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Basu S, Venkataramani AS, Schillinger D. The Risk Of Perpetuating Health Disparities Through Cost-Effectiveness Analyses. Health Aff (Millwood) 2024; 43:1165-1171. [PMID: 39102593 DOI: 10.1377/hlthaff.2023.01583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
Cost-effectiveness analyses are commonly used to inform health care and public health policy decisions. However, standard approaches may systematically disadvantage marginalized groups by incorporating assumptions of persisting health inequities. We examined how competing risks, baseline health care costs, and indirect costs can differentially affect cost-effectiveness analyses for racial and ethnic minority populations. We illustrate that these structural factors can reduce estimated quality-adjusted life-years and cost savings for disadvantaged groups, making interventions focused on disadvantaged populations appear less cost-effective. For example, analyses of a sugar-sweetened beverage tax may estimate higher costs per quality-adjusted life-year gained for Black versus White populations because of differences in competing risks and insurance status that manifest in higher health care cost savings from averted disease among White people. To ensure that cost-effectiveness assessments do not perpetuate inequities, alternative approaches are needed that account for the impact of structural factors on different groups and that consider scenarios in which health inequities are reduced. Sensitivity analyses focusing on health equity could help advance interventions that disproportionately benefit disadvantaged communities.
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Affiliation(s)
- Sanjay Basu
- Sanjay Basu , Waymark, San Francisco, California
| | | | - Dean Schillinger
- Dean Schillinger, University of California San Francisco, San Francisco, California
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Tabb LP, Bayliss R, Xu Y. Spatial and spatio-temporal statistical implications for measuring structural racism: A review of three widely used residential segregation measures. Spat Spatiotemporal Epidemiol 2024; 50:100678. [PMID: 39181606 DOI: 10.1016/j.sste.2024.100678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 08/27/2024]
Abstract
Social determinants of health are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning and quality of life outcomes and risks - these social determinants of health often aid in explaining the racial and ethnic health inequities present in the United States (US). The root cause of these social determinants of health has been tied to structural racism, and residential segregation is one such domain of structural racism that allows for the operationalization of the geography of structural racism. This review focuses on three residential segregation measures that are often utilized to capture segregation as a function of race/ethnicity, income, and simultaneously race/ethnicity and income. Empirical findings related to the spatial and spatio-temporal heterogeneity of these residential segregation measures are presented. We also discuss some of the implications of utilizing these three residential segregation measures.
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Affiliation(s)
- Loni Philip Tabb
- Department of Epidemiology and Biostatistics, Drexel University, Dornsife School of Public Health, Philadelphia, PA, USA.
| | - Ruby Bayliss
- Department of Epidemiology and Biostatistics, Drexel University, Dornsife School of Public Health, Philadelphia, PA, USA
| | - Yang Xu
- Department of Epidemiology and Biostatistics, Drexel University, Dornsife School of Public Health, Philadelphia, PA, USA
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Kim H, Mahmood A, Kedia S, Ogunsanmi DO, Sharma S, Wyant DK. Impact of Residential Segregation on Healthcare Utilization and Perceived Quality of Care Among Informal Caregivers in the United States. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02018-9. [PMID: 38758399 DOI: 10.1007/s40615-024-02018-9] [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: 02/01/2024] [Revised: 04/10/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024]
Abstract
This study aimed to investigate the impact of racial residential segregation on healthcare utilization and perceived quality of care among informal caregivers in the US. It further assessed potential variations in the estimated impact across caregivers' race and socioeconomic status. We used data from the Health Information National Trends Survey Data Linkage Project (fielded in 2020) for a sample of 583 self-identified informal caregivers in the US. Fitting a series of regression models with the maximum likelihood estimation, we computed the beta coefficients (β) of interest and their associated Wald 95% confidence limits (CI). Caregivers who resided in areas with higher segregation, compared to those living in lower segregated areas, were less likely to visit a healthcare professional [β = - 2.08; Wald 95%CI - 2.093, - 2.067] (moderate); [β = - 2.53; Wald 95%CI - 2.549, - 2.523] (high)]. Further, caregivers residing in moderate [β = - 0.766; Wald 95%CI - 0.770, - 0.761] and high [β = - 0.936; Wald 95%CI - 0.941, - 0.932] segregation regions were less likely to perceive a better quality of care compared to those located in low segregation areas. Moreover, as segregation level increased, Black caregivers were less likely to see a health professional, less frequently used healthcare services, and had poorer perceived healthcare quality when compared to Whites. Our findings indicate that higher residential segregation is associated with lower healthcare utilization, such as visiting a healthcare professional, and poorer perceived healthcare quality among informal caregivers. Given the essential role of informal caregivers in the current healthcare system, it is vital to investigate and address challenges associated with access to and quality of essential healthcare services to improve caregivers' health and well-being, specifically for caregivers of minority backgrounds.
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Affiliation(s)
- Hyunmin Kim
- College of Nursing and Health Professions, School of Health Professions, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - Asos Mahmood
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, 956 Court Ave Avenue, Ste D222A, Memphis, TN, 38103, USA.
- Department of Medicine-General Internal Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Deborah O Ogunsanmi
- Tennessee Population Health Consortium and Institute for Health Outcomes and Policy Research, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sadikshya Sharma
- College of Nursing and Health Professions, School of Health Professions, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - David K Wyant
- Jack C. Massey College of Business, Frist College of Medicine, Belmont University, Nashville, TN, USA
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Vu H, Green TL, Swan LET. Born on the wrong side of the tracks: Exploring the causal effects of segregation on infant health. JOURNAL OF HEALTH ECONOMICS 2024; 95:102876. [PMID: 38763530 DOI: 10.1016/j.jhealeco.2024.102876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 01/24/2024] [Accepted: 03/15/2024] [Indexed: 05/21/2024]
Abstract
Prior research has found that a high level of residential racial segregation, or the degree to which racial/ethnic groups are isolated from one another, is associated with worsened infant health outcomes, particularly among non-Hispanic (NH) Black infant populations. However, because exposure to segregation is non-random, it is unclear whether and to what extent segregation is causally linked to infant health. To overcome this empirical limitation, we leverage exogenous variation in the placement of railroad tracks in the 19th century to predict contemporary segregation, an approach first introduced by Ananat (2011). In alignment with prior literature, we find that residential segregation has statistically significant associations with negative birth outcomes among Black infant populations in the area. Using OLS methods underestimates the negative impacts of segregation on infant health. We fail to detect comparable effects on health outcomes among NH White infant populations. Further, we identify several key mechanisms by which residential segregation could influence health outcomes among Black infant populations, including lower access to prenatal care during the first trimester, higher levels of anti-Black prejudice, greater transportation barriers, and increased food insecurity. Given that poor birth outcomes have adverse effects on adults' health and well-being, the findings suggest that in-utero exposure to residential segregation could have important implications for Black-White inequality over the life course.
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Affiliation(s)
- Hoa Vu
- School of Education and Social Policy, Northwestern University, United States of America.
| | - Tiffany L Green
- Department of Population Health Sciences, University of Wisconsin-Madison, United States of America.
| | - Laura E T Swan
- Department of Population Health Sciences, University of Wisconsin-Madison, United States of America.
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Staiger B, Helfer M, Van Parys J. The effect of Medicaid expansion on the take-up of disability benefits by race and ethnicity. HEALTH ECONOMICS 2024; 33:526-540. [PMID: 38087876 DOI: 10.1002/hec.4783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 02/03/2024]
Abstract
Public disability programs provide financial support to 12 million working-age individuals per year, though not all eligible individuals take up these programs. Mixed evidence exists regarding the impact of Medicaid eligibility expansion on program take-up, and even less is known about the relationship between Medicaid expansion and racial and ethnic disparities in take-up. Using 2009-2020 Current Population Survey data, we compare changes in Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) take-up among respondents with disabilities living in Medicaid expansion states to respondents with disabilities living in non-expansion states, before and after Medicaid expansion. We further explore heterogeneity by race/ethnicity. We find that Medicaid expansion reduced SSI take-up by 10% overall, particularly among White and Hispanic respondents (10% and 21%, respectively). Medicaid expansion increased SSDI take-up by 8% overall, particularly among White and Black respondents (9% and 11%, respectively). Moreover, we find that Medicaid expansion reduced the probability that respondents with disabilities had employer-sponsored health insurance by approximately 8%, suggesting that expansion may have reduced job-lock among the SSDI-eligible, contributing to the observed increase in SSDI take-up.
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Affiliation(s)
| | - Madeline Helfer
- National Bureau of Economic Research, Cambridge, Massachusetts, USA
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Wang R, Carson KA, Sao SS, Coleman JS. Association of Neighborhood Economic Status and Race With Developing Pelvic Inflammatory Disease After Sexually Transmitted Infections. Obstet Gynecol 2023; 142:948-955. [PMID: 37734094 PMCID: PMC10510783 DOI: 10.1097/aog.0000000000005341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/14/2023] [Accepted: 05/05/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To explore the association of neighborhood-level socioeconomic status (SES) and race with developing pelvic inflammatory disease (PID) after sexually transmitted infection (STI) among female adolescents and young adults in Maryland. METHODS We used Maryland statewide hospital claims data (outpatient and inpatient visits) for this retrospective cohort study. Female adolescents and young adults aged 15-24 years who had at least one STI from July 1, 2013, to March 31, 2015, were included. A participant entered the cohort on the date of the first STI diagnosis and was followed up until PID occurrence or 3 years after the first STI. Median household income of the participant's residential ZIP code tabulation area was used as the neighborhood-level SES. Discrete-time hazard models were used to estimate the hazard of PID. RESULTS Of the 2,873 participants, 88.5% were of Black race, and 67.2% were aged 20-24 years. The hazard of PID after an STI among Black women was 1.40 times that of White women (95% CI 1.06-1.85). After adjustment for age, insurance type, and number of STI events, the hazard ratio (HR) did not change. However, adding neighborhood-level SES to the model attenuated the disparity in PID after STI between Black and White women (HR 1.25, 95% CI 0.94-1.67). CONCLUSION Racial disparities in PID diagnosis are mitigated by neighborhood-level SES.
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Affiliation(s)
- Runzhi Wang
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Kelly G, Idubor OI, Binney S, Schramm PJ, Mirabelli MC, Hsu J. The Impact of Climate Change on Asthma and Allergic-Immunologic Disease. Curr Allergy Asthma Rep 2023; 23:453-461. [PMID: 37284923 PMCID: PMC10613957 DOI: 10.1007/s11882-023-01093-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE OF REVIEW This review discusses climate change-related impacts on asthma and allergic-immunologic disease, relevant US public health efforts, and healthcare professional resources. RECENT FINDINGS Climate change can impact people with asthma and allergic-immunologic disease through various pathways, including increased exposure to asthma triggers (e.g., aeroallergens, ground-level ozone). Climate change-related disasters (e.g., wildfires, floods) disrupting healthcare access can complicate management of any allergic-immunologic disease. Climate change disproportionately affects some communities, which can exacerbate disparities in climate-sensitive diseases like asthma. Public health efforts include implementing a national strategic framework to help communities track, prevent, and respond to climate change-related health threats. Healthcare professionals can use resources or tools to help patients with asthma and allergic-immunologic disease prevent climate change-related health impacts. Climate change can affect people with asthma and allergic-immunologic disease and exacerbate health disparities. Resources and tools are available to help prevent climate change-related health impacts at the community and individual level.
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Affiliation(s)
- Grace Kelly
- Epidemiology Elective Program, National Center for STLT Public Health Infrastructure and Workforce, and Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Osatohamwen I Idubor
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC, 4770 Buford Highway Mailstop S106-6, Atlanta, GA, 30341, USA
| | - Sophie Binney
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC, 4770 Buford Highway Mailstop S106-6, Atlanta, GA, 30341, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Paul J Schramm
- Climate and Health Program, Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC, Atlanta, GA, USA
| | - Maria C Mirabelli
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC, 4770 Buford Highway Mailstop S106-6, Atlanta, GA, 30341, USA
| | - Joy Hsu
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC, 4770 Buford Highway Mailstop S106-6, Atlanta, GA, 30341, 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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Wichmann B, Wichmann R. COVID-19 and Indigenous health in the Brazilian Amazon. ECONOMIC MODELLING 2022; 115:105962. [PMID: 35874451 PMCID: PMC9290384 DOI: 10.1016/j.econmod.2022.105962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 06/07/2022] [Accepted: 07/10/2022] [Indexed: 06/15/2023]
Abstract
We test whether the COVID-19 pandemic has an ethnicity-differentiated (Indigenous vs non-Indigenous) effect on infant health in the Brazilian Amazon. Using vital statistics data we find that Indigenous infants born during the pandemic are 0.5% more likely to have very low birth weights. Access to health care contributes to health gaps. Thirteen percent of mothers travel to deliver their babies. For traveling mothers, having an Indigenous baby during the pandemic increases the probability of very low birth weight by 3%. Indigenous mothers are 7.5% less likely to receive adequate prenatal care. Mothers that travel long distances to deliver their babies and give birth during the pandemic are 35% less likely to receive proper prenatal care. We also find evidence that the pandemic shifts medical resources from rural to urban areas, which disproportionately benefits non-Indigenous mothers. These results highlight the need for policies to reduce health inequalities in the Amazon.
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Affiliation(s)
- Bruno Wichmann
- Department of Resource Economics & Environmental Sociology, College of Natural and Applied Sciences, University of Alberta, 503 General Services Building, Edmonton, AB T6G-2H1, Canada
| | - Roberta Wichmann
- Brazilian Institute of Education, Development and Research - IDP, Economics Graduate Program, SGAS Quadra 607, Modulo 49, Via L2 Sul, Brasilia, DF CEP 70.200-670, Brazil
- World Bank, SCES Trecho 03, Lote 05, Ed. Polo 8, S/N, Brasilia, DF CEP 70200-003, Brazil
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Schwartz GL, Wang G, Kershaw KN, McGowan C, Kim MH, Hamad R. The long shadow of residential racial segregation: Associations between childhood residential segregation trajectories and young adult health among Black US Americans. Health Place 2022; 77:102904. [PMID: 36063651 PMCID: PMC10166594 DOI: 10.1016/j.healthplace.2022.102904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 01/10/2023]
Abstract
Residential racial segregation is a key manifestation of anti-Black structural racism, thought to be a fundamental cause of poor health; evidence has shown that it yields neighborhood disinvestment, institutional discrimination, and targeting of unhealthy products like tobacco and alcohol. Yet research on the long-term impacts of childhood exposure to residential racial segregation is limited. Here, we analyzed data on 1823 Black participants in the Panel Study of Income Dynamics, estimating associations between childhood segregation trajectories and young adult health. Black young adults who consistently lived in high-segregation neighborhoods throughout childhood experienced unhealthier smoking and drinking behaviors and higher odds of obesity compared to other trajectory groups, including children who moved into or out of high-segregation neighborhoods. Results were robust to controls for neighborhood and family poverty. Findings underscore that for Black children who grow up in segregated neighborhoods, the roots of structurally-determined health inequities are established early in life.
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Affiliation(s)
- Gabriel L Schwartz
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States.
| | - Guangyi Wang
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
| | - Kiarri N Kershaw
- Northwestern Feinberg School of Medicine, Suite 1400, 680 N Lake Shore Drive, Chicago, IL, 60611, United States
| | - Cyanna McGowan
- Northwestern Feinberg School of Medicine, Suite 1400, 680 N Lake Shore Drive, Chicago, IL, 60611, United States
| | - Min Hee Kim
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
| | - Rita Hamad
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
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Wang G, Schwartz GL, Kershaw KN, McGowan C, Kim MH, Hamad R. The association of residential racial segregation with health among U.S. children: A nationwide longitudinal study. SSM Popul Health 2022; 19:101250. [PMID: 36238814 PMCID: PMC9550534 DOI: 10.1016/j.ssmph.2022.101250] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/02/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Residential racial segregation in the U.S. has been hypothesized as a fundamental cause driving health disparities across racial groups. Potential mechanisms include economic and social marginalization, subsequent constrained opportunities, and high stress. Yet evidence on residential segregation's association with health among Black and White children-particularly longitudinally-is sparse. This study aims to address this gap. We used data from the Panel Study of Income Dynamics (PSID), a national longitudinal study of U.S. households, analyzing information on 1,251 Black and 1,427 White children who participated in the Child Development Supplement (CDS) at least twice (survey waves 1997, 2002, 2007, 2014). We fit individual fixed-effects models to estimate the within-person association of neighborhood-level residential segregation, measured with local Getis-Ord G* statistics, with three outcomes (general health, weight status, and behavioral problems). We examined heterogeneous effects by age and sex. We also examined associations between health and childhood segregation trajectories, i.e., the pattern of children's residential segregation exposures from birth through when their health outcomes were measured, providing additional insight on dynamic experiences of segregation. In fixed effects models, among Black children, higher segregation was associated with worse self-rated health, especially for Black children who were older (aged 11-17 years). In trajectory models, among White children, moving out of highly segregated neighborhoods was associated with a lower probability of poor self-rated health, while moving into those neighborhoods or back and forth between neighborhood types were both associated with increased behavioral problems. Our findings highlight the importance of early-life residential segregation in shaping persistent racial health disparities, as well as the costs of segregation for all children living in highly segregated neighborhoods.
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Affiliation(s)
- Guangyi Wang
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
| | - Gabriel L. Schwartz
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
| | - Kiarri N. Kershaw
- Northwestern University Feinberg School of Medicine, Suite 1400, 680 N Lake Shore Drive, Chicago, IL, 60611, United States
| | - Cyanna McGowan
- Northwestern University Feinberg School of Medicine, Suite 1400, 680 N Lake Shore Drive, Chicago, IL, 60611, United States
| | - Min Hee Kim
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
| | - Rita Hamad
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
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Franz B, Milner A, Braddock IIJH. Do Black Lives Matter in the American Public's Mitigation Responses to the COVID-19 Pandemic? An Analysis of Mask Wearing and Racial/Ethnic Disparities in Deaths from COVID-19. J Racial Ethn Health Disparities 2022; 9:1577-1583. [PMID: 34269992 PMCID: PMC8284029 DOI: 10.1007/s40615-021-01097-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mask wearing has varied considerably throughout the COVID-19 pandemic and has been most often associated with political affiliation and specific health beliefs. The purpose of this study was to determine the relationship between mask usage, neighborhood racial segregation, and racial disparities in COVID-19 deaths. METHODS We used linear regression to assess whether the racial/ethnic composition of deaths and residential segregation predicted Americans' decisions to wear masks in July 2020. RESULTS After controlling for mask mandates, mask usage increased when White death rates relative to Black and Hispanic rates increased. CONCLUSIONS Mask wearing may be shaped by an insensitivity to Black and Hispanic deaths and a corresponding unwillingness to engage in health-protective behaviors. The broader history of systemic racism and residential segregation may also explain why white Americans do not wear masks or perceive themselves to be at risk when communities of color are disproportionately affected by COVID-19.
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Affiliation(s)
- Berkeley Franz
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA.
| | - Adrienne Milner
- Department of Health Sciences, Brunel University London, Uxbridge, UK
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Samuels EA, Taylor RA, Pendyal A, Shojaee A, Mainardi AS, Lemire ER, Venkatesh AK, Bernstein SL, Haber AL. Mapping emergency department asthma visits to identify poor-quality housing in New Haven, CT, USA: a retrospective cohort study. Lancet Public Health 2022; 7:e694-e704. [PMID: 35907420 PMCID: PMC9387147 DOI: 10.1016/s2468-2667(22)00143-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Housing conditions are a key driver of asthma incidence and severity. Previous studies have shown increased emergency department visits for asthma among residents living in poor-quality housing. Interventions to improve housing conditions have been shown to reduce emergency department visits for asthma, but identification and remediation of poor housing conditions is often delayed or does not occur. This study evaluates whether emergency department visits for asthma can be used to identify poor-quality housing to support proactive and early intervention. METHODS We conducted a retrospective cohort study of children and adults living in and around New Haven, CT, USA, who were seen for asthma in an urban, tertiary emergency department between March 1, 2013, and Aug 31, 2017. We geocoded and mapped patient addresses to city parcels, and calculated a composite estimate of the incidence of emergency department use for asthma for each parcel (Nv × Np/log2[P], where Nv is the estimated mean number of visits per patient, Np is the number of patients, and P is the estimated population). To determine whether parcel-level emergency department use for asthma was associated with public housing inspection scores, we used regression analyses, adjusting for neighbourhood-level and individual-level factors contributing to emergency department use for asthma. Public housing complex inspection scores were obtained from standardised home inspections, which are conducted every 1-3 years for publicly funded housing. We used a sliding-window approach to estimate how far in advance of a failed inspection the model could identify elevated use of emergency departments for asthma, using the city-wide 90th percentile as a cutoff for elevated incidence. FINDINGS 11 429 asthma-related emergency department visits from 6366 unique patients were included in the analysis. Mean patient age was 32·4 years (SD 12·8); 3836 (60·3%) patients were female, 2530 (39·7%) were male, 3461 (57·2%) were Medicaid-insured, and 2651 (41·6%) were Black. Incidence of emergency department use for asthma was strongly correlated with lower housing inspection scores (Pearson's r=-0·55 [95% CI -0·70 to -0·35], p=3·5 × 10-6), and this correlation persisted after adjustment for patient-level and neighbourhood-level demographics using a linear regression model (r=-0·54 [-0·69 to -0·33], p=7·1 × 10-6) and non-linear regression model (r=-0·44 [-0·62 to -0·21], p=3·8 × 10-4). Elevated asthma incidence rates were typically detected around a year before a housing complex failed a housing inspection. INTERPRETATION Emergency department visits for asthma are an early indicator of failed housing inspections. This approach represents a novel method for the early identification of poor housing conditions and could help to reduce asthma-related morbidity and mortality. FUNDING Harvard-National Institute of Environmental Health Sciences (NIEHS) Center for Environmental Health.
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Affiliation(s)
- Elizabeth A Samuels
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Akshay Pendyal
- Novant Health Heart and Vascular Institute, Presbyterian Medical Center, Charlotte, NC, USA
| | - Abbas Shojaee
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, USA
| | - Anne S Mainardi
- Department of Medicine, University of Tennessee Health Sciences Center, College of Medicine Chattanooga, Chattanooga, TN, USA
| | - Evan R Lemire
- Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Steven L Bernstein
- Emergency Medicine, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Adam L Haber
- Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA, USA.
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Blanchard AK, Blanchard JC, Suah A, Dade A, Burnett A, McDade W. Reflect and Reset: Black Academic Voices Call the Graduate Medical Education Community to Action. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:967-972. [PMID: 35294401 PMCID: PMC9232243 DOI: 10.1097/acm.0000000000004664] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The COVID-19 pandemic highlighted the great achievements that the biomedical community can accomplish, but raised the question: Can the same medical community that developed a complex vaccine in less than a year during a pandemic help to defeat social injustice and ameliorate the epidemic of health inequity? In this article, the authors, a group of Black academics, call on the graduate medical education (GME) community to reset its trajectory toward solutions for achieving diversity, improving inclusion, and combating racism using education as the new vector. Sponsoring institutions, which include universities, academic medical centers, teaching hospitals, and teaching health centers, are the center of the creation and dissemination of scholarship. They are often the main sources of care for many historically marginalized communities. The GME learning environment must provide the next generation of medical professionals with an understanding of how racism continues to have a destructive influence on health care professionals and their patients. Residents have the practical experience of longitudinal patient care, and a significant portion of an individual's professional identity is formed during GME; therefore, this is a key time to address explicit stereotyping and to identify implicit bias at the individual level. The authors propose 3 main reset strategies for GME-incorporating inclusive pedagogy and structural competency into education, building a diverse and inclusive learning environment, and activating community engagement-as well as tactics that sponsoring institutions can adapt to address racism at the individual learner, medical education program, and institutional levels. Sustained, comprehensive, and systematic implementation of multiple tactics could make a significant impact. It is an academic and moral imperative for the medical community to contribute to the design and implementation of solutions that directly address racism, shifting how resident physicians are educated and modeling just and inclusive behaviors for the next generation of medical leaders.
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Affiliation(s)
- Anita K. Blanchard
- A.K. Blanchard is retired professor, Department of Obstetrics & Gynecology, and former associate dean for graduate medical education and designated institutional official, University of Chicago Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0001-8904-8518
| | - Janice C. Blanchard
- J.C. Blanchard is professor, Department of Emergency Medicine, George Washington University, Washington, DC; ORCID: https://orcid.org/0000-0001-7230-2583
| | - Ashley Suah
- A. Suah was a resident graduate, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, at the time of writing and is now a fellow, Department of Surgery, Transplant Surgery, Emory Healthcare, Atlanta, Georgia
| | - Adrianne Dade
- A. Dade is associate professor, Department of Obstetrics & Gynecology, and residency program director, University of Chicago Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-3088-9640
| | - Alanna Burnett
- A. Burnett was a resident graduate, Department of Pediatrics, University of Chicago Medicine, Chicago, Illinois, at the time of writing and is now a fellow, Department of Pediatrics, Allergy and Immunology, Northwestern Medicine, Chicago, Illinois
| | - William McDade
- W. McDade is chief diversity, equity, and inclusion officer, Accreditation Council for Graduate Medical Education, Chicago, Illinois, and adjunct professor, Department of Anesthesiology, Rush Medical College, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-1068-8702
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15
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Oates GR, Schechter MS. Socioeconomic determinants of respiratory health in patients with cystic fibrosis: implications for treatment strategies. Expert Rev Respir Med 2022; 16:637-650. [PMID: 35705523 DOI: 10.1080/17476348.2022.2090928] [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: 11/04/2022]
Abstract
INTRODUCTION Great variation exists in the progression and outcomes of cystic fibrosis (CF) lung disease, due to both genetic and environmental influences. Social determinants mediate environmental exposures and treatment success; people with CF from socioeconomically disadvantaged backgrounds have worse health and die younger than those in more advantaged positions. AREAS COVERED This paper reviews the literature on the mechanisms that are responsible for generating and sustaining disparities in CF health, and the ways by which social determinants translate into health advantages or disadvantages in people with CF. The authors make recommendations for addressing social risk factors in CF clinical practice. EXPERT OPINION Socioeconomic factors are not dichotomous and their impact is felt at every step of the social ladder. CF care programs need to adopt a systematic protocol to screen for health-related social risk factors, and then connect patients to available resources to meet individual needs. Considerations such as daycare, schooling options, living and working conditions, and opportunities for physical exercise and recreation as well as promotion of self-efficacy are often overlooked. In addition, advocacy for changes in public policies on health insurance, environmental regulations, social welfare, and education would all help address the root causes of CF health inequities.
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Affiliation(s)
- Gabriela R Oates
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael S Schechter
- Division of Pulmonary Medicine, Department of Pediatrics, Virginia Commonwealth University and Children's Hospital of Richmond at VCU, USA
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16
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Joseph SP, Borrell LN, Lovinsky-Desir S, Moroko AR, Li S. Bullying and lifetime asthma among children and adolescents in the United States. Ann Epidemiol 2022; 69:41-47. [PMID: 35202781 DOI: 10.1016/j.annepidem.2022.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 01/25/2022] [Accepted: 02/13/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the association of experiencing bullying within the past year with the prevalence of lifetime childhood asthma in US children and adolescents; and whether this associations vary with sex of the child and select socioeconomic indicators. METHODS We performed secondary analysis of data from the 2018 National Survey of Children's Health participants aged 6 to 17 years (n=19,766). We used log-binomial regression to examine the association between bullying and lifetime childhood asthma before and after controlling for select covariates. We also tested interactions of bullying with sex and select socioeconomic indicators. RESULTS Children who experience bullying have a significantly increased probability of having asthma in adjusted analyses. The probability of childhood asthma increased with the frequency of bullying with PRs starting at 1.28 (95%CI:1.06, 1.55) for children bullied 1-2 times per year to 1.59 (95%:1.22, 2.09) for those being bullied at least 4 times per month. This association did not differ with sex of the child and select socioeconomic indicators. CONCLUSION We found that children who experienced bullying had a greater probability of having asthma relative to those who never experienced bullying. These finding highlight the impact of psychosocial stressors on asthma as a nontraditional trigger in children with asthma.
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Affiliation(s)
- Sharon P Joseph
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy.
| | - Luisa N Borrell
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy
| | | | - Andrew R Moroko
- Department of Environmental, Occupational, and Geospatial Health Sciences, CUNY Graduate School of Public Health & Health Policy
| | - Sheng Li
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy
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17
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Huang SJ, Sehgal NJ. Association of historic redlining and present-day health in Baltimore. PLoS One 2022; 17:e0261028. [PMID: 35045092 PMCID: PMC8769359 DOI: 10.1371/journal.pone.0261028] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In the 1930s, the Home Owners' Loan Corporation categorized neighborhoods by investment grade along racially discriminatory lines, a process known as redlining. Although other authors have found associations between Home Owners' Loan Corporation categories and current impacts on racial segregation, analysis of current health impacts rarely use these maps. OBJECTIVE To study whether historical redlining in Baltimore is associated with health impacts today. APPROACH Fifty-four present-day planning board-defined community statistical areas are assigned historical Home Owners' Loan Corporation categories by area predominance. Categories are red ("hazardous"), yellow ("definitely declining") with blue/green ("still desirable"/"best") as the reference category. Community statistical area life expectancy is regressed against Home Owners' Loan Corporation category, controlling for median household income and proportion of African American residents. CONCLUSION Red categorization is associated with 4.01 year reduction (95% CI: 1.47, 6.55) and yellow categorization is associated with 5.36 year reduction (95% CI: 3.02, 7.69) in community statistical area life expectancy at baseline. When controlling for median household income and proportion of African American residents, red is associated with 5.23 year reduction (95% CI: 3.49, 6.98) and yellow with 4.93 year reduction (95% CI: 3.22, 6.23). Results add support that historical redlining is associated with health today.
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Affiliation(s)
- Shuo Jim Huang
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, Maryland, United States of America
| | - Neil Jay Sehgal
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, Maryland, United States of America
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18
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Chesney ML, Duderstadt K. Children's Rights, Environmental Justice, and Environmental Health Policy in the United States. J Pediatr Health Care 2022; 36:3-11. [PMID: 34922676 DOI: 10.1016/j.pedhc.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 10/19/2022]
Abstract
Environmentalists have forewarned that our planet is in peril because of serious degradation and pollution of the earth's land, air, water, and food sources. Climate change is present and worsening at an alarming rate. Gaping disparities exist between high-income and low-income countries and high-income and low-income zip codes in the United States, resulting in marginalized and vulnerable populations bearing the greatest burden from the ill effects of pollution and environmental toxins. Infants and children carry the greatest risk for pollution-related diseases and exposure to chemical toxins as their bodies are rapidly developing. This review article provides a historical overview of children's rights to protection from environmental health risks, effects of environmental injustice, and U.S. statutory and regulatory policies responsible for protecting food, air, and water quality. The authors advocate for policy and clinical strategies to support children's health and the right to environmental protection.
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19
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Holder RL, Winter MA, Greenlee J, Robinson A, Dempster KW, Everhart RS. Racial Regard and Physical Health Among Low-Income Black Caregivers of Children With and Without Asthma. JOURNAL OF BLACK PSYCHOLOGY 2021. [DOI: 10.1177/00957984211059696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to examine the associations between child health, parent racial regard, and parent physical health in 87 African American and Black parents/caregivers of children with and without asthma from a low-income, under-resourced urban area. Participants completed the Private and Public Regard subscales of the Multidimensional Inventory of Black Identity (MIBI) and 12-item Short Form Health Survey (SF-12). Parents of children with asthma reported having poorer physical health, while those with higher public and private racial regard reported better physical health. The association between public regard and physical health was surpassed by an interaction of child asthma status and public regard: as public regard decreased, so did physical health, but only for parents raising a child with asthma. Findings suggest that the stresses associated with raising a child with chronic illness and perceiving lower public racial regard may together confer additional risk for poor physical health in African American and Black parents.
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Affiliation(s)
- Rachel L. Holder
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Marcia A. Winter
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Jessica Greenlee
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Akea Robinson
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Robin S. Everhart
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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20
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Martinez A, de la Rosa R, Mujahid M, Thakur N. Structural racism and its pathways to asthma and atopic dermatitis. J Allergy Clin Immunol 2021; 148:1112-1120. [PMID: 34743832 DOI: 10.1016/j.jaci.2021.09.020] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/03/2021] [Accepted: 09/20/2021] [Indexed: 12/31/2022]
Abstract
Black, Latinx, and Indigenous people in the United States experience a disproportionate burden of asthma and atopic dermatitis. The study of these disease disparities has focused on proximal socioenvironmental exposures and on the biomechanistic (including genetic) differences between racial and ethnic groups. Although biomedical research in allergy and immunology stands to benefit from the inclusion of diverse study populations, the narrow focus on biologic mechanisms disregards the complexity of interactions across biologic and structural factors, including the effects of structural racism. Structural racism is the totality of ways in which society fosters discrimination by creating and reinforcing inequitable systems through intentional policies and practices sanctioned by government and institutions. It is embedded across multiple levels, including the economic, educational, health care, and judicial systems, which are manifested in inequity in the physical and social environment. In this review, we present a conceptual framework and pull from the literature to demonstrate how structural racism is a root cause of atopic disease disparities by way of residential segregation, socioeconomic position, and mass incarceration, which may lead to aberrations in the innate and adaptive immune response and the augmentation of physiologic stress responses, contributing to a disproportionate disease burden for racial and ethnic populations.
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Affiliation(s)
- Adali Martinez
- School of Medicine, the University of California San Francisco, San Francisco, Calif
| | | | - Mahasin Mujahid
- School of Public Health, University of California Berkeley, Berkeley, Calif
| | - Neeta Thakur
- School of Medicine, the University of California San Francisco, San Francisco, Calif.
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21
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Bailey ZD, Feldman JM, Bassett MT. How Structural Racism Works - Racist Policies as a Root Cause of U.S. Racial Health Inequities. N Engl J Med 2021; 384:768-773. [PMID: 33326717 PMCID: PMC11393777 DOI: 10.1056/nejmms2025396] [Citation(s) in RCA: 834] [Impact Index Per Article: 278.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Zinzi D Bailey
- From the University of Miami Miller School of Medicine, Miami (Z.D.B.); and the FXB Center for Health and Human Rights, Harvard University, Boston (J.M.F., M.T.B.)
| | - Justin M Feldman
- From the University of Miami Miller School of Medicine, Miami (Z.D.B.); and the FXB Center for Health and Human Rights, Harvard University, Boston (J.M.F., M.T.B.)
| | - Mary T Bassett
- From the University of Miami Miller School of Medicine, Miami (Z.D.B.); and the FXB Center for Health and Human Rights, Harvard University, Boston (J.M.F., M.T.B.)
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22
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Currie J. What We Say And What We Do: Why US Investments In Children's Health Are Falling Short. Health Aff (Millwood) 2020; 39:1684-1692. [PMID: 33017250 DOI: 10.1377/hlthaff.2020.00633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This article explores the gap between what Americans say we believe with respect to spending on child health and what we actually do, which falls short of norms in other developed countries. Three possible reasons are identified: a lack of information about the effectiveness of government programs affecting child health, the idea that "investments" in child health should pay for themselves, and ideological preferences that prioritize other goals and that may themselves be rooted in this country's racial history. These factors are not mutually exclusive, and all may be at play simultaneously.
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Affiliation(s)
- Janet Currie
- Janet Currie is the Henry Putnam Professor of Economics and Public Affairs, Princeton School of Public and International Affairs, Princeton University, in Princeton, New Jersey
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23
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Translator Exposure APIs: Open Access to Data on Airborne Pollutant Exposures, Roadway Exposures, and Socio-Environmental Exposures and Use Case Application. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145243. [PMID: 32708093 PMCID: PMC7400024 DOI: 10.3390/ijerph17145243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 11/17/2022]
Abstract
Environmental exposures have profound effects on health and disease. While public repositories exist for a variety of exposures data, these are generally difficult to access, navigate, and interpret. We describe the research, development, and application of three open application programming interfaces (APIs) that support access to usable, nationwide, exposures data from three public repositories: airborne pollutant estimates from the US Environmental Protection Agency; roadway data from the US Department of Transportation; and socio-environmental exposures from the US Census Bureau’s American Community Survey. Three open APIs were successfully developed, deployed, and tested using random latitude/longitude values and time periods as input parameters. After confirming the accuracy of the data, we used the APIs to extract exposures data on 2550 participants from a cohort within the Environmental Polymorphisms Registry (EPR) at the National Institute of Environmental Health Sciences, and we successfully linked the exposure estimates with participant-level data derived from the EPR. We then conducted an exploratory, proof-of-concept analysis of the integrated data for a subset of participants with self-reported asthma and largely replicated our prior findings on the impact of select exposures and demographic factors on asthma exacerbations. Together, the three open exposures APIs provide a valuable resource, with application across environmental and public health fields.
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24
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Gibbons J, Yang TC, Brault E, Barton M. Evaluating Residential Segregation's Relation to the Clustering of Poor Health across American Cities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3910. [PMID: 32492811 PMCID: PMC7312480 DOI: 10.3390/ijerph17113910] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 12/11/2022]
Abstract
Residential segregation by race/ethnicity is widely recognized as a leading source of health disparities. Not clear from past research, however, is the overall health burden cities face due to clustering brought about by segregation. This study builds on previous research by directly measuring how spatially unequal health outcomes are within segregated cities. Utilizing Census-tract data from the Center for Disease Control and Prevention's 500 Cities project, we examine how different dimensions of spatial segregation are associated with the clustering of poor self-rated health in cities. We make novel usage of the Global Moran's I statistic to measure the spatial clustering of poor health within cities. We find spatial segregation is associated with poor health clustering, however the race/ethnicity and dimension of segregation matter. Our study contributes to existing research on segregation and health by unpacking the localized associations of residential segregation with poor health clustering in U.S. cities.
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Affiliation(s)
- Joseph Gibbons
- Department of Sociology, San Diego State University, San Diego, CA 92182, USA
| | - Tse-Chuan Yang
- Department of Sociology, University at Albany, SUNY, Albany, NY 12222, USA;
| | - Elizabeth Brault
- Department of Sociology, Louisiana State University, Baton Rouge, LA 70802, USA; (E.B.); (M.B.)
| | - Michael Barton
- Department of Sociology, Louisiana State University, Baton Rouge, LA 70802, USA; (E.B.); (M.B.)
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25
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Quaranta JE, Swaine J, Ryszka S. Preschool asthma: Examining environmental influences using geographic information systems. Public Health Nurs 2020; 37:405-411. [PMID: 32281188 DOI: 10.1111/phn.12729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study was conducted to explore if environmental factors co-occur in areas with high asthma rates in Head Start (HS) children. DESIGN Descriptive. SAMPLE Convenience sample of 56 children with asthma enrolled in HS, ages 3-5 years. MEASUREMENTS Geographic Information Systems using ArcGIS 10.4 was used to geocode and map aggregated address data at the census tract level through vector map analysis. Location, race, economic status, pollution remediation sites, age of housing, and blood lead levels were assessed for areas with high asthma concentration. RESULTS Most children with asthma resided in one census tract, which was 1% of the total service area. Fifty-six percent of housing was built before 1960 with only 10% after 1990, suggesting deteriorating conditions. Pollution remediation sites were found in the vicinity of asthma cases. Elevated lead levels were found in 22% of all HS children; specific values for the children with asthma were not available. CONCLUSION Several co-occurring factors were identified. The need for proactive interventions to decrease asthma risk/poor asthma outcomes with HS is evident. GIS locates children with high susceptibility to asthma. This allows public health nurses to target interventions and educate and empower families about environmental exposures and asthma risk factors.
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Affiliation(s)
- Judith E Quaranta
- Decker School of Nursing, Binghamton University, Binghamton, NY, USA
| | - Jennifer Swaine
- Decker School of Nursing, Binghamton University, Binghamton, NY, USA
| | - Sarah Ryszka
- Decker School of Nursing, Binghamton University, Binghamton, NY, USA
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26
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Chorniy A, Currie J, Sonchak L. DOES PRENATAL WIC PARTICIPATION IMPROVE CHILD OUTCOMES? AMERICAN JOURNAL OF HEALTH ECONOMICS 2020; 6:169-198. [PMID: 33178883 PMCID: PMC7652032 DOI: 10.1086/707832] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A large body of literature documents positive effects of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on birth outcomes, and separately connects health at birth and future outcomes. But little research investigates the link between prenatal WIC participation and childhood outcomes. We explore this question using a unique data set from South Carolina that links administrative birth, Medicaid, and education records. We find that relative to their siblings, prenatal WIC participants have a lower incidence of ADHD (attention-deficit/hyperactivity disorder) and other common childhood mental health conditions and a lower incidence of grade repetition. These findings demonstrate that a "WIC start" results in persistent improvements in child outcomes across a range of domains.
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27
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Swope CB, Hernández D. Housing as a determinant of health equity: A conceptual model. Soc Sci Med 2019; 243:112571. [PMID: 31675514 DOI: 10.1016/j.socscimed.2019.112571] [Citation(s) in RCA: 159] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/14/2019] [Accepted: 09/24/2019] [Indexed: 12/23/2022]
Abstract
Housing is a major pathway through which health disparities emerge and are sustained over time. However, no existing unified conceptual model has comprehensively elucidated the relationship between housing and health equity with attention to the full range of harmful exposures, their cumulative burden and their historical production. We synthesized literature from a diverse array of disciplines to explore the varied aspects of the relationship between housing and health and developed an original conceptual model highlighting these complexities. This holistic conceptual model of the impact of housing on health disparities illustrates how structural inequalities shape unequal distribution of access to health-promoting housing factors, which span four pillars: 1) cost (housing affordability); 2) conditions (housing quality); 3) consistency (residential stability); and 4) context (neighborhood opportunity). We further demonstrate that these four pillars can lead to cumulative burden by interacting with one another and with other structurally-rooted inequalities to produce and reify health disparities. We conclude by offering a comprehensive vision for healthy housing that situates housing's impact on health through a historical and social justice lens, which can help to better design policies and interventions that use housing to promote health equity.
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Affiliation(s)
- Carolyn B Swope
- Sociomedical Sciences Department, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Diana Hernández
- Sociomedical Sciences Department, Columbia University Mailman School of Public Health, New York, NY, USA
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Hartz J, Powell-Wiley TM. Locations! Location! Location? Elucidating the Social Determinants of Cardiometabolic Health Among United States Adolescents. J Adolesc Health 2018; 63:519-520. [PMID: 30348272 PMCID: PMC7445050 DOI: 10.1016/j.jadohealth.2018.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 08/31/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Jacob Hartz
- Division of Pediatric Cardiology, Boston Children’s
Hospital, Preventive Cardiology Program, Harvard Medical School, Boston,
Massachusetts
| | - Tiffany M. Powell-Wiley
- Social Determinants of Obesity, and Cardiovascular Risk Laboratory,
Division of Intramural Research, National Heart, Lung, and Blood Institute
and Intramural Research Program, National Institute on Minority Health, and
Health Disparities, National Institutes of Health, Bethesda, Maryland
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29
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Webb BC, Matthew DB. Housing: A Case for The Medicalization of Poverty. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2018; 46:588-594. [PMID: 30336092 DOI: 10.1177/1073110518804201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
"Medicalization" has been a contentious notion since its introduction centuries ago. While some scholars lamented a medical overreach into social domains, others hailed its promise for social justice advocacy. Against the backdrop of a growing commitment to health equity across the nation, this article reviews historical interpretations of medicalization, offers an application of the term to non-biologic risk factors for disease, and presents the case of housing the demonstrate the great potential of medicalizing poverty.
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Affiliation(s)
- B Cameron Webb
- B. Cameron Webb, M.D., J.D., is an Assistant Professor in the University of Virginia School of Medicine, where he is the Director of Health Policy and Equity for the Department of Public Health Sciences and a Hospitalist in the Department of Medicine. Dayna Bowen Matthew, J.D., Ph.D., is the William L. Matheson and Robert M. Morgenthau Distinguished Professor of Law and the F. Palmer Weber Research Professor of Civil Liberties and Human Rights at the University of Virginia School of Law. She holds an appointment in the School of Medicine's Department of Public Health Sciences
| | - Dayna Bowen Matthew
- B. Cameron Webb, M.D., J.D., is an Assistant Professor in the University of Virginia School of Medicine, where he is the Director of Health Policy and Equity for the Department of Public Health Sciences and a Hospitalist in the Department of Medicine. Dayna Bowen Matthew, J.D., Ph.D., is the William L. Matheson and Robert M. Morgenthau Distinguished Professor of Law and the F. Palmer Weber Research Professor of Civil Liberties and Human Rights at the University of Virginia School of Law. She holds an appointment in the School of Medicine's Department of Public Health Sciences
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30
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Levy JI, Quirós-Alcalá L, Fabian MP, Basra K, Hansel NN. Established and Emerging Environmental Contributors to Disparities in Asthma and Chronic Obstructive Pulmonary Disease. CURR EPIDEMIOL REP 2018; 5:114-124. [PMID: 30319934 PMCID: PMC6178976 DOI: 10.1007/s40471-018-0149-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW Multiple respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD), display significant socioeconomic and racial/ethnic disparities. The objective of this review is to evaluate the evidence supporting a link between disproportionate environmental exposures and these health disparities. RECENT FINDINGS Studies suggest that various co-occurring factors related to the home environment, neighborhood environment, non-modifiable individual factors, and individual behaviors and attributes can increase or modify the risk of adverse respiratory outcomes among socioeconomically-disadvantaged and racially/ethnically diverse populations. Pollutants in the home environment, including particulate matter, nitrogen dioxide, and pesticides, are elevated among lower socioeconomic status populations and have been implicated in the development or exacerbation of respiratory-related conditions. Neighborhood crime and green space are socioeconomically patterned and linked with asthma outcomes through psychosocial pathways. Non-modifiable individual factors such as genetic predisposition cannot explain environmental health disparities but can increase susceptibility to air pollution and other stressors. Individual behaviors and attributes, including obesity and physical activity, contribute to worse outcomes among those with asthma or COPD. SUMMARY The root causes of these multifactorial exposures are complex, but many likely stem from economic forces and racial/ethnic and economic segregation that influence the home environment, neighborhood environment, and access to healthy foods and consumer products. Critical research needs include investigations that characterize exposure to and health implications of numerous stressors simultaneously, both to guard against potential confounding in epidemiological investigations and to consider the cumulative impact of multiple elevated environmental exposures and sociodemographic stressors on health disparities.
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Affiliation(s)
- Jonathan I. Levy
- Department of Environmental Health, Boston University School of Public Health
| | - Lesliam Quirós-Alcalá
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health; Division of Pulmonary & Critical Care Medicine, Johns Hopkins University
| | - M. Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health
| | - Komal Basra
- Department of Environmental Health, Boston University School of Public Health
| | - Nadia N. Hansel
- Division of Pulmonary & Critical Care Medicine, Johns Hopkins University
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Kelley T, Kearney GD. Insights Into the Environmental Health Burden of Childhood Asthma. ENVIRONMENTAL HEALTH INSIGHTS 2018; 12:1178630218757445. [PMID: 29497308 PMCID: PMC5824896 DOI: 10.1177/1178630218757445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/16/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Tim Kelley
- Environmental Health Sciences Program, Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
| | - Gregory D Kearney
- Department of Public Health, East Carolina University, Greenville, NC, USA
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32
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Shah AN, Simmons J, Beck AF. Adding a Vital Sign: Considering the Utility of Place-Based Measures in Health Care Settings. Hosp Pediatr 2018; 8:hpeds.2017-0219. [PMID: 29317462 PMCID: PMC5790297 DOI: 10.1542/hpeds.2017-0219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Jeffrey Simmons
- Divisions of Hospital Medicine and
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrew F Beck
- Divisions of Hospital Medicine and
- General and Community Pediatrics, and
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