recent studies found no association between racial/ethnic residential segregation and diabetes prevalence, but higher segregation of Blacks was related to higher diabetes mortality. Implications of these recent studies are discussed as well as promising areas of future research.
Collapse
Affiliation(s)
- Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore, Suite 1400, Chicago, IL, 60611, USA.
| | - Ashley E Pender
- Department of Medicine, Northwestern University Feinberg School of Medicine, 251 E Huron St, Galter Suite 3-150, Chicago, IL, 60611, USA
| |
Collapse
|
19
|
Oka M, Wong DWS. Spatializing Area-Based Measures of Neighborhood Characteristics for Multilevel Regression Analyses: An Areal Median Filtering Approach. J Urban Health 2016; 93:551-71. [PMID: 27197736 PMCID: PMC4899334 DOI: 10.1007/s11524-016-0051-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Area-based measures of neighborhood characteristics simply derived from enumeration units (e.g., census tracts or block groups) ignore the potential of spatial spillover effects, and thus incorporating such measures into multilevel regression models may underestimate the neighborhood effects on health. To overcome this limitation, we describe the concept and method of areal median filtering to spatialize area-based measures of neighborhood characteristics for multilevel regression analyses. The areal median filtering approach provides a means to specify or formulate "neighborhoods" as meaningful geographic entities by removing enumeration unit boundaries as the absolute barriers and by pooling information from the neighboring enumeration units. This spatializing process takes into account for the potential of spatial spillover effects and also converts aspatial measures of neighborhood characteristics into spatial measures. From a conceptual and methodological standpoint, incorporating the derived spatial measures into multilevel regression analyses allows us to more accurately examine the relationships between neighborhood characteristics and health. To promote and set the stage for informative research in the future, we provide a few important conceptual and methodological remarks, and discuss possible applications, inherent limitations, and practical solutions for using the areal median filtering approach in the study of neighborhood effects on health.
Collapse
Affiliation(s)
- Masayoshi Oka
- Social and Cardiovascular Epidemiology Research Group, Faculty of Medicine, University of Alcalá, Campus Universitario - Ctra. Madrid-Barcelona, Km 33,6000, 28871, Alcalá de Henares, Madrid, Spain.
| | - David W S Wong
- Department of Geography and GeoInformation Science, College of Science, George Mason University, Fairfax, VA, USA
| |
Collapse
|
20
|
Ncube CN, Enquobahrie DA, Albert SM, Herrick AL, Burke JG. Association of neighborhood context with offspring risk of preterm birth and low birthweight: A systematic review and meta-analysis of population-based studies. Soc Sci Med 2016; 153:156-64. [PMID: 26900890 PMCID: PMC7302006 DOI: 10.1016/j.socscimed.2016.02.014] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/05/2016] [Accepted: 02/08/2016] [Indexed: 11/28/2022]
Abstract
Findings from studies investigating associations of residential environment with poor birth outcomes have been inconsistent. In a systematic review and meta-analysis, we examined associations of neighborhood disadvantage with preterm birth (PTB) and low birthweight (LBW), and explored differences in relationships among racial groups. Two reviewers searched English language articles in electronic databases of published literature. We used random effects logistic regression to calculate odds ratios (and 95% confidence intervals) relating neighborhood disadvantage with PTB and LBW. Neighborhood disadvantage, most disadvantaged versus least disadvantaged neighborhoods, was defined by researchers of included studies, and comprised of poverty, deprivation, racial residential segregation or racial composition, and crime. We identified 1314 citations in the systematic review. The meta-analyses included 7 PTB and 14 LBW cross-sectional studies conducted in the United States (U.S.). Overall, we found 27% [95%CI: 1.16, 1.39] and 11% [95%CI: 1.07, 1.14] higher risk for PTB and LBW among the most disadvantaged compared with least disadvantaged neighborhoods. No statistically significant association was found in meta-analyses of studies that adjusted for race. In race-stratified meta-analyses models, we found 48% [95%CI: 1.25, 1.75] and 61% [95%CI: 1.30, 2.00] higher odds of PTB and LBW among non-Hispanic white mothers living in most disadvantaged neighborhoods compared with those living in least disadvantaged neighborhoods. Similar, but less strong, associations were observed for PTB (15% [95%CI: 1.09, 1.21]) and LBW (17% [95%CI: 1.10, 1.25]) among non-Hispanic black mothers. Neighborhood disadvantage is associated with PTB and LBW, however, associations may differ by race. Future studies evaluating causal mechanisms underlying the associations, and racial/ethnic differences in associations, are warranted.
Collapse
Affiliation(s)
- Collette N Ncube
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, USA.
| | - Daniel A Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, 1959 NE Pacific Street, Health Sciences Building, Seattle, WA 98195-7236, USA.
| | - Steven M Albert
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, USA.
| | - Amy L Herrick
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, USA.
| | - Jessica G Burke
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, USA.
| |
Collapse
|
21
|
Ramírez IJ, Grady SC. El Niño, Climate, and Cholera Associations in Piura, Peru, 1991-2001: A Wavelet Analysis. ECOHEALTH 2016; 13:83-99. [PMID: 26832694 DOI: 10.1007/s10393-015-1095-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 11/19/2015] [Accepted: 12/06/2015] [Indexed: 05/15/2023]
Abstract
In Peru, it was hypothesized that epidemic cholera in 1991 was linked to El Niño, the warm phase of El Niño-Southern Oscillation. While previous studies demonstrated an association in 1997-1998, using cross-sectional data, they did not assess the consistency of this relationship across the decade. Thus, how strong or variable an El Niño-cholera relationship was in Peru or whether El Niño triggered epidemic cholera early in the decade remains unknown. In this study, wavelet and mediation analyses were used to characterize temporal patterns among El Niño, local climate variables (rainfall, river discharge, and air temperature), and cholera incidence in Piura, Peru from 1991 to 2001 and to estimate the mediating effects of local climate on El Niño-cholera relationships. The study hypothesis is that El Niño-related connections with cholera in Piura were transient and interconnected via local climate pathways. Overall, our findings provide evidence that a strong El Niño-cholera link, mediated by local hydrology, existed in the latter part of the 1990s but found no evidence of an El Niño association in the earlier part of the decade, suggesting that El Niño may not have precipitated cholera emergence in Piura. Further examinations of cholera epicenters in Peru are recommended to support these results in Piura. For public health planning, the results may improve existing efforts that utilize El Niño monitoring for preparedness during future climate-related extremes in the region.
Collapse
Affiliation(s)
- Iván J Ramírez
- Interdisciplinary Science Program, The New School, 65 W 11th Street, New York, NY, 10011, USA.
- Tishman Environment and Design Center, The New School, New York, NY, USA.
| | - Sue C Grady
- Department of Geography, Michigan State University, East Lansing, MI, USA
| |
Collapse
|
22
|
Lorch SA, Enlow E. The role of social determinants in explaining racial/ethnic disparities in perinatal outcomes. Pediatr Res 2016; 79:141-7. [PMID: 26466077 DOI: 10.1038/pr.2015.199] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 08/23/2015] [Indexed: 11/09/2022]
Abstract
In the United States, there continue to be significant racial/ethnic disparities in preterm birth (PTB) rates, infant mortality, and fetal mortality rates. One potential mediator of these disparities is social determinants of health, including individual socioeconomic factors; community factors such as crime, poverty, housing, and the racial/ethnic makeup of the community; and the physical environment. Previous work has identified statistically significant associations between each of these factors and adverse pregnancy outcomes. However, there are recent studies that provide new, innovative insights into this subject, including adding social determinant data to population-based datasets; exploring multiple constructs in their analysis; and examining environmental factors. The objective of this review will be to examine this recent research on the association of each of these sets of social determinants on racial/ethnic disparities PTB, infant mortality, and fetal mortality to highlight potential areas for targeted intervention to reduce these differences.
Collapse
Affiliation(s)
- Scott A Lorch
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania.,Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth Enlow
- Department of Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
23
|
Antipova A, Curtis A. The post-disaster negative health legacy: pregnancy outcomes in Louisiana after Hurricane Andrew. DISASTERS 2015; 39:665-86. [PMID: 25754615 DOI: 10.1111/disa.12125] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Disasters and displacement increasingly affect and challenge urban settings. How do pregnant women fare in the aftermath of a major disaster? This paper investigates the effect of pregnancies in disaster situations. The study tests a hypothesis that pregnant women residing in hurricane-prone areas suffer higher health risks. The setting is Louisiana in the Gulf Coast, United States, a state that continually experiences hurricane impacts. The time period for the analysis is three years following the landfall of Hurricane Andrew in 1992. We analysed low birth weight and preterm deliveries before and after landfall, as a whole and by race. Findings support an association between hazards and health of a community and indicate that pregnant women in the affected area, irrespective of race, are more likely to experience preterm deliveries compared to pre-event births. Results suggest there is a negative health legacy impact in Louisiana as a result of hurricane landfall.
Collapse
Affiliation(s)
- Anzhelika Antipova
- Assistant Professor, Department of Earth Sciences, University of Memphis, United States
| | - Andrew Curtis
- Director of the GIS Health and Hazards Lab and Associate Professor, Department of Geography, Kent State University, United States
| |
Collapse
|
24
|
Abstract
BACKGROUND Racial residential segregation has been associated with preterm birth. Few studies have examined mediating pathways, in part because, with binary outcomes, indirect effects estimated from multiplicative models generally lack causal interpretation. We develop a method to estimate additive-scale natural direct and indirect effects from logistic regression. We then evaluate whether segregation operates through poor-quality built environment to affect preterm birth. METHODS To estimate natural direct and indirect effects, we derive risk differences from logistic regression coefficients. Birth records (2000-2008) for Durham, North Carolina, were linked to neighborhood-level measures of racial isolation and a composite construct of poor-quality built environment. We decomposed the total effect of racial isolation on preterm birth into direct and indirect effects. RESULTS The adjusted total effect of an interquartile increase in racial isolation on preterm birth was an extra 27 preterm events per 1000 births (risk difference = 0.027 [95% confidence interval = 0.007 to 0.047]). With poor-quality built environment held at the level it would take under isolation at the 25th percentile, the direct effect of an interquartile increase in isolation was 0.022 (-0.001 to 0.042). Poor-quality built environment accounted for 35% (11% to 65%) of the total effect. CONCLUSION Our methodology facilitates the estimation of additive-scale natural effects with binary outcomes. In this study, the total effect of racial segregation on preterm birth was partially mediated by poor-quality built environment.
Collapse
|
25
|
Oka M, Wong DWS. Capturing the two dimensions of residential segregation at the neighborhood level for health research. Front Public Health 2014; 2:118. [PMID: 25202687 PMCID: PMC4142636 DOI: 10.3389/fpubh.2014.00118] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/30/2014] [Indexed: 11/13/2022] Open
Abstract
Two conceptual and methodological foundations of segregation studies are that (i) segregation involves more than one group, and (ii) segregation measures need to quantify how different population groups are distributed across space. Therefore, percentage of population belonging to a group is not an appropriate measure of segregation because it does not describe how populations are spread across different areal units or neighborhoods. In principle, evenness and isolation are the two distinct dimensions of segregation that capture the spatial patterns of population groups. To portray people’s daily environment more accurately, segregation measures need to account for the spatial relationships between areal units and to reflect the situations at the neighborhood scale. For these reasons, the use of local spatial entropy-based diversity index (SHi) and local spatial isolation index (Si) to capture the evenness and isolation dimensions of segregation, respectively, are preferable. However, these two local spatial segregation indexes have rarely been incorporated into health research. Rather ineffective and insufficient segregation measures have been used in previous studies. Hence, this paper empirically demonstrates how the two measures can reflect the two distinct dimensions of segregation at the neighborhood level, and argues conceptually and set the stage for their future use to effectively and meaningfully examine the relationships between residential segregation and health.
Collapse
Affiliation(s)
- Masayoshi Oka
- Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis , St. Louis, MO , USA ; Division of Epidemiology and Public Health, School of Medicine, University of Alcalá , Alcalá de Henares , Spain
| | - David W S Wong
- Department of Geography and GeoInformation Science, College of Science, George Mason University , Fairfax, VA , USA ; Department of Geography, University of Hong Kong , Pokfulam , Hong Kong
| |
Collapse
|
26
|
Venter PC, Malan L, Schutte AE. Psychosocial stress but not hypertensive status associated with angiogenesis in Africans. Blood Press 2014; 23:307-14. [PMID: 24786777 DOI: 10.3109/08037051.2014.901008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIM Increased angiogenic factors [vascular endothelial growth factor-A (VEGF-A) and angiopoietin-2 (Ang-2)] have been associated with vascular dysfunction and hypertension. Black Africans undergoing rapid urbanization present with elevated blood pressure (BP) and we aimed to determine whether angiogenic factors are elevated in urban versus rural Africans with normal and elevated BP. METHODS AND MATERIALS Africans (n = 272), matched for gender and age, were recruited from rural and urban communities in South Africa. Omron HEM-757 BP data were obtained and angiogenic markers in plasma and serum were determined. RESULTS Urban African men displayed a higher (43.90%) hypertension prevalence compared with their rural counterparts (18.52%) and disturbed angiongenic factors. Adjusted VEGF-A concentrations were higher in urban men and women compared with their rural counterparts. Similar VEGF-A levels were observed in rural and urban hypertensives. Logistic regression analysis demonstrated that VEGF-A and Ang-2 levels were associated with psychosocial stress but not with hypertensive status in Africans [odds ratios 1.01-1.09 (95% CI 1.01-1.15), p ≤ 0.05]. CONCLUSION Psychosocial stress per se was associated with disturbed VEGF-A and Ang-2. We suggest that hyperkinetic BP may act as compensatory mechanism when chronic psychosocial stress prevails, affecting vascular functioning and subsequent increased cardiovascular disease risk.
Collapse
Affiliation(s)
- Paul Cristiaan Venter
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus , Private Bag X6001, North-West, 2520 , South Africa
| | | | | |
Collapse
|
27
|
Delamater PL, Messina JP, Grady SC, WinklerPrins V, Shortridge AM. Do more hospital beds lead to higher hospitalization rates? a spatial examination of Roemer's Law. PLoS One 2013; 8:e54900. [PMID: 23418432 PMCID: PMC3572098 DOI: 10.1371/journal.pone.0054900] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 12/17/2012] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Roemer's Law, a widely cited principle in health care policy, states that hospital beds that are built tend to be used. This simple but powerful expression has been invoked to justify Certificate of Need regulation of hospital beds in an effort to contain health care costs. Despite its influence, a surprisingly small body of empirical evidence supports its content. Furthermore, known geographic factors influencing health services use and the spatial structure of the relationship between hospital bed availability and hospitalization rates have not been sufficiently explored in past examinations of Roemer's Law. We pose the question, "Accounting for space in health care access and use, is there an observable association between the availability of hospital beds and hospital utilization?" METHODS We employ an ecological research design based upon the Anderson behavioral model of health care utilization. This conceptual model is implemented in an explicitly spatial context. The effect of hospital bed availability on the utilization of hospital services is evaluated, accounting for spatial structure and controlling for other known determinants of hospital utilization. The stability of this relationship is explored by testing across numerous geographic scales of analysis. The case study comprises an entire state system of hospitals and population, evaluating over one million inpatient admissions. RESULTS We find compelling evidence that a positive, statistically significant relationship exists between hospital bed availability and inpatient hospitalization rates. Additionally, the observed relationship is invariant with changes in the geographic scale of analysis. CONCLUSIONS This study provides evidence for the effects of Roemer's Law, thus suggesting that variations in hospitalization rates have origins in the availability of hospital beds. This relationship is found to be robust across geographic scales of analysis. These findings suggest continued regulation of hospital bed supply to assist in controlling hospital utilization is justified.
Collapse
Affiliation(s)
- Paul L Delamater
- Department of Geography, Michigan State University, East Lansing, Michigan, United States of America.
| | | | | | | | | |
Collapse
|
28
|
Sudano JJ, Perzynski A, Wong DW, Colabianchi N, Litaker D. Neighborhood racial residential segregation and changes in health or death among older adults. Health Place 2013; 19:80-8. [PMID: 23201913 PMCID: PMC3537921 DOI: 10.1016/j.healthplace.2012.09.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 09/27/2012] [Accepted: 09/30/2012] [Indexed: 10/27/2022]
Abstract
We assessed relationships between neighborhood racial residential segregation (RRS), individual-level health declines and mortality using Health and Retirement Study data. We calculated the census-tract level Location Quotient for Racial Residential Segregation (LQRRS), and estimated adjusted relative risks (ARR) of LQRRS for declines in self-reported health or death 1992-2000, controlling for individual-level characteristics. Of 6653 adults, 3333 lived in minimal, 2242 in low, 562 in moderate, and 516 in high LQRRS tracts in 1992. Major decline/death rates were: 18.6%, 25.2%, 33.8% and 30.4% in minimal, low, moderate and high tracts, respectively. Adjusting for demographic characteristics, residence in low, moderate and high LQRRS census tracts was associated with greater likelihood of major decline/death compared to minimal LQRRS. Controlling for all variables, only moderate LQRRS predicted major decline/death, ARR=1.31 (95% CI 1.07, 1.59; p<.05).
Collapse
Affiliation(s)
- Joseph J Sudano
- Center for Health Care Research and Policy, Case Western Reserve University at The MetroHealth System, 2500 MetroHealth Drive, Rammelkamp 236a, Cleveland, OH 44109, USA.
| | | | | | | | | |
Collapse
|
29
|
Nyarko KA, Wehby GL. Residential segregation and the health of African-American infants: does the effect vary by prevalence? Matern Child Health J 2012; 16:1491-9. [PMID: 22105739 PMCID: PMC3343216 DOI: 10.1007/s10995-011-0915-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Segregation effects may vary between areas (e.g., counties) of low and high low birth weight (LBW; <2,500 g) and preterm birth (PTB; <37 weeks of gestation) rates due to interactions with area differences in risks and resources. We assess whether the effects of residential segregation on county-level LBW and PTB rates for African-American infants vary by the prevalence of these conditions. The study sample includes 368 counties of 100,000 or more residents and at least 50 African-American live births in 2000. Residentially segregated counties are identified alternatively by county-level dissimilarity and isolation indices. Quantile regression is used to assess how residential segregation affects the entire distributions of county-level LBW and PTB rates (i.e. by prevalence). Residential segregation increases LBW and PTB rates significantly in areas of low prevalence, but has no such effects for areas of high prevalence. As a sensitivity analysis, we use metropolitan statistical area level data and obtain similar results. Our findings suggest that residential segregation has adverse effects mainly in areas of low prevalence of LBW and preterm birth, which are expected overall to have fewer risk factors and more resources for infant health, but not in high prevalence areas, which are expected to have more risk factors and fewer resources. Residential policies aimed at area resource improvements may be more effective.
Collapse
Affiliation(s)
- Kwame A. Nyarko
- Dept. of Health Management and Policy College of Public Health University of Iowa 5233 Westlawn Iowa City, IA 52242 Phone: 319-335-7180 Fax: 319-384-5125
| | - George L. Wehby
- Dept. of Health Management and Policy College of Public Health University of Iowa 200 Hawkins Drive, E205 GH Iowa City, IA 52242
| |
Collapse
|
30
|
Kane RJ. The ecology of unhealthy places: Violence, birthweight, and the importance of territoriality in structurally disadvantaged communities. Soc Sci Med 2011; 73:1585-92. [DOI: 10.1016/j.socscimed.2011.08.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 07/18/2011] [Accepted: 08/27/2011] [Indexed: 10/17/2022]
|
31
|
Debbink MP, Bader MDM. Racial residential segregation and low birth weight in Michigan's metropolitan areas. Am J Public Health 2011; 101:1714-20. [PMID: 21778487 PMCID: PMC3154240 DOI: 10.2105/ajph.2011.300152] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2011] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the influence of racial residential segregation, independent of neighborhood economic factors, on the overall and specific etiological risks of low birth weight. METHODS We geocoded all singleton births in Michigan metropolitan areas during 2000 to census tracts. We used hierarchical generalized linear models to investigate the association between low birth weight (< 2500 g) and neighborhood-level economic and racial segregation, controlling for individual and neighborhood characteristics. We analyzed competing risks of the 2 etiologies of low birth weight: intrauterine growth restriction and preterm birth. RESULTS Living in a Black segregated area was associated with increased odds (odds ratio [OR] = 1.15; 95% confidence interval [CI] = 1.03, 1.29; P < .05) of low birth weight after adjusting for individual- and tract-level measures. The analysis suggested that the association between low birth weight and racial segregation was attributable primarily to increased risk of intrauterine growth restriction (OR = 1.19; 95% CI = 1.03, 1.37; P < .05). CONCLUSIONS Odds of low birth weight are higher in racially segregated Black neighborhoods in Michigan's metropolitan areas, independent of economic factors. The association appears to operate through intrauterine growth restriction rather than preterm birth.
Collapse
Affiliation(s)
- Michelle Precourt Debbink
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA.
| | | |
Collapse
|
32
|
Anthopolos R, James SA, Gelfand AE, Miranda ML. A spatial measure of neighborhood level racial isolation applied to low birthweight, preterm birth, and birthweight in North Carolina. Spat Spatiotemporal Epidemiol 2011; 2:235-46. [PMID: 22748223 DOI: 10.1016/j.sste.2011.06.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 05/26/2011] [Accepted: 06/24/2011] [Indexed: 11/18/2022]
Abstract
Research on racial residential segregation (RRS) and birth outcomes has focused on RRS at a broad geographic scale, in an aspatial framework, and in northern US cities. We developed a spatial measure of neighborhood level racial isolation of blacks. We examined the association between this new measure and low birthweight, preterm birth, and birthweight in the southern state of North Carolina. Natality data were obtained from the North Carolina Detailed Birth Record 1998-2002 files. Using multiple regression with cluster corrected standard errors, infants born to black and white mothers living in black isolated neighborhoods had, on average, decreased birthweight, and increased odds of low birthweight and preterm birth compared to their counterparts in less isolated areas. White mothers in predominantly black neighborhoods experienced greater increases in odds of each poor birth outcome than did black mothers. Black isolation may be proxying concentrated socioeconomic disadvantage, including disamenities in the built environment.
Collapse
Affiliation(s)
- Rebecca Anthopolos
- Nicholas School of the Environment, Box 90328, Duke University, Durham, NC 27708, USA.
| | | | | | | |
Collapse
|
33
|
Metcalfe A, Lail P, Ghali WA, Sauve RS. The association between neighbourhoods and adverse birth outcomes: a systematic review and meta-analysis of multi-level studies. Paediatr Perinat Epidemiol 2011; 25:236-45. [PMID: 21470263 DOI: 10.1111/j.1365-3016.2011.01192.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Many studies have examined the role of neighbourhood environment on birth outcomes but, because of differences in study design and modelling techniques, have found conflicting results. Seven databases were searched (1900-2010) for multi-level observational studies related to neighbourhood and pregnancy/birth. We identified 1502 articles of which 28 met all inclusion criteria. Meta-analysis was used to examine the association between neighbourhood income and low birthweight. Most studies showed a significant association between neighbourhood factors and birth outcomes. A significant pooled association was found for the relationship between neighbourhood income and low birthweight [odds ratio = 1.11, 95% confidence interval: 1.02, 1.20] whereby women who lived in low income neighbourhoods had significantly higher odds of having a low birthweight infant. This body of literature was found to consistently document significant associations between neighbourhood factors and birth outcomes. The consistency of findings from observational studies in this area indicates a need for causal studies to determine the mechanisms by which neighbourhoods influence birth outcomes.
Collapse
Affiliation(s)
- Amy Metcalfe
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | | | | |
Collapse
|
34
|
Racism and hypertension: a review of the empirical evidence and implications for clinical practice. Am J Hypertens 2011; 24:518-29. [PMID: 21331054 DOI: 10.1038/ajh.2011.9] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite improved hypertension (HTN) awareness and treatment, racial disparities in HTN prevalence persist. An understanding of the biopsychosocial determinants of HTN is necessary to address racial disparities in the prevalence of HTN. This review examines the evidence directly and indirectly linking multiple levels of racism to HTN. METHODS Published empirical research in EBSCO databases investigating the relationships of three levels of racism (individual/interpersonal, internalized, and institutional racism) to HTN was reviewed. RESULTS Direct evidence linking individual/interpersonal racism to HTN diagnosis is weak. However, the relationship of individual/interpersonal racism to ambulatory blood pressure (ABP) is more consistent, with all published studies reporting a positive relationship of interpersonal racism to ABP. There is no direct evidence linking internalized racism to BP. Population-based studies provide some evidence linking institutional racism, in the forms of residential racial segregation (RRS) and incarceration, to HTN incidence. Racism shows associations to stress exposure and reactivity as well as associations to established HTN-related risk factors including obesity, low levels of physical activity and alcohol use. The effects vary by level of racism. CONCLUSIONS Overall the findings suggest that racism may increase risk for HTN; these effects emerge more clearly for institutional racism than for individual level racism. All levels of racism may influence the prevalence of HTN via stress exposure and reactivity and by fostering conditions that undermine health behaviors, raising the barriers to lifestyle change.
Collapse
|
35
|
White K, Borrell LN. Racial/ethnic residential segregation: framing the context of health risk and health disparities. Health Place 2011; 17:438-48. [PMID: 21236721 PMCID: PMC3056936 DOI: 10.1016/j.healthplace.2010.12.002] [Citation(s) in RCA: 210] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 12/01/2010] [Accepted: 12/06/2010] [Indexed: 11/16/2022]
Abstract
An increasing body of public health literature links patterns of racial/ethnic residential segregation to health status and health disparities. Despite substantial new empirical work, meaningful understanding of the pathways through which segregation operates to influence health remains elusive. The literature on segregation and health was appraised with an emphasis on select conceptual, methodological, and analytical issues. Recommendations for advancing the next generation of racial/ethnic residential segregation and health research will require closer attention to sharpening the methodology of measuring segregation, testing mediating pathways and effect modification, incorporating stronger test of causality, exploring factors of resilience in segregated areas, applying a life-course perspective, broadening the scope of the investigation of segregation to include nativity status in blacks and other racial/ethnic groups, and linking segregation measures with biological data.
Collapse
Affiliation(s)
- Kellee White
- Department of Epidemiology and Biostatistics University of South Carolina Arnold School of Public Health 800 Sumter Street, Suite 205 Columbia, SC 29201
| | - Luisa N. Borrell
- Department of Health Sciences Graduate Program in Public Health CUNY Institute for Health Equity Lehman College, CUNY 250 Bedford Park Boulevard West Gillet 336 Bronx, NY 10468
| |
Collapse
|
36
|
Silver D, Mijanovich T, Uyei J, Kapadia F, Weitzman BC. Lifting boats without closing gaps: child health outcomes in distressed US cities from 1992-2002. Am J Public Health 2010; 101:278-84. [PMID: 21164084 DOI: 10.2105/ajph.2010.194761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We compared cause-specific mortality and birth rates for children and youths aged younger than 18 years in 100 US cities from 1992 through 2002. METHODS We used 5 census indicators to categorize the 100 most populous US cities in 1990 as economically distressed or nondistressed. We used Poisson regression to calculate rate ratios for cause-specific mortality and birth rates, comparing distressed cities to nondistressed cities overall and by race/ethnicity from 1992 through 2002. We also calculated rates of change in these variables within each city over this period. RESULTS Despite improvements in health for the study population in all cities, disparities between city groups held steady or widened over the study period. Gaps in outcomes between Whites and Blacks persisted across all cities. Living in a distressed city compounded the disparities in poor outcomes for Black children and youths. CONCLUSIONS A strong national economy during the study period may have facilitated improvements in health outcomes for children and youths in US cities, but these benefits did not close gaps between distressed and nondistressed cities.
Collapse
Affiliation(s)
- Diana Silver
- Department of Nutrition, Food Studies and Public Health, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY 10012, USA.
| | | | | | | | | |
Collapse
|
37
|
Kramer MR, Cooper HL, Drews-Botsch CD, Waller LA, Hogue CR. Metropolitan isolation segregation and Black-White disparities in very preterm birth: a test of mediating pathways and variance explained. Soc Sci Med 2010; 71:2108-16. [PMID: 20947234 PMCID: PMC2992580 DOI: 10.1016/j.socscimed.2010.09.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 06/01/2010] [Accepted: 09/03/2010] [Indexed: 11/15/2022]
Abstract
Residential isolation segregation (a measure of residential inter-racial exposure) has been associated with rates of preterm birth (<37 weeks gestation) experienced by Black women. Epidemiologic differences between very preterm (<32 weeks gestation) and moderately preterm births (32-36 weeks) raise questions about whether this association is similar across gestational ages, and through what pathways it might be mediated. Hierarchical Bayesian models were fit to answer three questions: is the isolation-prematurity association similar for very and moderately preterm birth; is this association mediated by maternal chronic disease, socioeconomic status, or metropolitan area crime and poverty rates; and how much of the geographic variation in Black-White very preterm birth disparities is explained by isolation segregation? Singleton births to Black and White women in 231 U.S. metropolitan statistical areas in 2000-2002 were analyzed and isolation segregation was calculated for each. We found that among Black women, isolation is associated with very preterm birth and moderately preterm birth. The association may be partially mediated by individual level socioeconomic characteristics and metropolitan level violent crime rates. There is no association between segregation and prematurity among White women. Isolation segregation explains 28% of the geographic variation in Black-White very preterm birth disparities. Our findings highlight the importance of isolation segregation for the high-burden outcome of very preterm birth, but unexplained excess risk for prematurity among Black women is substantial.
Collapse
|
38
|
Racial residential segregation impacts on low birth weight using improved neighborhood boundary definitions. Spat Spatiotemporal Epidemiol 2010; 1:239-49. [PMID: 22749499 DOI: 10.1016/j.sste.2010.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Research on local racial residential segregation and health generally utilize census tract boundaries as a proxy from within which to estimate individual exposures. Census tracts however, may not accurately reflect the neighborhood environments in which people live and interact. Census tract geography may also capture non-exchangeable populations in socially stratified cities, impacting statistical assumptions of independence. To address these concerns, this study assessed the impact of racial residential segregation (i.e., racial isolation and racial clusters) on low birth weight (i.e., intrauterine growth retardation (IUGR) and preterm birth) in the Detroit Metropolitan Area using optimized neighborhood boundary definitions. Automated zone-matching (AZM) methodology was applied to redefine neighborhood (zones). Maternal and infant health information was obtained from Michigan's vital statistics birth registry (n=137,965) for the years 2004-2006. Multilevel models were estimated to assess the effect of high racial isolation and high racial clusters on IUGR and preterm birth, controlling for maternal race, single marital status, smoking and area-level poverty. The results from this study showed that high racial isolation had a significant effect on IUGR, while the odds of preterm birth were higher in racially clustered zones. African American mothers were at increased odds of having IUGR or preterm infants than other mothers; however, these disparities reduced in highly segregated zones. The predicted incidence of IUGR across racially isolated zones and census tracts differed indicating a modifiable area unit problem (MAUP). MAUP effects were not observed in models predicting preterm incidence in high racial clusters or IUGR or preterm incidence in high poverty areas, demonstrating the stability-reliability of these estimates. Future research should continue to optimize neighborhood boundary definitions, while assessing the sensitivity of segregation measures to changes in scale, to improve our understanding of segregation impacts on racial disparities in low birth weight.
Collapse
|
39
|
The joint influence of area income, income inequality, and immigrant density on adverse birth outcomes: a population-based study. BMC Public Health 2009; 9:237. [PMID: 19602256 PMCID: PMC2714302 DOI: 10.1186/1471-2458-9-237] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 07/14/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The association between area characteristics and birth outcomes is modified by race. Whether such associations vary according to social class indicators beyond race has not been assessed. METHODS This study evaluated effect modification by maternal birthplace and education of the relationship between neighbourhood characteristics and birth outcomes of newborns from 1999-2003 in the province of Québec, Canada (N = 353,120 births). Areas (N = 143) were defined as administrative local health service delivery districts. Multi-level logistic regression was used to model the association between three area characteristics (median household income, immigrant density and income inequality) and the two outcomes preterm birth (PTB) and small-for-gestational age (SGA) birth. Effect modification by social class indicators was evaluated in analyses stratified according to maternal birthplace and education. RESULTS Relative to the lowest tertile, high median household income was associated with SGA birth among Canadian-born mothers (odds ratio (OR) 1.13, 95% confidence interval (CI) 1.06, 1.20) and mothers with high school education or less (OR 1.13, 95% CI 1.02, 1.24). Associations between median household income and PTB were weaker. Relative to the highest tertile, low immigrant density was associated with a lower odds of PTB among foreign-born mothers (OR 0.79, 95% CI 0.63, 1.00) but a higher odds of PTB among Canadian-born mothers (OR 1.14, 95% CI 1.07, 1.21). Associations with income inequality were weak or absent. CONCLUSION The association between area factors and birth outcomes is modified by maternal birthplace and education. Studies have found that race interacts in a similar manner. Public health policies focussed on perinatal health must consider the interaction between individual and area characteristics.
Collapse
|
40
|
Abstract
Very preterm birth (<32 weeks' gestation) occurs in approximately 2% of livebirths but is a leading cause of infant mortality and morbidity in the United States. African-American women have a 2-fold to 3-fold elevated risk compared with non-Hispanic white women for reasons that are incompletely understood. This paper reviews the evidence for the biologic and social patterning of very preterm birth, with attention to leading hypotheses regarding the etiology of the racial disparity. A systematic review of the literature in the MEDLINE, CINAHL, PsycInfo, and EMBASE indices was conducted. The literature to date suggests a complex, multifactorial causal framework for understanding racial disparities in very preterm birth, with maternal inflammatory, vascular, or neuroendocrine dysfunction as proximal pathways and maternal exposure to stress, racial differences in preconceptional health, and genetic, epigenetic, and gene-environment interactions as more distal mediators. Interpersonal and institutionalized racism are mechanisms that may drive racially patterned differences. Current literature is limited in that research on social determinants and biologic processes of prematurity has been generally disconnected. Improved etiologic understanding and the potential for effective intervention may come with better integration of these research approaches.
Collapse
Affiliation(s)
- Michael R Kramer
- Women's and Children's Center, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | | |
Collapse
|
41
|
Abstract
For decades, racial residential segregation has been observed to vary with health outcomes for African Americans, although only recently has interest increased in the public health literature. Utilizing a systematic review of the health and social science literature, the authors consider the segregation-health association through the lens of 4 questions of interest to epidemiologists: How is segregation best measured? Is the segregation-health association socially or biologically plausible? What evidence is there of segregation-health associations? Is segregation a modifiable risk factor? Thirty-nine identified studies test an association between segregation and health outcomes. The health effects of segregation are relatively consistent, but complex. Isolation segregation is associated with poor pregnancy outcomes and increased mortality for blacks, but several studies report health-protective effects of living in clustered black neighborhoods net of social and economic isolation. The majority of reviewed studies are cross-sectional and use coarse measures of segregation. Future work should extend recent developments in measuring and conceptualizing segregation in a multilevel framework, build upon the findings and challenges in the neighborhood-effects literature, and utilize longitudinal data sources to illuminate opportunities for public health action to reduce racial disparities in disease.
Collapse
Affiliation(s)
- Michael R Kramer
- Women's and Children's Center, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | | |
Collapse
|
42
|
Acevedo-Garcia D, Osypuk TL. Invited commentary: residential segregation and health--the complexity of modeling separate social contexts. Am J Epidemiol 2008; 168:1255-8. [PMID: 18974060 DOI: 10.1093/aje/kwn290] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
When researching racial disparities in health, residential segregation cannot be ignored. Because of segregation, contextual differences by race are so pronounced that ignoring them may lead to mis-estimating the effect of individual-level factors. However, given the stark racial separation of social contexts, researching how residential segregation and neighborhood inequality contribute to racial health disparities remains methodologically challenging. Estimating the contribution of neighborhood effects to health disparities would require overlap in the racial distributions of neighborhood environment, for example, in the distributions of neighborhood poverty. Because of segregation, though, the extent of such overlap is extremely restricted. Previous analyses of the 2000 US Census found, on average, only a 24% overlap between the distribution of neighborhood poverty for black children and that for white children in metropolitan areas. Propensity score methods may be 1 useful tool for addressing limited overlap or exchangeability. However, as shown by their application to the segregation and health relation, their use should be informed by a sound conceptualization of the scale of the social exposure of interest, the hypothesized pathways between the exposure and the health outcome, and possible unmeasured confounders.
Collapse
Affiliation(s)
- Dolores Acevedo-Garcia
- Department of Society, Human Development and Health, Harvard School of Public Health, 766 Huntington Avenue, Boston, MA 02115, USA.
| | | |
Collapse
|