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Edwards JR, Ong C, Barber S, Headen I, Tabb LP, De Roos AJ, Schinasi LH. Methodologic Strategies for Quantifying Associations of Historical and Contemporary Mortgage Discrimination on Population Health Equity: A Systematic Review. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02137-3. [PMID: 39289334 DOI: 10.1007/s40615-024-02137-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 08/11/2024] [Accepted: 08/12/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND Mortgage discrimination refers to the systematic withholding of home mortgages from minoritized groups. In recent years, there has been an increase in empirical research investigating associations of historical and contemporary mortgage discrimination on contemporary outcomes. Investigators have used a variety of measurement methods and approaches, which may have implications for results and interpretation. PURPOSE We conducted a systematic review of peer-reviewed literature that has quantified links between both historical and current mortgage discrimination with contemporary adverse environmental, social, and health outcomes. Our goals were to document the methodology used to measure and assign mortgage discrimination, to assess implications for results and interpretation, and to make recommendations for future work. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, literature searches were conducted in September 2022 using terms that combined concepts of mortgage discrimination, health, and neighborhood environment. RESULTS In total, 45 papers fit the eligibility criteria. In these, researchers investigated associations between mortgage discrimination and: (1) health outcomes (N = 28); (2) environmental and social exposures including heat, air pollution, greenspace, soil lead levels, and crime (N = 12); and (3) built environment features, including presence of retail alcohol, fast food, and tobacco stores (N = 5). Eleven included studies used Home Mortgage Discrimination Act (HMDA) data to identify racialized bias in mortgage discrimination or redlining, and 34 used Homeowner Loan Corporation (HOLC) maps. The construction and parametrization of mortgage discrimination or redlining and the spatial assignment of HOLC grades to contemporary addresses or neighborhoods varied substantially across studies. CONCLUSIONS Results from our review suggest the need for careful consideration of optimal methods to analyze mortgage discrimination such as HOLC spatial assignment or HMDA index parametrization, contemplation of covariates, and place-based knowledge of the study location.
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Affiliation(s)
- Janelle R Edwards
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
- Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, PA, USA.
- Dornsife School of Public Health, Ubuntu Center On Racism, Global Movements, and Population Health Equity, Drexel University, Philadelphia, PA, USA.
| | - Christian Ong
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Sharrelle Barber
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, PA, USA
- Dornsife School of Public Health, Ubuntu Center On Racism, Global Movements, and Population Health Equity, Drexel University, Philadelphia, PA, USA
| | - Irene Headen
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Dornsife School of Public Health, Ubuntu Center On Racism, Global Movements, and Population Health Equity, Drexel University, Philadelphia, PA, USA
| | - Loni P Tabb
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Dornsife School of Public Health, Ubuntu Center On Racism, Global Movements, and Population Health Equity, Drexel University, Philadelphia, PA, USA
| | - Anneclaire J De Roos
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, PA, USA
| | - Leah H Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, PA, USA
- Dornsife School of Public Health, Ubuntu Center On Racism, Global Movements, and Population Health Equity, Drexel University, Philadelphia, PA, USA
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Hing AK, Chantarat T, Fashaw-Walters S, Hunt SL, Hardeman RR. Instruments for racial health equity: a scoping review of structural racism measurement, 2019-2021. Epidemiol Rev 2024; 46:1-26. [PMID: 38412307 PMCID: PMC11405678 DOI: 10.1093/epirev/mxae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/27/2023] [Accepted: 02/21/2024] [Indexed: 02/29/2024] Open
Abstract
Progress toward racial health equity cannot be made if we cannot measure its fundamental driver: structural racism. As in other epidemiologic studies, the first step is to measure the exposure. But how to measure structural racism is an ongoing debate. To characterize the approaches epidemiologists and other health researchers use to quantitatively measure structural racism, highlight methodological innovations, and identify gaps in the literature, we conducted a scoping review of the peer-reviewed and gray literature published during 2019-2021 to accompany the 2018 published work of Groos et al., in which they surveyed the scope of structural racism measurement up to 2017. We identified several themes from the recent literature: the current predominant focus on measuring anti-Black racism; using residential segregation as well as other segregation-driven measures as proxies of structural racism; measuring structural racism as spatial exposures; increasing calls by epidemiologists and other health researchers to measure structural racism as a multidimensional, multilevel determinant of health and related innovations; the development of policy databases; the utility of simulated counterfactual approaches in the understanding of how structural racism drives racial health inequities; and the lack of measures of antiracism and limited work on later life effects. Our findings sketch out several steps to improve the science related to structural racism measurements, which is key to advancing antiracism policies.
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Affiliation(s)
- Anna K Hing
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
- Center for Antiracism Research for Health Equity, School of Public Health, University of Minnesota, Minneapolis, MN, United States
- Minnesota Population Center, Institute for Social Research and Data Innovation, University of Minnesota, Minneapolis, MN, United States
| | - Tongtan Chantarat
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
- Minnesota Population Center, Institute for Social Research and Data Innovation, University of Minnesota, Minneapolis, MN, United States
| | - Shekinah Fashaw-Walters
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
- Center for Antiracism Research for Health Equity, School of Public Health, University of Minnesota, Minneapolis, MN, United States
- Minnesota Population Center, Institute for Social Research and Data Innovation, University of Minnesota, Minneapolis, MN, United States
| | - Shanda L Hunt
- University Libraries, University of Minnesota, Minneapolis, MN, United States
| | - Rachel R Hardeman
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
- Center for Antiracism Research for Health Equity, School of Public Health, University of Minnesota, Minneapolis, MN, United States
- Minnesota Population Center, Institute for Social Research and Data Innovation, University of Minnesota, Minneapolis, MN, United States
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Hoffman C, Harris M, Acharya K, Malnory M, Cohen S, Lagatta J. Impact of systematic screening for social determinants of health in a level IV neonatal intensive care unit. J Perinatol 2024:10.1038/s41372-024-02096-x. [PMID: 39244612 DOI: 10.1038/s41372-024-02096-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 08/13/2024] [Accepted: 08/15/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVE To determine whether screening for social determinants of health (SDoH) in a level IV neonatal intensive care unit (NICU) could uncover additional family needs. METHODS Secondary analysis of a prospective study in a level IV NICU. Participants filled out the Protocol for Responding to and Assessing Patients' Assets, Risks and Experiences (PRAPARE) tool, which includes economic, housing, transportation, and safety questions. Questionnaires were completed via secure tablet; the research team notified social workers of reported needs. Illness and demographic characteristics were compared between families who did and did not report resource needs. Manual chart review assessed subsequent response to reported SDoH needs. RESULTS Of 319 respondents, 61(19%) reported resource needs. Of 61 families, 88% received repeat social work encounters to re-assess for resources; 59% received new resource referrals. CONCLUSIONS Systematic SDoH screening can identify needs throughout the NICU stay, even among families already connected to social work support.
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Affiliation(s)
- Caitlin Hoffman
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Melissa Harris
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Krishna Acharya
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Margaret Malnory
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Susan Cohen
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joanne Lagatta
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
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Williams JB, Johnson AJ, Ruiz M, Campbell LC. Black college women's preventive health behaviors: Applications of a Black Feminist-Womanist research paradigm. Prev Med 2024; 189:108126. [PMID: 39232990 DOI: 10.1016/j.ypmed.2024.108126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 08/28/2024] [Accepted: 08/31/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVE The researchers applied Lindsay-Dennis' Black Feminist-Womanist research paradigm to Andersen's Behavioral Model for Health Service Use to guide initial research about Black American women's preventive health behaviors. METHODS This article highlights this application, using interpretive phenomenological analysis for qualitative questions assessing how 40 Black college women define health and their experiences in health care. This was part of a larger convergent parallel mixed-methods approach in a 2022 cross-sectional online survey. RESULTS Participants defined health as a concept involving health literacy, physical and mental health, and being free from health conditions or disease. Regarding health-related lived experiences, negative experiences were more frequently reported than positive experiences. However, many participants reported both positive and negative health care related experiences. Predisposing, enabling, and need factors were all present in qualitative responses. CONCLUSIONS This article highlights the fit of a Black Feminist-Womanist research paradigm to Andersen's model to better understand Black women's health experiences and illustrates ways that medical mistrust, health literacy, and past experiences with health care can influence health service use. Areas for future research on barriers and facilitators to preventive care and implications for reducing health disparities are also discussed.
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Affiliation(s)
- Juinell B Williams
- South Central Mental Illness Research Education and Clinical Center, Michael E. DeBakey Veterans Affairs Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, United States of America; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States of America.
| | - Angela J Johnson
- Department of Psychology, Rawl Building, E. 5(th) St., East Carolina University, Greenville, North Carolina 27858, United States of America
| | - Michelle Ruiz
- Department of Psychology, Rawl Building, E. 5(th) St., East Carolina University, Greenville, North Carolina 27858, United States of America
| | - Lisa C Campbell
- Department of Psychology, Rawl Building, E. 5(th) St., East Carolina University, Greenville, North Carolina 27858, United States of America
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Warren KF, Dail RB, Dawson RM, Boghossian NS, Felder TM. When a baby is born, so is a parent: Understanding the effects of preterm birth on Black parents through the lens of the NIMHD framework. Nurs Outlook 2024; 72:102246. [PMID: 39116649 DOI: 10.1016/j.outlook.2024.102246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 06/29/2024] [Accepted: 07/06/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND The rate of preterm birth (PTB) is high in the United States and Black infants remain disproportionately affected, with the disparity between Black and White infant deaths greater today than it was under antebellum slavery. PURPOSE The National Institute on Minority Health and Disparities Research Framework reflects a unique set of determinants relevant to the understanding and promotion of minority health. METHODS We have applied this framework to better understand the effects of PTB on Black parents and the distribution of the social determinants of health, including structural determinants and root causes of inequities. DISCUSSION This adaptation shows the intersection in maternal and infant health that shapes individuals' experiences, drives disparities and impacts perinatal outcomes in critical periods over the lifecourse. CONCLUSION In our efforts to achieve health equity, it is imperative that we study the underlying mechanisms and recognize that policies, institutional structures, and social factors are drivers of racism.
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Affiliation(s)
- Karen F Warren
- University of South Carolina, College of Nursing, Columbia, SC.
| | - Robin B Dail
- University of South Carolina, College of Nursing, Columbia, SC
| | - Robin M Dawson
- University of South Carolina, College of Nursing, Columbia, SC
| | - Nansi S Boghossian
- University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Tisha M Felder
- University of South Carolina, College of Nursing, Columbia, SC
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Lagatta J, Hoffman C, Harris M, Acharya K, Malnory M, Cohen S. Impact of systematic screening for social determinants of health in a level IV neonatal intensive care unit. RESEARCH SQUARE 2024:rs.3.rs-4656439. [PMID: 39108473 PMCID: PMC11302683 DOI: 10.21203/rs.3.rs-4656439/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Objective To determine whether screening for social determinants of health (SDoH) in a level IV neonatal intensive care unit (NICU) could uncover additional family needs. Methods Secondary analysis of a prospective study in a level IV NICU. Participants filled out the Protocol for Responding to and Assessing Patients' Assets, Risks and Experiences (PRAPARE) tool, which includes economic, housing, transportation, and safety questions. Questionnaires were completed via secure tablet; the research team notified social workers of reported needs. Illness and demographic characteristics were compared between families who did and did not report resource needs. Manual chart review assessed subsequent response to reported SDoH needs. Results Of 319 respondents, 61(19%) reported resource needs. Of 61 families, 88% received repeat social work encounter to re-assess for resources; 59% received new resource referrals. Conclusions Systematic SDoH screening can identify needs throughout the NICU stay, even among families already connected to social work support.
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Barcelona V, Condon EM, Jacoby SF. Leveraging biosocial methods to examine and address structural determinants of health and promote health equity. Nurs Outlook 2024; 72:102195. [PMID: 38810533 PMCID: PMC11330731 DOI: 10.1016/j.outlook.2024.102195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/26/2024] [Accepted: 04/28/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Biosocial approaches in nursing research have largely focused on the ways that social determinants of health influence individual-level outcomes, including symptom management, family and social support, and educational interventions. PURPOSE Theoretical, methodological, and practical strategies are needed to expand current biosocial methods for nursing science and focus on upstream, structural determinants of health and the policies that underlie health inequities. METHODS This paper summarizes presentations given at the 2023 Council for the Advancement of Nursing Science Advanced Methods Conference, Biosocial Methods to Advance Health Equity, in a panel titled "Individual, community, systems and policy related to biosocial methods." DISCUSSION Nurses are uniquely positioned to examine upstream, structural determinants of health by leveraging expertise in biosocial methods, collaborating with interdisciplinary researchers and community members, and advocating for policy change. By conducting theory-grounded biosocial research, nurse researchers can significantly advance scientific knowledge and promote health equity for individuals and communities. CONCLUSION Nurse scientists are conducting research using biosocial methods and provide recommendations for expansion of this approach in the field.
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Affiliation(s)
| | - Eileen M Condon
- University of Connecticut School of Nursing, Storrs, CT; Department of Pediatrics, University of Connecticut School of Medicine, Storrs, CT
| | - Sara F Jacoby
- Department of Family and Community, University of Pennsylvania School of Nursing, Philadelphia, PA
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Matoba N, Kim C, Branche T, Collins JW. Social Determinants of Premature Birth. Clin Perinatol 2024; 51:331-343. [PMID: 38705644 DOI: 10.1016/j.clp.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Social determinants of health have received increasing attention in public health, leading to increased understanding of how social factors-individual and contextual-shape the health of the mother and infant. However, racial differences in birth outcomes persist, with incomplete explanation for the widening disparity. Here, we highlight the social determinants of preterm birth, with special attention to the social experiences among African American women, which are likely attributed to structural racism and discrimination throughout life.
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Affiliation(s)
- Nana Matoba
- Division of Neonatology, Rady Children's Hospital San Diego, Department of Pediatrics, University of California San Diego, 3020 Children's Way, MC 5008, San Diego, CA 92123, USA.
| | - Christina Kim
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University, 225 East Chicago Avenue, Box #45, Chicago, IL 60611, USA
| | - Tonia Branche
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University, 225 East Chicago Avenue, Box #45, Chicago, IL 60611, USA
| | - James W Collins
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University, 225 East Chicago Avenue, Box #45, Chicago, IL 60611, USA
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Shkembi A, Smith LM, Neitzel RL. Linking environmental injustices in Detroit, MI to institutional racial segregation through historical federal redlining. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2024; 34:389-398. [PMID: 36544051 PMCID: PMC11222141 DOI: 10.1038/s41370-022-00512-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To identify the most pervasive environmental exposures driving environmental disparities today associated with historical redlining in Detroit. METHODS We overlaid Detroit's 1939 Home Owners' Loan Corporation (HOLC) shapefile from the Mapping Inequality project onto the EPA EJScreen and the DOT National Transportation Noise maps to analyze differences in current demographic and environmental indicators between historically redlined (D-grade) and non-redlined neighborhoods using simple linear regression and a boosted classification tree algorithm. RESULTS Historically redlined neighborhoods in Detroit experienced significantly higher environmental hazards than non-redlined neighborhoods in the form of 12.1% (95% CI: 7.2-17.1%) higher levels of diesel particulate matter (PM), 32.2% (95% CI: 3.3-69.3%) larger traffic volumes, and 65.7% (95% CI: 8.6-152.8%) higher exposure to hazardous road noise (LEQ(24h) >70 dBA). Historically redlined neighborhoods were situated near 1.7-times (95% CI: 1.4-2.1) more hazardous waste sites and twice as many (95% CI: 1.5-2.7) risk management plan (RMP) sites than non-redlined neighborhoods. The lifetime cancer risk from inhalation of air toxics was 4.4% (95% CI: 2.9-6.6%) higher in historically redlined communities, and the risk of adverse respiratory health outcomes from air toxics was 3.9% (95% CI: 2.1-5.6%) higher. All factors considered together, among the environmental hazards considered, the most pervasive hazards in historically redlined communities are proximity to RMP sites, hazardous road noise, diesel PM, and cancer risk from air pollution. CONCLUSIONS Historically redlined neighborhoods may have a disproportionately higher risk of developing cancer and adverse respiratory health outcomes from air toxics. Policies targeting air and noise pollution from transportation sources, particularly from sources of diesel exhaust, in historically redlined neighborhoods may ameliorate some of the impacts of structural environmental racism from historical redlining in Detroit.
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Affiliation(s)
- Abas Shkembi
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA.
| | - Lauren M Smith
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Richard L Neitzel
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA
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Nelin TD, Scott KA, Just AC, Burris HH. Place-Based Strategies Addressing Neighborhood Environments to Improve Perinatal and Preterm Infant Outcomes. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1646. [PMID: 37892309 PMCID: PMC10605196 DOI: 10.3390/children10101646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/21/2023] [Accepted: 09/30/2023] [Indexed: 10/29/2023]
Abstract
Preterm birth (defined as birth <37 weeks of gestation) is a significant health concern globally, with lasting implications for individuals, families, and society. In the United States, high preterm birth rates among Black and low-income populations likely result from differences in environmental exposures. Structural racism and economic disadvantage have led to unequal distribution of polluting industrial sites and roadways across society as well as differential access to health-promoting resources which contribute to preterm birth risk. Once born, preterm infants remain at risk for numerous environmentally responsive adverse health outcomes that affect growth and development throughout childhood and adulthood. In this commentary, we describe associations of neighborhood environments with pregnancy and preterm infant health outcomes and propose strategies to address harmful exposures that affect families across the lifespan.
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Affiliation(s)
- Timothy D. Nelin
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (K.A.S.); (H.H.B.)
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center of Excellence in Environmental Toxicology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Leonard Davis Institute of Health Economics, Philadelphia, PA 19104, USA
| | - Kristan A. Scott
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (K.A.S.); (H.H.B.)
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Allan C. Just
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02912, USA;
| | - Heather H. Burris
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (K.A.S.); (H.H.B.)
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center of Excellence in Environmental Toxicology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Leonard Davis Institute of Health Economics, Philadelphia, PA 19104, USA
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Hwang SS, Bourque SL, Hannan KE, Passarella M, Radack J, Formanowski B, Lorch SA. Racial and Ethnic Disparities in Sudden Unexpected Infant Death Among US Infants Born Preterm. J Pediatr 2023; 260:113498. [PMID: 37211205 DOI: 10.1016/j.jpeds.2023.113498] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/03/2023] [Accepted: 05/14/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To investigate among US infants born at <37 weeks gestation (a) racial and ethnic disparities in sudden unexpected infant death (SUID) and (b) state variation in SUID rates and non-Hispanic Black (NHB)-non-Hispanic White (NHW) SUID disparity ratio. METHODS In this retrospective cohort analysis of linked birth and death certificates from 50 states from 2005 to 2014, SUID was defined by the following International Classification of Diseases, 9th or 10th edition, codes listed on death certificates: (7980, R95 or Recode 135; ASSB: E913, W75 or Recode 146; Unknown: 7999 R99 or Recode 134). Multivariable models were used to assess the independent association between maternal race and ethnicity and SUID, adjusting for several maternal and infant characteristics. The NHB-NHW SUID disparity ratios were calculated for each state. RESULTS Among 4 086 504 preterm infants born during the study period, 8096 infants (0.2% or 2.0 per 1000 live births) experienced SUID. State variation in SUID ranged from the lowest rate of 0.82 per 1000 live births in Vermont to the highest rate of 3.87 per 1000 live births in Mississippi. Unadjusted SUID rates across racial and ethnic groups varied from 0.69 (Asian/Pacific Islander) to 3.51 (NHB) per 1000 live births. In the adjusted analysis, compared with NHW infants, NHB and Alaska Native/American Indian preterm infants had greater odds of SUID (aOR, 1.5;[95% CI, 1.42-1.59] and aOR, 1.44 [95% CI, 1.21-1.72]) with varying magnitude of SUID rates and NHB-NHW disparities across states. CONCLUSIONS Significant racial and ethnic disparities in SUID among preterm infants exist with variation across US states. Additional research to identify the drivers of these disparities within and across states is needed.
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Affiliation(s)
- Sunah S Hwang
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
| | - Stephanie L Bourque
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Kathleen E Hannan
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Molly Passarella
- Division of Neonatology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joshua Radack
- Division of Neonatology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brielle Formanowski
- Division of Neonatology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Scott A Lorch
- Division of Neonatology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Pearson AL, Zhou Y, Buxton RT, Horton TH, Pfeiffer KA, Beyer KM. The effects of contemporary redlining on the mental health of Black residents. SSM Popul Health 2023; 23:101462. [PMID: 37456619 PMCID: PMC10339054 DOI: 10.1016/j.ssmph.2023.101462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/29/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
Understanding how structural racism, including institutionalized practices such as redlining, influence persistent inequities in health and neighborhood conditions is still emerging in urban health research. Such research often focuses on historical practices, giving the impression that such practices are a thing of the past. However, mortgage lending bias can be readily detected in contemporary datasets and is an active form of structural racism with implications for health and wellbeing. The objective of the current study was to test for associations among multiple measures of mental health and a measure of contemporary redlining. We linked a redlining index constructed using Home Mortgage Disclosure Act data (2007-2013) to 2021 health data for Black/African American participants in the Study of Active Neighborhoods in Detroit (n = 220 with address data). We used multilevel regression models to examine the relationship between redlining and a suite of mental health outcomes (perceived stress, anxiety, depressive symptoms, and satisfaction with life), accounting for covariates including racial composition of the neighborhood. We considered three mediating factors: perceived neighborhood cohesion, aesthetics, and discrimination. Although all participants lived in redlined neighborhoods compared to the complete Detroit Metropolitan area, participants with very low income, low levels of experienced discrimination, and lower perceptions of neighborhood aesthetics resided in highly redlined neighborhoods (score ≥5). We observed that higher resident-reported neighborhood aesthetics were found in neighborhoods with lower redlining scores and were associated with higher levels of satisfaction with life. We found that lower levels of redlining were significantly associated with higher levels of perceived discrimination, which was significantly, positively associated with anxiety, depressive symptoms, and perceived stress scores. Our findings highlight that contemporary redlining practices may influence the aesthetics of the built environment because these neighborhoods experience less investment, with implications for residents' satisfaction with life. However, areas with lower redlining may be areas where Black/African American people experience increased perceived discrimination.
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Affiliation(s)
- Amber L. Pearson
- Department of Geography, Michigan State University, East Lansing, MI, 48824, USA
| | - Yuhong Zhou
- Institute for Health & Equity, Medical College Wisconsin, Milwaukee, WI, 53226, USA
| | - Rachel T. Buxton
- Department of Biology, Carleton University, Ottawa, K1S 5B6, Canada
| | - Teresa H. Horton
- Department of Anthropology, Northwestern University, Evanston, IL, 60208, USA
| | - Karin A. Pfeiffer
- Department of Kinesiology, Michigan State University, East Lansing, MI, 48824, USA
| | - Kirsten M.M. Beyer
- Institute for Health & Equity, Medical College Wisconsin, Milwaukee, WI, 53226, USA
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Hibbs S, Simon BA, Howland J, Rankin KM, Collins JW. Women's Economic Mobility and Small for Gestational Age Rates: The Effect of Paternal Early-Life Socioeconomic Position. Matern Child Health J 2023; 27:1643-1650. [PMID: 37314672 DOI: 10.1007/s10995-023-03707-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To determine whether paternal early-life socioeconomic position (defined by neighborhood income) modifies the association of maternal economic mobility and infant small for gestational age (weight for gestational age < 10th percentile, SGA) rates. METHODS Stratified and multilevel binomial regression analyses were executed on the Illinois transgenerational dataset of parents (born 1956-1976) and their infants (born 1989-1991) with appended U.S. census income information. Only Chicago-born women with an early-life residence in impoverished or affluent neighborhoods were studied. RESULTS The incidence of impoverished-born women's upward economic mobility among births (n = 3777) with early-life low socioeconomic position (SEP) fathers was less than that of those (n = 576) with early-life high SEP fathers: 56% vs 71%, respectively, p < 0.01. The incidence of affluent-born women's downward economic mobility among births (n = 2370) with early-life low SEP fathers exceeded that of those (n = 3822) with early-life high SEP fathers: 79% vs 66%, respectively, p < 0.01. The adjusted RR of infant SGA for maternal upward (compared to lifelong impoverishment) economic mobility among fathers with early-life low and high SEP equaled 0.68 (0.56, 0.82) and 0.81 (0.47, 1.42), respectively. The adjusted RR of infant SGA for maternal downward (compared to lifelong residence in affluent neighborhoods) economic mobility among fathers with early-life low and high SEP were 1.37 (0.91, 2.05) and 1.17 (0.86, 1.59), respectively. CONCLUSIONS Paternal early-life SEP is associated with maternal economic mobility (both upward and downward); however, it does not modify the relationship between maternal economic mobility and infant SGA rates.
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Affiliation(s)
- Shayna Hibbs
- Division of Neonatology-#45, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611, USA
| | - Blair A Simon
- Division of Neonatology-#45, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611, USA
| | - Julia Howland
- Department of Epidemiology, University of Illinois School of Public Health, Chicago, USA
| | - Kristin M Rankin
- Department of Epidemiology, University of Illinois School of Public Health, Chicago, USA
| | - James W Collins
- Division of Neonatology-#45, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611, USA.
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Falako S, Okoli N, Boateng MO, Sandoval J, Gumudavelly D, Larsuel S, Opara I. Utilizing Community-Centered Approaches to Address Black Maternal Mortality. HEALTH EDUCATION & BEHAVIOR 2023; 50:500-504. [PMID: 37525982 PMCID: PMC11161891 DOI: 10.1177/10901981231177078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
The rise of Black maternal mortality rates throughout the country demonstrates a great need to utilize innovative frameworks to craft solutions that improve health outcomes for Black birthing people. Previous research and interventions have examined individual- and policy-level factors to reduce maternal mortality; however, these methods may lack a true community-centered approach to understanding the experiences of Black birthing people in local communities that have been disproportionately impacted. In addition, certain research methods may not recognize other marginalized intersectional identities (e.g., Black transgender men) who experience inequities in Black maternal health. This commentary aims to provide recommendations for utilizing community-centered strategies on Black maternal mortality informed by community-based participatory research principles.
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Affiliation(s)
- Simileoluwa Falako
- Yale University, New Haven, CT, USA
- Columbia University, New York, NY, USA
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15
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Needham BL, Ali T, Allgood KL, Ro A, Hirschtick JL, Fleischer NL. Institutional Racism and Health: a Framework for Conceptualization, Measurement, and Analysis. J Racial Ethn Health Disparities 2023; 10:1997-2019. [PMID: 35994173 PMCID: PMC9395863 DOI: 10.1007/s40615-022-01381-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/28/2022]
Abstract
Despite growing interest in the health-related consequences of racially discriminatory institutional policies and practices, public health scholars have yet to reach a consensus on how to measure and analyze exposure to institutional racism. The purpose of this paper is to provide an overview of the conceptualization, measurement, and analysis of institutional racism in the context of quantitative research on minority health and health disparities in the United States. We begin by providing definitions of key concepts (e.g., racialization, racism, racial inequity) and describing linkages between these ideas. Next, we discuss the hypothesized mechanisms that link exposure to institutional racism with health. We then provide a framework to advance empirical research on institutional racism and health, informed by a literature review that summarizes measures and analytic approaches used in previous studies. The framework addresses six considerations: (1) policy identification, (2) population of interest, (3) exposure measurement, (4) outcome measurement, (5) study design, and (6) analytic approach. Research utilizing the proposed framework will help inform structural interventions to promote minority health and reduce racial and ethnic health disparities.
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Affiliation(s)
- Belinda L. Needham
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI USA
| | - Talha Ali
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT USA
| | - Kristi L. Allgood
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI USA
| | - Annie Ro
- Department of Health, Society, and Behavior, University of California-Irvine Program in Public Health, Irvine, CA USA
| | - Jana L. Hirschtick
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI USA
| | - Nancy L. Fleischer
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI USA
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Gao X, Snowden JM, Tucker CM, Allen A, Morello-Frosch R, Abrams B, Carmichael SL, Mujahid MS. Remapping racial and ethnic inequities in severe maternal morbidity: The legacy of redlining in California. Paediatr Perinat Epidemiol 2023; 37:379-389. [PMID: 36420897 PMCID: PMC10373920 DOI: 10.1111/ppe.12935] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/20/2022] [Accepted: 10/22/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Historical mortgage redlining, a racially discriminatory policy designed to uphold structural racism, may have played a role in producing the persistently elevated rate of severe maternal morbidity (SMM) among racialised birthing people. OBJECTIVE This study examined associations between Home-Owner Loan Corporation (HOLC) redlining grades and SMM in a racially and ethnically diverse birth cohort in California. METHODS We leveraged a population-based cohort of all live hospital births at ≥20 weeks of gestation between 1997 and 2017 in California. SMM was defined as having one of 21 procedures and diagnoses, per an index developed by Centers for Disease Control and Prevention. We characterised census tract-level redlining using HOLC's security maps for eight California cities. We assessed bivariate associations between HOLC grades and participant characteristics. Race and ethnicity-stratified mixed effects logistic regression models assessed the risk of SMM associated with HOLC grades within non-Hispanic Black, Asian/Pacific Islander, American Indian/Alaskan Native and Hispanic groups, adjusting for sociodemographic information, pregnancy-related factors, co-morbidities and neighbourhood deprivation index. RESULTS The study sample included 2,020,194 births, with 24,579 cases of SMM (1.2%). Living in a census tract that was graded as "Hazardous," compared to census tracts graded "Best" and "Still Desirable," was associated with 1.15 (95% confidence interval [CI] 1.03, 1.29) and 1.17 (95% CI 1.09, 1.25) times the risk of SMM among Black and Hispanic birthing people, respectively, independent of sociodemographic factors. These associations persisted after adjusting for pregnancy-related factors and neighbourhood deprivation index. CONCLUSIONS Historical redlining, a tool of structural racism that influenced the trajectory of neighbourhood social and material conditions, is associated with increased risk of experiencing SMM among Black and Hispanic birthing people in California. These findings demonstrate that addressing the enduring impact of macro-level and systemic mechanisms that uphold structural racism is a vital step in achieving racial and ethnic equity in birthing people's health.
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Affiliation(s)
- Xing Gao
- Division of Epidemiology, School of Public Health, University of California Berkeley, California, Berkeley, USA
| | - Jonathan M. Snowden
- Division of Epidemiology, School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon, USA
| | - Curisa M. Tucker
- Division of Neonatal & Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Amani Allen
- Division of Epidemiology, School of Public Health, University of California Berkeley, California, Berkeley, USA
- Division of Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Rachel Morello-Frosch
- Division of Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, California, USA
- Division of Environmental Health Sciences, University of California Berkeley, Berkeley, California, USA
- Department of Environmental Science, Policy and Management, University of California Berkeley, Berkeley, California, USA
| | - Barbara Abrams
- Division of Epidemiology, School of Public Health, University of California Berkeley, California, Berkeley, USA
- Division of Maternal Child and Adolescent Health, School of Public Health, University of California Berkeley, Berkeley, California, USA
- Division of Public Health Nutrition, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Suzan L. Carmichael
- Division of Neonatal & Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, California, USA
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Stanford University, Stanford, California, USA
| | - Mahasin S. Mujahid
- Division of Epidemiology, School of Public Health, University of California Berkeley, California, Berkeley, USA
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Matoba N, Collins JW, Dizon MLV. Fetal Origins of Health Disparities: Transgenerational Consequences of Racism. Dev Neurosci 2023; 46:112-118. [PMID: 37290414 DOI: 10.1159/000531462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 05/24/2023] [Indexed: 06/10/2023] Open
Abstract
Despite advances in perinatal medicine, racial disparity in birth outcomes remains a public health problem in the USA. The underlying mechanisms for this long-standing racial disparity are incompletely understood. This review presents transgenerational risk factors for racial disparities in preterm birth, exploring the impact of interpersonal and structural racism, theoretical models of stress, and biological markers of racial disparities.
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Affiliation(s)
- Nana Matoba
- Department of Pediatrics, Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Pediatrics, Division of Neonatology, University of California San Diego, Rady Children's Hospital San Diego, San Diego, California, USA
| | - James W Collins
- Department of Pediatrics, Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Maria L V Dizon
- Department of Pediatrics, Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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18
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Lemke MK, Brown KK, Fallah-Fini S, Hall A, Obasanya M. Complex systems and participatory approaches to address maternal health disparities: Findings from a system dynamics group model building project in North Texas. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 71:303-316. [PMID: 36378746 DOI: 10.1002/ajcp.12636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 10/23/2022] [Accepted: 11/03/2022] [Indexed: 06/06/2023]
Abstract
Focusing on non-Hispanic Black women (NHBW) in North Texas, this study employed participatory system dynamics modeling to explore three hypotheses: (1) stakeholders will conceptualize structural racism is a pervasive macrostructural force that exerts downstream impacts to shape and perpetuate maternal health disparities among NHBW; (2) stakeholders will identify key causal forces and leverage points that exist across levels of influence; and (3) stakeholders will identify complex interactions, in the form of circular causality, that are present among the key causal forces and leverage points that shape NHBW maternal health disparities. Nine participants engaged in a virtual system dynamics group model-building session that focused on eliciting key variables, behavior-over-time graphs (BOTGs), causal loop diagram (CLD), and targets for action. Participants identified 83 key variables. BOTGs included an average of 6.56 notations and time horizons that, on average, started in 1956. The CLD featured 11 reinforcing and seven balancing feedback loops. Eleven targets for action were identified. Structural racism was revealed as a pervasive macrostructural force that shaped maternal health outcomes among NHBW. Key causal forces and leverage points were identified across levels of influence. Finally, feedback loops within the CLD exhibited circular causality.
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Affiliation(s)
- Michael K Lemke
- Department of Social Sciences, University of Houston-Downtown, Houston, Texas, USA
| | - Kyrah K Brown
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA
| | - Saeideh Fallah-Fini
- Industrial and Manufacturing Engineering Department, California State Polytechnic University, Pomona, Pomona, California, USA
| | - Ariel Hall
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA
| | - Mercy Obasanya
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA
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19
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Braveman P. Preventing Maternal Mortality. Med Care 2023; 61:255-257. [PMID: 36929776 DOI: 10.1097/mlr.0000000000001847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Paula Braveman
- Family and Community Medicine, University of California, San Francisco, CA
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20
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Weiss AJ, Reina M, Matoba N, Prachand N, Collins JW. The Relation of Neighborhood Racial and Income Polarity to Preterm Birth Rates in Chicago. Matern Child Health J 2023; 27:556-565. [PMID: 36754921 DOI: 10.1007/s10995-023-03608-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVES To investigate the extent to which spatial social polarization is associated with preterm birth among urban African-American and non-Latinx white women, and whether prenatal care modifies this relationship. METHODS We performed multilevel logistic regression analyses on a 2013-2017 dataset of Chicago vital records (N = 29,179) with appended Index of Concentration at the Extremes (ICE) values for race and income. RESULTS Women who resided in the bottom ICE quintile neighborhoods had a preterm birth rate of 11.5%, compared to 7.3% for those who live in the top ICE quintile areas; adjusted odds ratio (aOR) equaled 1.72 (95% confidence interval [CI] = 1.39, 2.12). This disparity widened for early (< 34 weeks) preterm birth rates, aOR = 2.60 (1.77, 3.81). These associations persisted among women with adequate prenatal care utilization. CONCLUSIONS FOR PRACTICE Spatial polarization of race and income in urban African-American and non-Latinx white women's residential environment is strongly associated with preterm birth rates, even among those who receive adequate prenatal care. These findings highlight the benefit of using ICE to contextualize the impact of urban neighborhood-level characteristics on preterm birth rates.
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Affiliation(s)
- Aaron J Weiss
- Department of Pediatrics, Division of Neonatology, Nemours Children's Hospital, 6535 Nemours Parkway, Orlando, FL, 32827, USA. .,Department of Pediatrics, Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Margarita Reina
- City of Chicago, Department of Public Health, Epidemiology, Chicago, IL, USA
| | - Nana Matoba
- Department of Pediatrics, Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nik Prachand
- City of Chicago, Department of Public Health, Epidemiology, Chicago, IL, USA
| | - James W Collins
- Department of Pediatrics, Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Larkin CJ, Thirunavu VM, Nahi SL, Roumeliotis AG, Shlobin NA, Kandula V, Shah PV, Chan KS, Yerneni K, Abecassis ZA, Karras CL, Dahdaleh NS. Analysis of socioeconomic and demographic factors on post-treatment outcomes for metastatic spinal tumors. Clin Neurol Neurosurg 2023; 225:107581. [PMID: 36608466 DOI: 10.1016/j.clineuro.2022.107581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/29/2022] [Accepted: 12/29/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Sociodemographic factors may play a role in incidence and treatment of metastatic spinal tumors, as there is a delay in diagnosis and increased incidence of relevant primaries. There has yet to be a detailed analysis of the impact of sociodemographic factors on surgical outcomes for spinal metastases. We sought to examine the influence of socioeconomic factors on outcomes for patients with metastatic spinal tumors. METHODS Two hundred and sixty-three patients who underwent surgery for metastatic spinal tumors were identified. Sociodemographic characteristics were then collected and assigned to patients based on their ZIP code. The Chi-square test and the Mann-Whitney-U test were used for binary and continuous variables, respectively. Multivariate regression models were also used to control for age, smoking status, body mass index, and Charlson Comorbidity Index. RESULTS Males had significantly lower rates of post-treatment complication compared to females (22.7 % vs 39.3 %, p = 0.0052), and those in high educational attainment ZIP codes had significantly shorter length of stay (LOS) compared to low educational attainment ZIP codes (9.3 days vs 12.2 days, p = 0.0058). Multivariate regression revealed that living in a high percentage white ZIP code and being male significantly decreased risk of post-treatment complication by 19 % (p = 0.042) and 14 % (p = 0.032), respectively. Living in a high educational attainment ZIP code decreased LOS by 3 days (p = 0.019). CONCLUSIONS Males had significantly lower rates of post-treatment complication. Patients in high percentage white areas also had decreased rate of post-treatment complications. Patients living in areas with high educational attainment had shorter length of stay.
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Affiliation(s)
- Collin J Larkin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Vineeth M Thirunavu
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
| | - Skylar L Nahi
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Anastasios G Roumeliotis
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Viswajit Kandula
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Parth V Shah
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Kyle S Chan
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Ketan Yerneni
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Zachary A Abecassis
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Constantine L Karras
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Nader S Dahdaleh
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Balascio P, Moore M, Gongalla M, Regan A, Ha S, Taylor BD, Hill AV. Measures of Racism and Discrimination in Preterm Birth Studies. Obstet Gynecol 2023; 141:69-83. [PMID: 36701611 PMCID: PMC9886318 DOI: 10.1097/aog.0000000000005023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/29/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Preterm birth (any birth at less than 37 weeks of gestation) disproportionally affects Black birthing people and is associated with adverse perinatal and fetal health outcomes. Racism increases the risk of preterm birth, but standardized measurement metrics are elusive. This narrative synthesis examines literature on measures of racial discrimination used in preterm birth research. DATA SOURCES Six databases (CINAHL, Cochrane, EMBASE, PubMed [MEDLINE], Scopus, Web of Science) and ClinicalTrials.gov were searched. Search terms were categorized into three groups (racism terms, measurement terms, preterm birth terms) to identify original research articles that explored associations between racism and preterm birth. English-language, original research articles with U.S. populations were included. METHODS OF STUDY SELECTION Studies were excluded if conducted in only White populations, if only paternal factors were included, or if only racial differences in preterm birth were described. Articles were independently reviewed by two blinded researchers for inclusion at every stage of screening and data extraction; a third reviewer resolved discrepancies. TABULATION, INTEGRATION, AND RESULTS Sixty studies were included in the final analysis. Articles primarily included measures examining interpersonal forms of racism (n=17) through the Experiences of Discrimination and Everyday Discrimination scales, neighborhood composition (n=22) with the Neighborhood Deprivation Index and the Index of Concentration at the Extremes, policy-level racism (n=12) through institutions such as residential racial segregation or policy inequities, or multiple forms (n=9). CONCLUSION Among studies, assessment methods and application of constructs varied. This heterogeneity poses significant challenges to understanding associations between racial discrimination and preterm birth and to describing potential etiologic pathways of preterm birth, which ultimately hinders development of effective intervention. Strategies to capture multilevel exposures to racism require the development and expansion of metrics that are culturally inclusive, empirically valid, and reliable among Black pregnant populations. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022327484.
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Affiliation(s)
- Phoebe Balascio
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, and the Department of Sociology, College of Liberal Arts, Temple University, Philadelphia, Pennsylvania; the Division of Basic Science and Translational Research, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, Texas; and the School of Nursing and Health Professions, University of San Francisco, San Francisco, and the Department of Public Health, Health Science Research Institute, University of California, Merced, Merced, California
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Logan J, Crepaz N, Luo F, Dong X, Gant Z, Ertl A, Girod C, Patel N, Jin C, Balaji A, Sweeney P. HIV Care Outcomes in Relation to Racial Redlining and Structural Factors Affecting Medical Care Access Among Black and White Persons with Diagnosed HIV-United States, 2017. AIDS Behav 2022; 26:2941-2953. [PMID: 35277807 PMCID: PMC10428000 DOI: 10.1007/s10461-022-03641-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 11/30/2022]
Abstract
Black/African American (Black) versus White persons are unequally burdened by human immunodeficiency virus (HIV) in the United States. Structural factors can influence social determinants of health, key components in reducing HIV-related health inequality by race. This analysis examined HIV care outcomes among Black and White persons with diagnosed HIV (PWDH) in relation to three structural factors: racial redlining, Medicaid expansion, and Ryan White HIV/AIDS Program (RWHAP) use. Using National HIV Surveillance System, U.S. Census, and Home Mortgage Disclosure Act data, we examined linkage to HIV care and viral suppression (i.e., viral load < 200 copies/mL) in relation to the structural factors among 12,996 Black and White PWDH with HIV diagnosed in 2017/alive at year-end 2018, aged ≥ 18 years, and residing in 38 U.S. jurisdictions with complete laboratory data, geocoding, and census tract-level redlining indexes. Compared to White PWDH, a lower proportion of Black PWDH were linked to HIV care within 1 month after diagnosis and were virally suppressed in 2018. Redlining was not associated with the HIV care outcomes. A higher prevalence of PWDH residing (v. not residing) in states with Medicaid expansion were linked to HIV care ≤ 1 month after diagnosis. A higher prevalence of those residing (v. not residing) in states with > 50% of PWDH in RWHAP had viral suppression. Direct exposure to redlining was not associated with poor HIV care outcomes. Structural factors that reduce the financial burden of HIV care and improve care access like Medicaid expansion and RWHAP might improve HIV care outcomes of PWDH.
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Affiliation(s)
- J Logan
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 1600 Clifton Road NE, MS US8-2, Atlanta, GA, 30333, USA.
| | - Nicole Crepaz
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 1600 Clifton Road NE, MS US8-2, Atlanta, GA, 30333, USA
| | - Feijun Luo
- Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Zanetta Gant
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 1600 Clifton Road NE, MS US8-2, Atlanta, GA, 30333, USA
| | - Allison Ertl
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Candace Girod
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nimeshkumar Patel
- Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Chan Jin
- ICF International, Atlanta, GA, USA
| | - Alexandra Balaji
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 1600 Clifton Road NE, MS US8-2, Atlanta, GA, 30333, USA
| | - Patricia Sweeney
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 1600 Clifton Road NE, MS US8-2, Atlanta, GA, 30333, USA
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Chu MT, Ettinger de Cuba S, Fabian MP, Lane KJ, James-Todd T, Williams DR, Coull BA, Carnes F, Massaro M, Levy JI, Laden F, Sandel M, Adamkiewicz G, Zanobetti A. The immigrant birthweight paradox in an urban cohort: Role of immigrant enclaves and ambient air pollution. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2022; 32:571-582. [PMID: 34980894 PMCID: PMC9250941 DOI: 10.1038/s41370-021-00403-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Foreign-born Black and Latina women on average have higher birthweight infants than their US-born counterparts, despite generally worse socioeconomic indicators and prenatal care access, i.e., "immigrant birthweight paradox" (IBP). Residence in immigrant enclaves and associated social-cultural and economic benefits may be drivers of IBP. Yet, enclaves have been found to have higher air pollution, a risk factor for lower birthweight. OBJECTIVE We investigated the association of immigrant enclaves and children's birthweight accounting for prenatal ambient air pollution exposure. METHODS In the Boston-based Children's HealthWatch cohort of mother-child dyads, we obtained birthweight-for-gestational-age z-scores (BWGAZ) for US-born births, 2006-2015. We developed an immigrant enclave score based on census-tract percentages of foreign-born, non-citizen, and linguistically-isolated households statewide. We estimated trimester-specific PM2.5 concentrations and proximity to major roads based residential address at birth. We fit multivariable linear regressions of BWGAZ and examined effect modification by maternal nativity. Analyses were restricted to nonsmoking women and term births. RESULTS Foreign-born women had children with 0.176 (95% CI: 0.092, 0.261) higher BWGAZ than US-born women, demonstrating the IBP in our cohort. Immigrant enclave score was not associated with BWGAZ, even after adjusting for air pollution exposures. However, this association was significantly modified by maternal nativity (pinteraction = 0.014), in which immigrant enclave score was positively associated with BWGAZ for only foreign-born women (0.090, 95% CI: 0.007, 0.172). Proximity to major roads was negatively associated with BWGAZ (-0.018 per 10 m, 95% CI: -0.032, -0.003) and positively correlated with immigrant enclave scores. Trimester-specific PM2.5 concentrations were not associated with BWGAZ. SIGNIFICANCE Residence in immigrant enclaves was associated with higher birthweight children for foreign-born women, supporting the role of immigrant enclaves in the IBP. Future research of the IBP should account for immigrant enclaves and assess their spatial correlation with potential environmental risk factors and protective resources.
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Affiliation(s)
- MyDzung T Chu
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.
| | | | - M Patricia Fabian
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Kevin James Lane
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Tamarra James-Todd
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of African and African American Studies, Harvard University, Cambridge, MA, USA
| | - Brent A Coull
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Fei Carnes
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Marisa Massaro
- Biostatistics and Epidemiology Data Analytics Center, School of Public Health, Boston University, Boston, MA, USA
| | - Jonathan I Levy
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Francine Laden
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Megan Sandel
- Department of Pediatrics, School of Medicine, Boston University, Boston, MA, USA
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Ndukwe T, Cole E, Scanzera AC, Chervinko MA, Chiang MF, Campbell JP, Chan RVP. Health Equity and Disparities in ROP Care: A Need for Systematic Evaluation. Front Pediatr 2022; 10:806691. [PMID: 35433564 PMCID: PMC9010777 DOI: 10.3389/fped.2022.806691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/03/2022] [Indexed: 12/04/2022] Open
Abstract
Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder that can have devastating visual sequelae if not managed appropriately. From an ophthalmology standpoint, ROP care is complex, since it spans multiple care settings and providers, including those in the neonatal intensive care unit (NICU), step down nurseries, and the outpatient clinic setting. This requires coordination and communication between providers, ancillary staff, and most importantly, effective communication with the patient's family members and caregivers. Often, factors related to the social determinants of health play a significant role in effective communication and care coordination with the family, and it is important for ophthalmologists to recognize these risk factors. The aim of this article is to (1) review the literature related to disparities in preterm birth outcomes and infants at risk for ROP; (2) identify barriers to ROP care and appropriate follow up, and (3) describe patient-oriented solutions and future directions for improving ROP care through a health equity lens.
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Affiliation(s)
- Tochukwu Ndukwe
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Emily Cole
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Angelica C. Scanzera
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Margaret A. Chervinko
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Michael F. Chiang
- National Institutes of Health, National Eye Institute, Bethesda, MD, United States
| | - John Peter Campbell
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR, United States
| | - Robison Vernon Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
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Collins JW, David RJ. Black Babies Matter. Clin Perinatol 2022; 49:93-101. [PMID: 35210011 DOI: 10.1016/j.clp.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Despite dramatic advancements in neonatal intensive care since the 1960s, African-American infants still have more than a two-fold higher first-year mortality rate than non-Latinx White infants. Our essay examines the impact of upstream factors closely linked to the historical and contemporary context of structural racism in the United States on the African-American women's birth outcome disadvantage. In the process, we propose a paradigm to address the racial health inequity in adverse birth outcome by considering the interplay of racism and social class.
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Affiliation(s)
- James W Collins
- Neonatal Intensive Care Unit, Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Box 45, 225 E. Chicago Avenue, Chicago, IL 60611, USA.
| | - Richard J David
- Division of Neonatology, Stroger Hospital of Cook County, University of Illinois at Chicago College of Medicine, 1969 Ogden Avenue, Chicago, IL 60612, USA
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Infant Mortality Rates Among US-Born and Foreign-Born Latinx Women: The Effect of Black Race. Matern Child Health J 2022; 26:511-516. [PMID: 35199230 DOI: 10.1007/s10995-021-03366-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine the extent to which Black race is associated with the infant mortality rate (< 365 day, IMR) of births to US-born and foreign-born Latinx women. METHODS Stratified and multivariable binominal log-linear regression analyses were performed on the 2010-2013 National Center for Health Statistics linked birth-death certificate files of singleton infants. RESULTS The IMR of births to US-born Black Latinx women (N = 54,542) exceeded that of births to US-born White Latinx women (N = 1,320,084): 5.7/1000 vs 4.2/1000, RR = 1.4 (1.2, 1.5). In contrast, the IMR of births to foreign-born Black Latinx women (N = 35,544) approximated that of births to foreign-born White Latinx women (N = 1,372,172): 3.8/1000 vs 3.6/1000, RR = 1.0 (0.9, 1.2) The adjusted (controlling for maternal age, education, prenatal care, high parity, and region of residence) RR of infant mortality for births to US-born and foreign-born Black (versus non-Latinx White) Latinx women equaled 1.4 (1.2, 1.6) and 1.0 (0.8, 1.2), respectively. The adjusted RR of infant mortality for births to US-born and foreign-born White (versus non-Latinx White) Latinx women equaled 1.0 (0.9, 1.0) and 0.8 (0.7, 0.8), respectively. CONCLUSIONS Black race is associated with a 1.4-fold higher IMR among births to US-born Latinx women. A similar phenomenon does not occur among foreign-born Latinx women. These intriguing findings highlight that the social construct of Black race across the life-course of Latinx women are detrimental to infant outcome.
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Johnson JD, Louis JM. Does race or ethnicity play a role in the origin, pathophysiology, and outcomes of preeclampsia? An expert review of the literature. Am J Obstet Gynecol 2022; 226:S876-S885. [PMID: 32717255 DOI: 10.1016/j.ajog.2020.07.038] [Citation(s) in RCA: 92] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/17/2020] [Accepted: 07/22/2020] [Indexed: 12/15/2022]
Abstract
The burden of preeclampsia, a substantial contributor to perinatal morbidity and mortality, is not born equally across the population. Although the prevalence of preeclampsia has been reported to be 3% to 5%, racial and ethnic minority groups such as non-Hispanic Black women and American Indian or Alaskan Native women are widely reported to be disproportionately affected by preeclampsia. However, studies that add clarity to the causes of the racial and ethnic differences in preeclampsia are limited. Race is a social construct, is often self-assigned, is variable across settings, and fails to account for subgroups. Studies of the genetic structure of human populations continue to find more variations within racial groups than among them. Efforts to examine the role of race and ethnicity in biomedical research should consider these limitations and not use it as a biological construct. Furthermore, the use of race in decision making in clinical settings may worsen the disparity in health outcomes. Most of the existing data on disparities examine the differences between White and non-Hispanic Black women. Fewer studies have enough sample size to evaluate the outcomes in the Asian, American Indian or Alaskan Native, or mixed-race women. Racial differences are noted in the occurrence, presentation, and short-term and long-term outcomes of preeclampsia. Well-established clinical risk factors for preeclampsia such as obesity, diabetes, and chronic hypertension disproportionately affect non-Hispanic Black, American Indian or Alaskan Native, and Hispanic populations. However, with comparable clinical risk factors for preeclampsia among women of different race or ethnic groups, addressing modifiable risk factors has not been found to have the same protective effect for all women. Abnormalities of placental formation and development, immunologic factors, vascular changes, and inflammation have all been identified as contributing to the pathophysiology of preeclampsia. Few studies have examined race and the pathophysiology of preeclampsia. Despite attempts, a genetic basis for the disease has not been identified. A number of genetic variants, including apolipoprotein L1, have been identified as possible risk modifiers. Few studies have examined race and prevention of preeclampsia. Although low-dose aspirin for the prevention of preeclampsia is recommended by the US Preventive Service Task Force, a population-based study found racial and ethnic differences in preeclampsia recurrence after the implementation of low-dose aspirin supplementation. After implementation, recurrent preeclampsia reduced among Hispanic women (76.4% vs 49.6%; P<.001), but there was no difference in the recurrent preeclampsia in non-Hispanic Black women (13.7 vs 18.1; P=.252). Future research incorporating the National Institute on Minority Health and Health Disparities multilevel framework, specifically examining the role of racism on the burden of the disease, may help in the quest for effective strategies to reduce the disproportionate burden of preeclampsia on a minority population. In this model, a multilevel framework provides a more comprehensive approach and takes into account the influence of behavioral factors, environmental factors, and healthcare systems, not just on the individual.
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Affiliation(s)
- Jasmine D Johnson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC
| | - Judette M Louis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL.
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Li M, Yuan F. Historical Redlining and Resident Exposure to COVID-19: A Study of New York City. RACE AND SOCIAL PROBLEMS 2022; 14:85-100. [PMID: 34178163 PMCID: PMC8212581 DOI: 10.1007/s12552-021-09338-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 05/17/2023]
Abstract
The Coronavirus Disease 2019 (COVID-19) has been reported to disproportionately impact racial/ethnic minorities in the USA, both in terms of infections and deaths. This racial disparity in the COVID-19 outcomes may result from the segregation of minorities in neighborhoods with health-compromising conditions. We, thus, anticipate that neighborhoods would be especially vulnerable to COVID-19 if they are of present-day economic and racial disadvantage and were redlined historically. To test this expectation, we examined the change of both confirmed COVID-19 cases and deaths from April to July, 2020, in zip code tabulation areas (ZCTAs) in the New York City using multilevel regression analysis. The results indicate that ZCTAs with a higher proportion of black and Hispanic populations are associated with a higher percentage of COVID-19 infection. Historically low-graded neighborhoods show a higher risk for COVID-19 infection, even for ZCTAs with present-day economic and racial privilege. These associations change over time as the pandemic unfolds. Racial/ethnic minorities are bearing the brunt of the COVID-19 pandemic's health impact. The current evidence shows that the pre-existing social structure in the form of racial residential segregation could be partially responsible for the disparities observed, highlighting an urgent need to stress historical segregation and to build a less segregated and more equal society.
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Affiliation(s)
- Min Li
- Department of Anthropology & Sociology, Western Carolina University, 107A Mckee Building, 1 University Drive, Cullowhee, NC 28723 USA
| | - Faxi Yuan
- Zachry Department of Civil Engineering, Texas A&M University, College Station, TX 77843 USA
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30
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Hwang SS. The Limitations of Race/Ethnicity Categories in Reporting and Addressing (Disparities in Perinatal Health Outcomes. J Pediatr 2022; 240:9-10. [PMID: 34752808 DOI: 10.1016/j.jpeds.2021.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Sunah S Hwang
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
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31
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Braveman P, Dominguez TP, Burke W, Dolan SM, Stevenson DK, Jackson FM, Collins JW, Driscoll DA, Haley T, Acker J, Shaw GM, McCabe ERB, Hay WW, Thornburg K, Acevedo-Garcia D, Cordero JF, Wise PH, Legaz G, Rashied-Henry K, Frost J, Verbiest S, Waddell L. Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:684207. [PMID: 36303973 PMCID: PMC9580804 DOI: 10.3389/frph.2021.684207] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022] Open
Abstract
In 2017-2019, the March of Dimes convened a workgroup with biomedical, clinical, and epidemiologic expertise to review knowledge of the causes of the persistent Black-White disparity in preterm birth (PTB). Multiple databases were searched to identify hypothesized causes examined in peer-reviewed literature, 33 hypothesized causes were reviewed for whether they plausibly affect PTB and either occur more/less frequently and/or have a larger/smaller effect size among Black women vs. White women. While definitive proof is lacking for most potential causes, most are biologically plausible. No single downstream or midstream factor explains the disparity or its social patterning, however, many likely play limited roles, e.g., while genetic factors likely contribute to PTB, they explain at most a small fraction of the disparity. Research links most hypothesized midstream causes, including socioeconomic factors and stress, with the disparity through their influence on the hypothesized downstream factors. Socioeconomic factors alone cannot explain the disparity's social patterning. Chronic stress could affect PTB through neuroendocrine and immune mechanisms leading to inflammation and immune dysfunction, stress could alter a woman's microbiota, immune response to infection, chronic disease risks, and behaviors, and trigger epigenetic changes influencing PTB risk. As an upstream factor, racism in multiple forms has repeatedly been linked with the plausible midstream/downstream factors, including socioeconomic disadvantage, stress, and toxic exposures. Racism is the only factor identified that directly or indirectly could explain the racial disparities in the plausible midstream/downstream causes and the observed social patterning. Historical and contemporary systemic racism can explain the racial disparities in socioeconomic opportunities that differentially expose African Americans to lifelong financial stress and associated health-harming conditions. Segregation places Black women in stressful surroundings and exposes them to environmental hazards. Race-based discriminatory treatment is a pervasive stressor for Black women of all socioeconomic levels, considering both incidents and the constant vigilance needed to prepare oneself for potential incidents. Racism is a highly plausible, major upstream contributor to the Black-White disparity in PTB through multiple pathways and biological mechanisms. While much is unknown, existing knowledge and core values (equity, justice) support addressing racism in efforts to eliminate the racial disparity in PTB.
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Affiliation(s)
- Paula Braveman
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Tyan Parker Dominguez
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Wylie Burke
- University of Washington School of Medicine, Seattle, WA, United States
| | - Siobhan M. Dolan
- Albert Einstein College of Medicine, New York, NY, United States
| | | | | | - James W. Collins
- Northwestern University School of Medicine, Chicago, IL, United States
| | - Deborah A. Driscoll
- University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Terinney Haley
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Julia Acker
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Gary M. Shaw
- Stanford University School of Medicine, Stanford, CA, United States
| | - Edward R. B. McCabe
- David Geffen School of Medicine at University of California, Los Angeles, CA, United States
| | | | - Kent Thornburg
- School of Medicine, Oregon State University, Portland, OR, United States
| | | | - José F. Cordero
- University of Georgia College of Public Health, Athens, GA, United States
| | - Paul H. Wise
- Stanford University School of Medicine, Stanford, CA, United States
| | - Gina Legaz
- March of Dimes, White Plains, NY, United States
| | | | | | - Sarah Verbiest
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Gailey S, Cross RI, Messer LC, Bruckner TA. Characteristics associated with downward residential mobility among birthing persons in California. Soc Sci Med 2021; 279:113962. [PMID: 34020159 DOI: 10.1016/j.socscimed.2021.113962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/10/2021] [Accepted: 04/21/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Substantial research documents health consequences of neighborhood disadvantage. Patterns of residential mobility that differ by race/ethnicity and socioeconomic status (SES) may sort non-Hispanic (NH) Black and low-SES families into disadvantaged neighborhoods. In this study, we leverage a sibling-linked dataset to track residential mobility among birthing persons between pregnancies and investigate baseline characteristics associated with downward mobility, including race/ethnicity, SES, and pre-existing health conditions. METHODS We used a probabilistic linkage strategy to identify births to the same person between 2007 and 2015 (n = 624,222) and categorized downward residential mobility by quartile-level increases in neighborhood disadvantage. We defined strong downward mobility as a move from a neighborhood with very low (quartile 1) to very high (quartile 4) disadvantage and estimated the logit (i.e., log-odds) of strong downward mobility as a function of racial/ethnic, sociodemographic, and health characteristics of the birthing person and their first birth. We further explored the role of neighborhood housing affordability by examining changes in affordability from first to second birth by race/ethnicity. RESULTS NH Black birthing persons show an over three-fold increased odds of strong downward mobility relative to NH white birthing persons (OR = 3.34, CI: 2.91, 3.84). To a lesser extent, Hispanic race/ethnicity, WIC receipt, low educational attainment, obesity, and infant preterm birth (PTB) also predict strong downward mobility. Examination of changes in neighborhood affordability indicate that over half of NH Black birthing persons move to a more affordable neighborhood, compared to less than a quarter of NH white birthing persons, before the birth of their second child. Results remain consistent across outcomes, measures of neighborhood SES, and modified log-Poisson models. CONCLUSION We find an elevated risk of strong downward mobility among NH Black and low-SES birthing persons. Future research may identify other factors (e.g., housing affordability) that generate downward residential mobility to identify interventions that promote neighborhood equity.
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Affiliation(s)
- Samantha Gailey
- School of Social Ecology, University of California Irvine, Irvine, CA, USA.
| | - Rebekah Israel Cross
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Lynne C Messer
- OHSU-PSU School of Public Health, Portland State University, Portland, OR, USA
| | - Tim A Bruckner
- Program in Public Health & Center for Population, Inequality, and Policy, University of California Irvine, Irvine, CA, USA
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García AA, West Ohueri C, Garay R, Guzmán M, Hanson K, Vasquez M, Zuñiga J, Tierney W. Community engagement as a foundation for improving neighborhood health. Public Health Nurs 2021; 38:223-231. [PMID: 33522011 DOI: 10.1111/phn.12870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/02/2021] [Accepted: 01/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Health inequities and disparities are associated with non-White race/ethnicity, immigrant status, income, and geographic location. Community engagement is essential to identify health and social needs and to plan health care and social services programs. To begin a larger community-based participatory study, the purpose of this study was to explore community residents' perceptions of barriers and facilitators to achieving and maintaining health. DESIGN, SAMPLE, AND MEASUREMENTS This qualitative descriptive study used focus group interviews. We recruited a convenience sample (n = 50) from community meetings and gathering for five audio-recorded focus groups that used a semi-structured interview guide. Transcripts were coded to identify common topics in each group and major themes across groups. RESULTS Participants were predominantly women (58%), Hispanic/Latinx, and Spanish-speaking (57%), who rented their homes (69%). Two main themes emerged: (a) social determinants as barriers to health and (b) need for trust to participate in health programs. CONCLUSIONS Although health care providers are frequently concerned about providing access to care, community members identified a variety of social determinants that affected their health. Listening and responding to community members' priorities are the foundation to improving health in neighborhoods directly affected by inequities.
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Affiliation(s)
| | - Chelsi West Ohueri
- Department of Anthropology, The University of Texas at Austin College of Liberal Arts, Austin, TX, USA
| | - Ricardo Garay
- Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Monica Guzmán
- Restore Rundberg Neighborhood Revitalization Project, Austin, TX, USA
| | - Kacey Hanson
- Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Monique Vasquez
- Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Julie Zuñiga
- The University of Texas at Austin School of Nursing, Austin, TX, USA
| | - William Tierney
- Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, TX, USA
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Matoba N, Mestan KK, Collins JW. Understanding Racial Disparities of Preterm Birth Through the Placenta. Clin Ther 2021; 43:287-296. [PMID: 33483135 DOI: 10.1016/j.clinthera.2020.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 01/13/2023]
Abstract
The racial disparity associated with preterm birth is a public health concern in the United States. The placenta is the principal metabolic, respiratory, and endocrine organ of the fetus and a key route by which environmental exposures are transmitted from mother to offspring. Available at every delivery, it may serve as a marker of differences in prenatal exposures that manifest differently by race. Recently, we described differences in placental pathology between African-American and White preterm births: the prevalence of chronic inflammation was higher among African-American women's placentas compared with those of White women. Similarly, racial differences have been shown in placental malperfusion and placental weight. Social determinants such as poverty and stress from discrimination have been implicated in racial disparities in preterm birth. To date, however, the underlying biological mechanisms, whether through inflammatory, oxidative stress, or other pathways involving epigenetic programming, remain largely unknown. The placenta, complemented by maternal and umbilical cord blood biomarkers, may provide important information on the perinatal environment that explains the origins of racial disparities in preterm birth rates and subsequent health outcomes. This article reviews existing literature and current research gaps. Opportunities are discussed for future placental research that may reveal novel mechanisms leading to the development of new approaches in the prevention and management of preterm birth and its outcomes.
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Affiliation(s)
- Nana Matoba
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Department of Pediatrics, Division of Neonatology, Chicago, IL, USA.
| | - Karen K Mestan
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Department of Pediatrics, Division of Neonatology, Chicago, IL, USA
| | - James W Collins
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Department of Pediatrics, Division of Neonatology, Chicago, IL, USA
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35
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Heard-Garris N, Boyd R, Kan K, Perez-Cardona L, Heard NJ, Johnson TJ. Structuring Poverty: How Racism Shapes Child Poverty and Child and Adolescent Health. Acad Pediatr 2021; 21:S108-S116. [PMID: 34740417 PMCID: PMC8574214 DOI: 10.1016/j.acap.2021.05.026] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/14/2021] [Accepted: 05/26/2021] [Indexed: 01/01/2023]
Abstract
Black, Native, and Latinx populations represent the racial and ethnic groups most impacted by poverty. This unequal distribution of poverty must be understood as a consequence of policy decisions-some that have sanctioned violence and others that have created norms-that continue to shape who has access to power, resources, rights, and protections. In this review, we draw on scholarship from multiple disciplines, including pediatrics, public health, environmental health, epidemiology, social and biomedical science, law, policy, and urban planning to explore the central question-What is the relationship between structural racism, poverty, and pediatric health? We discuss historic and present-day events that are critical to the understanding of poverty in the context of American racism and pediatric health. We challenge conventional paradigms that treat racialized poverty as an inherent part of American society. We put forth a conceptual framework to illustrate how white supremacy and American capitalism drive structural racism and shape the racial distribution of resources and power where children and adolescents live, learn, and play, ultimately contributing to pediatric health inequities. Finally, we offer antipoverty strategies grounded in antiracist practices that contend with the compounding, generational impact of racism and poverty on heath to improve child, adolescent, and family health.
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Affiliation(s)
- Nia Heard-Garris
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago (N Heard-Garris and K Kan), Chicago, Ill; Northwestern University Feinberg School of Medicine (N Heard-Garris and K Kan), Chicago, Ill; Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago (N Heard-Garris, K Kan, and L Perez-Cardona), Chicago, Ill.
| | - Rhea Boyd
- Palo Alto Medical Foundation (R Boyd), San Francisco, Calif
| | - Kristin Kan
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago (N Heard-Garris and K Kan), Chicago, Ill; Northwestern University Feinberg School of Medicine (N Heard-Garris and K Kan), Chicago, Ill; Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago (N Heard-Garris, K Kan, and L Perez-Cardona), Chicago, Ill
| | - Leishla Perez-Cardona
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago (N Heard-Garris, K Kan, and L Perez-Cardona), Chicago, Ill
| | - Nevin J Heard
- College of Education, Roosevelt University (N Heard), Chicago, Ill
| | - Tiffani J Johnson
- Department of Emergency Medicine, University of California, Davis (TJ Johnson), Sacramento, Calif
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Johnson JD, Green CA, Vladutiu CJ, Manuck TA. Racial Disparities in Prematurity Persist among Women of High Socioeconomic Status. Am J Obstet Gynecol MFM 2020; 2:100104. [PMID: 33179010 DOI: 10.1016/j.ajogmf.2020.100104] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives Despite persistent racial disparities in preterm birth (PTB) in the US among non-Hispanic (NH) black women compared to NH white women, it remains controversial whether sociodemographic factors can explain these differences. We sought to evaluate whether disparities in PTB persist among NH black women with high socioeconomic status (SES). Study Design We conducted a population-based cohort study of all live births in the US from 2015-2017 using birth certificate data from the National Vital Statistics System. We included singleton, non-anomalous live births among women who were of high SES (defined as having ≥ 16 years of education, private insurance, and not receiving Women, Infants and Children [WIC] benefits) and who identified as NH white, NH black, or 'mixed' NH black and white race. The primary outcome was PTB <37 weeks; secondary outcomes included PTB <34 and <28 weeks. In addition, analyses were repeated considering birthweight <2500g as a surrogate for preterm birth <37 weeks, birthweight <1500g as a surrogate for preterm birth <34 weeks, and birthweight <750g as a surrogate for preterm birth <28 weeks' gestation. Data were analyzed with chi-square, t-test, and logistic regression. Results 2,170,686 live births met inclusion criteria, with 92.9% NH white, 6.7% NH black, and 0.4% both NH white and black race. Overall, 5.9% delivered <37, 1.3% <34, and 0.3 % <28 weeks. In unadjusted analyses of women with high SES, the PTB rate at each gestational age cutoff was higher for women of 'mixed' NH white and black race, and highest for women who were NH black only compared to women who were NH white only. In regression models we further adjusted for women with insurance and prenatal care their entire pregnancy, maternal race was associated with higher odds of PTB at each GA cutoff, with the highest odds observed at <28 weeks. Finally, in further adjustement analysis including only the 1,934,912 women who received prenatal care in the first trimester, findings were similar. Rates of preterm birth at each gestational age cutoff remained highest for women who identified as non-Hispanic black, intermediate for women identifying as both non-Hispanic black and white race, and lowest for non-Hispanic white women at <37 weeks (9.9% vs. 6.1% vs. 5.5%, respectively; p<0.001), <34 weeks (3.5% vs. 1.5% vs. 1.1%, respectively; p<0.001), and <28 weeks' gestation (1.2% vs. 0.4% vs. 0.2%, respectively, p<0.001). Conclusions Even among college-educated women with private insurance who are not receiving WIC, racial disparities in prematurity persist. These national findings are consistent with prior studies that suggest factors other than socio-demographics are important in the underlying pathogenesis of PTB.
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Affiliation(s)
- Jasmine D Johnson
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC
| | - Celeste A Green
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC
| | - Catherine J Vladutiu
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC
| | - Tracy A Manuck
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC
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