The association of residential racial segregation with health among U.S. children: A nationwide longitudinal study

Association of Neighborhood Opportunity, Race, and Ethnicity with Pediatric Day-of-surgery Cancellations: A Cohort Study

BACKGROUND

Day-of-surgery cancellations impede healthcare access and contribute to inequities in pediatric healthcare. Socially disadvantaged families have many risk factors for surgical cancellation, including low health literacy, transportation barriers, and childcare constraints. These social determinants of health are captured by the Child Opportunity Index 2.0, a national quantification of neighborhood-level characteristics that contribute to a child's vulnerability to adversity. This study examined the association of neighborhood opportunity with pediatric day-of-surgery cancellations.

METHODS

A retrospective cohort study of children younger than 18 yr of age scheduled for ambulatory surgery at a tertiary pediatric hospital between 2017 and 2022 was conducted. Primary addresses were geocoded to determine Child Opportunity Index 2.0 neighborhood opportunity. Log-binomial regression was used to estimate the relative risk of day-of-surgery cancellation comparing different levels of neighborhood opportunity. This study also estimated the relative risk of cancellations associated with race and ethnicity, by neighborhood opportunity.

RESULTS

Overall, the incidence of day-of-surgery cancellation was 3.8%. The incidence of cancellation was lowest in children residing in very-high-opportunity neighborhoods and highest in children residing in very-low-opportunity neighborhoods (2.4% vs. 5.7%, P < 0.001). The adjusted relative risk of day-of-surgery cancellation in very-low-opportunity neighborhoods compared to very-high-opportunity neighborhoods was 2.24 (95% CI, 2.05 to 2.44; P < 0.001). The results showed statistical evidence of an interaction of Children's Opportunity Index with race and ethnicity. In very-low-opportunity neighborhoods, Black children had 1.48 times greater risk of day-of-surgery cancellation than White children (95% CI, 1.35 to 1.63; P < 0.001). Likewise, in very-high-opportunity neighborhoods, Black children had 2.17 times greater risk of cancellation (95% CI, 1.75 to 2.69; P < 0.001).

CONCLUSIONS

This study found a strong relationship between pediatric day-of-surgery cancellation and neighborhood opportunity. Black children at every level of opportunity had the highest risk of cancellation, suggesting that there are additional factors that render them more vulnerable to neighborhood disadvantage.

EDITOR’S PERSPECTIVE

How long-term changes in neighborhood and school racial composition shape children's behavior problems

Relatively few neighborhood-focused studies explicitly model the relationship between neighborhood change- i.e., racial change within a neighborhood-and individual mental health, instead focusing on the current composition of the neighborhood or on the outcomes of individuals that switch neighborhood contexts via moves. Further, while neighborhoods and schools are interconnected, researchers tend to focus on only one of these contexts in their work. Combining family and student data from the Panel Study of Income Dynamics (PSID) with multiple waves of neighborhood and school administrative data, our study extends current scholarship in this area by explicitly focusing on the relationship between exposure to neighborhood and school racial change-i.e., change occurring within the neighborhood or school in the prior decade-and the behavior problems of current students. We further analyze how associations vary: 1) by student race; 2) between newcomers to the neighborhood and those that lived in the neighborhood as it underwent demographic change; 3) and in neighborhoods with higher proportions of same-race residents. Our findings suggest that the relationship between local neighborhood contexts and the behavioral problems of children is nuanced and depends on the racial trajectories-change or stability-of neighborhoods, schools, and the interaction of both. Compared to longer-term residents, White newcomers tended to have more behavioral problems across racially changing and stable neighborhoods alike, regardless of the racial trajectories observed in the local school. Our results align with past work documenting the protective effect of same-race peers for Black children. Conversely, we find White students exhibit greater behavioral problems in settings with very high proportions of same-race peers, particularly in neighborhoods and schools that are simultaneously becoming increasingly racially isolated.

Leveraging Experience Sampling/Ecological Momentary Assessment for Sociological Investigations of Everyday Life

Experience sampling (ES) - also referred to as ecological momentary assessment (EMA) - is a data collection method that involves asking study participants to report on their thoughts, feelings, behaviors, activities, and environments in (or near) real time. ES/EMA is typically administered using an intensive longitudinal design (repeated assessments within and across days). Although use of ES/EMA is widespread in psychology and health sciences, uptake of the method among sociologists has been limited. We argue that ES/EMA offers key advantages for the investigation of sociologically relevant phenomena, particularly in light of recent disciplinary emphasis on investigating the everyday mechanisms through which social structures and micro (individual and relational) processes are mutually constitutive. We describe extant and potential research applications illustrating advantages of ES/EMA regarding enhanced validity, disentangling short-term dynamics, and the potential for linkage with spatially and temporally referenced data sources. We also consider methodological challenges facing sociological research using ES/EMA.

Associations Between Neighborhood Racialized Economic Segregation with Cardiometabolic Health and Cortisol in a Racially/Ethnically Diverse Sample of Children from Minneapolis-St. Paul

Introduction

Past research shows that structural racism contributes to disparities in cardiometabolic health among racially/ethnically minoritized populations.

Methods

This cross-sectional study examined the correlation between census tract-level racialized economic segregation and child health metrics among a racially and ethnically diverse cohort of 350 children (ages 6.5-13.8) from Minneapolis-St. Paul, MN.

Results

A consistent cardiometabolic and cortisol outcome gradient was observed across the index of concentration at the extremes tertiles, such that health risk factors increased as tract privilege decreased.

Conclusion

Racialized economic segregation was associated with less favorable child health outcomes, underscoring the potential importance of place-based interventions for promoting children's health.

Association Between Changes in Racial Residential and School Segregation and Trends in Racial Health Disparities, 2000-2020: A Life Course Perspective

INTRODUCTION

Most studies of the relationship between racial segregation and racial health disparities have focused on residential segregation. School-based racial segregation is an additional form of segregation that may be associated with racial disparities in health. This study examines the relationship between both residential segregation and school segregation and racial health disparities among non-Hispanic Black compared to non-Hispanic White persons at the county level in the United States. It also examines the relationship between changes in residential and school segregation and subsequent trajectories in a variety of racial health disparities across the life course.

METHODS

Using the CDC WONDER Multiple Case of Death database, we derived an annual estimate of race-specific death rates and rate ratios for each county during the period 2000-2020. We then examined the relationship between baseline levels of residential and school segregation in 1991 as well as changes between 1991-2000 and the trajectories of the observed racial health disparities between 2000 and 2020. We used latent trajectory analysis to identify counties with similar patterns of residential and school segregation over time and to identify counties with similar trajectories in each racial health disparity. Outcomes included life expectancy, early mortality (prior to age 65), infant mortality, firearm homicide, total homicide, and teenage pregnancy rates.

RESULTS

During the period 1991-2020, racial residential segregation remained essentially unchanged among the 1051 counties in our sample; however, racial school segregation increased during this period. Increases in school segregation from 1991 to 2000 were associated with higher racial disparities in each of the health outcomes during the period 2000-2020 and with less progress in reducing these disparities.

CONCLUSION

This paper provides new evidence that school segregation is an independent predictor of racial health disparities and that reducing school segregation-even in the face of high residential segregation-could have a long-term impact on reducing racial health disparities. Furthermore, it suggests that the health consequences of residential segregation have not been eliminated from our society but are now being exacerbated by a new factor: school-based segregation. Throughout this paper, changes in school-based segregation not only show up as a consistent significant predictor of greater racial disparities throughout the life course, but at times, an even stronger predictor of health inequity than residential segregation.

Policy solutions to eliminate racial and ethnic child health disparities in the USA

Societal systems act individually and in combination to create and perpetuate structural racism through both policies and practices at the local, state, and federal levels, which, in turn, generate racial and ethnic health disparities. Both current and historical policy approaches across multiple sectors-including housing, employment, health insurance, immigration, and criminal legal-have the potential to affect child health equity. Such policies must be considered with a focus on structural racism to understand which have the potential to eliminate or at least attenuate disparities. Policy efforts that do not directly address structural racism will not achieve equity and instead worsen gaps and existing disparities in access and quality-thereby continuing to perpetuate a two-tier system dictated by racism. In Paper 2 of this Series, we build on Paper 1's summary of existing disparities in health-care delivery and highlight policies within multiple sectors that can be modified and supported to improve health equity, and, in so doing, improve the health of racially and ethnically minoritised children.

The Affordable Rental Housing Crisis and Population Health Equity: a Multidimensional and Multilevel Framework

The US is facing a severe affordable rental housing crisis that contributes to multiple forms of housing insecurity including homelessness, crowded and poor quality housing conditions, unstable housing arrangements, and cost burdens. A considerable body of evidence finds that housing insecurity is an important determinant of health. However, the existing literature may fall short of conceptualizing and measuring the full impact of housing insecurity on population health and on racial health equity. In this paper, we seek to expand the conceptualization of housing as a determinant of population health equity by considering housing insecurity as a manifestation of structural racism that intersects with other manifestations and impacts of structural racism to affect, not only the health of housing insecure individuals, but also the health of the networks and communities in which these individuals live. First, we situate the current housing crisis within larger systems of structural racism. We extend prior work documenting the confluence of ways that racist policies and practices have created unequal burdens of housing insecurity to also discuss the ways that the meanings and impacts of housing insecurity may be shaped by racism. Next, we consider how the health impacts of this unequal burden of housing insecurity can extend beyond individual households to affect networks and communities. Ultimately, we provide a multilevel framework that can inform research, policy, and practice to address housing and health equity.

Association Between Changes in Racial Residential Segregation and Trends in Racial Disparities in Early Mortality in 220 Metropolitan Areas, 2001-2018

INTRODUCTION

Racial residential segregation has been shown to affect the absolute levels of racial disparities in a wide variety of health outcomes in the USA but it is not known whether changes in segregation also influence these racial health disparities. This study examines the relationship between changes in racial residential segregation over four decades (1980-2020) and trends in racial disparities in early mortality (under age 65) rates among non-Hispanic Black and non-Hispanic White persons across a wide range of health outcomes in 220 metropolitan statistical areas (MSAs) during the period 2001-2018.

METHODS

Using the CDC WONDER Underlying Cause of Death database, we derived annual estimates of race-specific death rates and rate ratios for each MSA. We used latent trajectory analysis to examine the relationship between the level of segregation and changes in segregation over time in an MSA and trends in death rate disparities in that MSA.

RESULTS

The trajectory analysis resulted in a linear, three group model in which trajectory Groups 1 and 2 had decreasing trends in the ratios of Black to White death rates over time while in Group 3, the disparity remained almost constant over time. Increases in the level of segregation in an MSA from 1980 to 2000 were significantly associated with the likelihood that the MSA was in Group 3 and experienced no improvement in racial health disparities in mortality over time.

CONCLUSION

This paper provides new evidence that changes in segregation are related to trends in racial health disparities in mortality rates over time.