1
|
Ogungbe O, Yeh HC, Cooper LA. Living Within the Redlines: How Structural Racism and Redlining Shape Diabetes Disparities. Diabetes Care 2024; 47:927-929. [PMID: 38768331 DOI: 10.2337/dci24-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Oluwabunmi Ogungbe
- Johns Hopkins School of Nursing, Baltimore, MD
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Hsin-Chieh Yeh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Lisa A Cooper
- Johns Hopkins School of Nursing, Baltimore, MD
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
2
|
Jain S, Bey GS, Forrester SN, Rahman-Filipiak A, Thompson Gonzalez N, Petrovsky DV, Kritchevsky SB, Brinkley TE. Aging, Race, and Health Disparities: Recommendations From the Research Centers Collaborative Network. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae028. [PMID: 38442186 PMCID: PMC11101762 DOI: 10.1093/geronb/gbae028] [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: 06/03/2023] [Indexed: 03/07/2024] Open
Abstract
Racial disparities in adverse health outcomes with aging have been well described. Yet, much of the research focuses on racial comparisons, with relatively less attention to the identification of underlying mechanisms. To address these gaps, the Research Centers Collaborative Network held a workshop on aging, race, and health disparities to identify research priorities and inform the investigation, implementation, and dissemination of strategies to mitigate disparities in healthy aging. This article provides a summary of the key recommendations and highlights the need for research that builds a strong evidence base with both clinical and policy implications. Successful execution of these recommendations will require a concerted effort to increase participation of underrepresented groups in research through community engagement and partnerships. In addition, resources to support and promote the training and development of health disparities researchers will be critical in making health equity a shared responsibility for all major stakeholders.
Collapse
Affiliation(s)
- Snigdha Jain
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ganga S Bey
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sarah N Forrester
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Annalise Rahman-Filipiak
- Department of Psychiatry—Neuropsychology Section, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicole Thompson Gonzalez
- Department of Integrative Anthropological Sciences, University of California Santa Barbara, Santa Barbara, California, USA
| | - Darina V Petrovsky
- School of Nursing, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey, USA
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Tina E Brinkley
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| |
Collapse
|
3
|
Rishworth A, Wilson K, Adams M, Galloway T. Landscapes of inequities, structural racism, and disease during the COVID-19 pandemic: Experiences of immigrant and racialized populations in Canada. Health Place 2024; 87:103214. [PMID: 38520992 DOI: 10.1016/j.healthplace.2024.103214] [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: 11/06/2023] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 03/25/2024]
Abstract
The COVID-19 pandemic has disproportionately affected immigrant and racialized communities globally and revealed another public health crisis - structural racism. While structural racism is known to foster discrimination via mutually reinforcing systems, the unevenness of COVID-19 infections, hospitalizations, and deaths across societies has precipitated attention to the impacts of structural racism. Research highlights the inequitable burden of COVID-19 among immigrant and racialized groups; however, little is known about the synergistic impacts of structural racism and COVID-19 on the health and wellbeing of these groups. Fewer studies examine how structural racism and COVID-19 intersect within neighbourhoods to co-produce landscapes of disease exposure and management. This article examines the pathways through which structural racism shapes access, use, and control of environmental resources among immigrant and racialized individuals in the neighbourhoods of the Peel Region and how they converged to shape health and disease dynamics during the height of Canada's COVID-19 pandemic. Findings from in-depth interviews reveal that mutually reinforcing inequitable systems created environments for COVID-19 to reinscribe disparities in access, use, and control of key resources needed to manage health and disease, and created new forms of disparities and landscapes of inequality for immigrants and racialized individuals. We close with a discussion on the impacts for policy and practice.
Collapse
Affiliation(s)
- Andrea Rishworth
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, ON, Canada.
| | - Kathi Wilson
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, ON, Canada.
| | - Matthew Adams
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, ON, Canada.
| | - Tracey Galloway
- Department of Anthropology, University of Toronto, Mississauga, ON, Canada.
| |
Collapse
|
4
|
Aikins M, Willems Y, Mitchell C, Goosby B, Raffington L. Linked emergence of racial disparities in mental health and epigenetic biological aging across childhood and adolescence. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.26.586786. [PMID: 38586008 PMCID: PMC10996608 DOI: 10.1101/2024.03.26.586786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Marginalization due to structural racism may confer an increased risk for aging-related diseases - in part - via effects on people's mental health. Here we leverage a prospective birth cohort study to examine whether the emergence of racial disparities in mental health and DNA-methylation measures of biological aging (i.e., DunedinPACE, GrimAge Acceleration, PhenoAge Acceleration) are linked across childhood and adolescence. We further consider to what extent racial disparities are statistically accounted for by perinatal and postnatal factors in preregistered analyses of N=4,898 participants from the Future of Families & Child Wellbeing Study, of which N=2,039 had repeated saliva DNA methylation at ages 9 and 15 years. We find that racially marginalized children had higher levels of externalizing and internalizing behaviors and diverging longitudinal internalizing slopes. Black compared to White identifying children, children living in more racially segregated neighborhoods, and racially marginalized children more affected by colorism tended to have higher age-9 levels of biological aging and more biological age acceleration over adolescence. Notably, longitudinal increases in internalizing and externalizing behavior were correlated with longitudinal increases in biological aging. While racial and ethnic disparities in mental health were largely statistically accounted for by socioeconomic variables, racial differences in biological aging were often still visible beyond covariate controls. Our findings indicate that racial disparities in mental health and biological aging are linked and emerge early in life. Programs promoting racial health equity must address the psychological and physical impacts of structural racism in children. Comprehensive measures of racism are lacking in current population cohorts.
Collapse
Affiliation(s)
- Muna Aikins
- Max Planck Research Group Biosocial – Biology, Social Disparities, and Development; Max Planck Institute for Human Development; Berlin, Germany
| | - Yayouk Willems
- Max Planck Research Group Biosocial – Biology, Social Disparities, and Development; Max Planck Institute for Human Development; Berlin, Germany
| | - Colter Mitchell
- Survey Research Center of the Institute for Social Research; University of Michigan, Ann Arbor, MI, USA
- Population Studies Center of the Institute for Social Research; University of Michigan, Ann Arbor, MI, USA
| | - Bridget Goosby
- Population Research Center; University of Texas at Austin, Austin, TX, USA
| | - Laurel Raffington
- Max Planck Research Group Biosocial – Biology, Social Disparities, and Development; Max Planck Institute for Human Development; Berlin, Germany
| |
Collapse
|
5
|
Yip JLY, Poduval S, de Souza-Thomas L, Carter S, Fenton K. Anti-racist interventions to reduce ethnic disparities in healthcare in the UK: an umbrella review and findings from healthcare, education and criminal justice. BMJ Open 2024; 14:e075711. [PMID: 38418232 PMCID: PMC10910548 DOI: 10.1136/bmjopen-2023-075711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 02/07/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVES To assess the evidence for anti-racist interventions which aim to reduce ethnic disparities in healthcare, with a focus on implementation in the UK healthcare system. DESIGN Umbrella review. DATA SOURCES Embase, Medline, Social Policy and Practice, Social Care Online and Web of Science were searched for publications from the year 2000 up to November 2023. ELIGIBILITY CRITERIA Only systematic and scoping reviews of anti-racist interventions reported in English were included. Reviews were excluded if no interventions were reported, no comparator interventions were reported or the study was primarily descriptive. DATA EXTRACTION AND SYNTHESIS A narrative synthesis approach was used to integrate and categorise the evidence on anti-racist interventions for healthcare. Quality appraisal (including risk of bias) was assessed using the AMSTAR-2 tool. RESULTS A total of 29 reviews are included in the final review. 26 are from the healthcare sector and three are from education and criminal justice. The most promising interventions targeting individuals include group-based health education and providing culturally tailored interventions. On a community level, participation in all aspects of care pathway development that empowers ethnic minority communities may provide an effective approach to reducing ethnic health disparities. Interventions to improve quality of care for conditions with disproportionately worse outcomes in ethnic minority communities show promise. At a policy level, structural interventions including minimum wage policies and integrating non-medical interventions such as housing support in clinical care has some evidence for improving outcomes in ethnic minority communities. CONCLUSIONS Many of the included studies were low or critically low quality due to methodological or reporting limitations. For programme delivery, different types of pathway integration, and providing a more person-centred approach with fewer steps for patients to navigate can contribute to reducing disparities. For organisations, there is an overemphasis on individual behaviour change and recommendations should include a shift in focus and resources to policies and practices that seek to dismantle institutional and systemic racism through a multilevel approach.
Collapse
Affiliation(s)
| | - Shoba Poduval
- Institute of Health Informatics, University College London, London, UK
| | | | - Sophie Carter
- Office for Health Improvement and Disparities, London, UK
- Health Innovation Manchester, Manchester, UK
| | - Kevin Fenton
- Office for Health Improvement and Disparities, London, UK
| |
Collapse
|
6
|
Padilla T, Reyes A. Hitting closer to home: State policies' impacts on health by race and legal status. Soc Sci Med 2024; 343:116562. [PMID: 38242032 PMCID: PMC11104556 DOI: 10.1016/j.socscimed.2024.116562] [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: 05/08/2023] [Revised: 12/24/2023] [Accepted: 01/03/2024] [Indexed: 01/21/2024]
Abstract
While the proliferation of inclusionary and exclusionary state policies has led to an increasingly heterogeneous patchwork of state climates, state policy and the climates they create have become increasingly important for health outcomes. We leverage the heterogeneity across state policy climates to test the relationship between state-level policies and health inequality across the US. We include 24 state policies related to public health and safety, immigration enforcement, integration, and healthcare to capture the state climate. Using the Survey of Income and Program Participation (SIPP), a nationally representative study of households in the U.S., we estimate multilevel regression models to assess the relationship between state policy climate and healthcare utilization. We further examine differential effects of the policy climate across various vulnerable groups, by examining differences by citizenship status and race. We find that more exclusionary policies may be detrimental to healthcare utilization for all residents regardless of race and legal status- but ultimately racial minorities and noncitizens see the greatest benefits from inclusive policy climates.
Collapse
Affiliation(s)
- Tatiana Padilla
- Cornell University, 116 Reservoir Ave, Martha Van Rensselaer Hall, Ithaca, NY, 14853, United States.
| | - Adriana Reyes
- Cornell University, 116 Reservoir Ave, Martha Van Rensselaer Hall, Ithaca, NY, 14853, United States
| |
Collapse
|
7
|
Napierala E, Rencher B, Solomon L, Parker C. Can federal policy help overcome systemically reinforced racial inequities in social determinants of health? An observational study of Georgia and neighboring U.S. states. BMC Public Health 2024; 24:304. [PMID: 38279142 PMCID: PMC10811892 DOI: 10.1186/s12889-024-17726-4] [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: 08/13/2023] [Accepted: 01/10/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Despite increasing attention to racial inequities in social determinants of health and health outcomes, less attention has been focused on how structural barriers - embedded in programs and codified in laws - shape opportunities to achieve health. METHODS To better understand how U.S. federal policies targets structural barriers to opportunity and health at the population level, we conducted a legal review to identify landmark pieces of federal policy that held potential to impact key social determinants of health. Then, using publicly available data for Georgia and five neighboring U.S. states (Alabama, Florida, North Carolina, South Carolina, and Tennessee), we conducted an observational case study to examine recent trends for access to health care, housing, and education because they were each associated with comprehensive federal legislation meant to alleviate inequities resulting from long-standing structural barriers and were each identified by Healthy People 2030 as key social determinants of health. RESULTS From 2010 to 2021, population-level improvements were seen in health insurance rates, mortgage and rental burden, and educational attainment, with improvements seen for both Black and White populations in Georgia, regionally in the Southeast region, and nationally in the United States. However, seemingly meaningful gaps between the Black and White populations across social determinants of health have not been eliminated at any geographical level. CONCLUSIONS This analysis adds to a growing body of evidence that historically racialized social structures hamper Black populations' opportunities to build wealth, gain a quality education, own a home in a neighborhood of opportunity, and access health care, compared to their White peers. Given that the root causes of health disparities and inequities lie at the intersection of health, health care, economics, education, and other social systems, a multisectoral approach to policy is needed to address these systemic issues. While federal laws do provide momentum for proximal benefits for social change, in modern federalism they alone are insufficient to address needed local system change and nonlegal policy interventions, implemented at the local programmatic level, may serve as complementary mechanism to address the lingering effects of barriers to equal opportunity.
Collapse
Affiliation(s)
- Eric Napierala
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, 55 Park Place, 8th floor, Atlanta, GA, 30303, USA
| | - Bill Rencher
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, 55 Park Place, 8th floor, Atlanta, GA, 30303, USA
| | - Lori Solomon
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, 55 Park Place, 8th floor, Atlanta, GA, 30303, USA.
| | - Chris Parker
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, 55 Park Place, 8th floor, Atlanta, GA, 30303, USA
| |
Collapse
|
8
|
M’Koma AE, Ware JN, Nabaweesi RK, Chirwa SS. Managing Pregnancy and Nursing Affecting African American Women with Inflammatory Bowel Disease: Clinical Outcomes and Parenthood. MEDICAL RESEARCH ARCHIVES 2023; 11:3784. [PMID: 37492395 PMCID: PMC10367541 DOI: 10.18103/mra.v11i6.3784] [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: 07/27/2023]
Abstract
Inflammatory bowel disease (IBD) is a term for two autoimmune diseases encompassing Crohn's disease (CD) and ulcerative colitis (UC) which are lifelong diseases affecting more than 3 million adults (1.3%) in the United States. IBD is characterized by chronic inflammation of the whole digestive system which results in damage to the gastrointestinal (GI) tract. IBD often emerges during adolescence and young adulthood. Maternal morbidity includes physical and psychological conditions that result from or are aggravated by pregnancy and have an adverse effect on a woman's health, the baby's health or both. Some women have health challenges that arise before or during pregnancy that could lead to complications. It is recommended for women to receive health care counseling before and during pregnancy. Compared to other developed countries, the United States has the highest rate of women dying of pregnancy related complications. During the past 25 years maternal mortality has been getting worse. African American women (AAW) with and/or without IBD are dying at significantly higher rates than other groups. This is linked to several factors, i.e., systemic, institutionalized, and structural racism in health-care delivery and subsequent toxic stress from people's lived experiences of racism, limited knowledge about healthcare system function, lack of access to healthcare, (inclusiveness and insurance policies) all of which negatively impact these patients. African Americans (AAs) are also up to three times as likely to experience severe maternal morbidity: unexpected outcomes of labor and delivery, deficient or lacking prenatal care and social determinants of health like lack of transportation, adequate employment, limited literacy, and limited healthcare access contribute to poor health outcomes. Studies on IBD patients indicate Medicaid expansion is associated with reduced rates of maternal morbidity, particularly for African American Women (AAW) and increased access to preconception and prenatal services that make pregnancy and childbirth safer for parent and baby. Herein we examine the physiological changes of pregnancy in patients diagnosed with inflammatory bowel disease and their relationship perinatal outcomes and parenthood.
Collapse
Affiliation(s)
- Amosy E. M’Koma
- Departments of Biochemistry, Cancer Biology, Neuroscience and Pharmacology
| | | | | | - Sanika S. Chirwa
- Departments of Biochemistry, Cancer Biology, Neuroscience and Pharmacology
| |
Collapse
|
9
|
Purrington KS, Hastert TA, Madhav KC, Nair M, Snider N, Ruterbusch JJ, Schwartz AG, Stoffel EM, Peters ES, Rozek LS. The role of area-level socioeconomic disadvantage in racial disparities in cancer incidence in metropolitan Detroit. Cancer Med 2023. [PMID: 37184135 DOI: 10.1002/cam4.6065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/17/2023] [Accepted: 04/30/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Neighborhood deprivation is associated with both race and cancer incidence, but there is a need to better understand the effect of structural inequities on racial cancer disparities. The goal of this analysis was to evaluate the relationship between a comprehensive measure of neighborhood-level social disadvantage and cancer incidence within the racially diverse population of metropolitan Detroit. METHODS We estimated breast, colorectal, lung, and prostate cancer incidence rates using Metropolitan Detroit Cancer Surveillance System and US decennial census data. Neighborhood socioeconomic disadvantage was measured by the Area Deprivation Index (ADI) using Census Bureau's American Community Survey data at the Public Use Microdata Areas (PUMA) level. Associations between ADI at time of diagnosis and cancer incidence were estimated using Poisson mixed-effects models adjusting for age and sex. Attenuation of race-incidence associations by ADI was quantified using the "mediation" package in R. RESULTS ADI was inversely associated with incidence of breast cancer for both non-Hispanic White (NHW) and non-Hispanic Black (NHB) women (NHW: per-quartile RR = 0.92, 95% CI 0.88-0.96; NHB: per-quartile RR = 0.94, 95% CI 0.91-0.98) and with prostate cancer incidence only for NHW men (per-quartile RR = 0.94, 95% CI 0.90-0.97). ADI was positively associated with incidence of lung cancer for NHWs and NHBs (NHW: per-quartile RR = 1.12, 95% CI 1.04-1.21; NHB: per-quartile RR = 1.37, 95% CI 1.25-1.51) and incidence of colorectal cancer (CRC) only among NHBs (per-quartile RR = 1.11, 95% CI 1.02-1.21). ADI significantly attenuated the relationship between race and hormone receptor positive, HER2-negative breast cancer (proportion attenuated = 8.5%, 95% CI 4.1-16.6%) and CRC cancer (proportion attenuated = 7.3%, 95% CI 3.7 to 12.8%), and there was a significant interaction between race and ADI for lung (interaction RR = 1.22, p < 0.0001) and prostate cancer (interaction RR = 1.09, p = 0.00092). CONCLUSIONS Area-level socioeconomic disadvantage is associated with risk of common cancers in a racially diverse population and plays a role in racial differences in cancer incidence.
Collapse
Affiliation(s)
- Kristen S Purrington
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Michigan, Detroit, USA
| | - Theresa A Hastert
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Michigan, Detroit, USA
| | - K C Madhav
- Department of Internal Medicine, Yale School of Medicine, Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Connecticut, New Haven, USA
| | - Mrudula Nair
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
| | - Natalie Snider
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
| | - Julie J Ruterbusch
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Michigan, Detroit, USA
| | - Ann G Schwartz
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Michigan, Detroit, USA
| | - Elena M Stoffel
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System, Michigan, Ann Arbor, USA
| | - Edward S Peters
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Laura S Rozek
- Department of Oncology, Georgetown University School of Medicine, District of Columbia, Washington, USA
| |
Collapse
|