Cause-Specific Mortality and Racial Differentials in Life Expectancy, Chicago 2018-2019

BACKGROUND

In Chicago in 2018, the average life expectancy (ALE) for NH Blacks was 71.5 years, 9.1 fewer years than for NH Whites (80.6 years). Inasmuch as some causes of death are increasingly recognized products of structural racism, in urban areas, such causes may have potential for reducing racial inequities through public health intervention. Our purpose is to allocate racial inequities in ALE in Chicago to differentials in cause-specific mortality.

METHODS

Using multiple decrement processes and decomposition analysis, we examine cause-specific mortality in Chicago to determine the causes of death that contribute to the gap in life expectancy between NH Blacks and NH Whites.

RESULTS

Among females, the racial difference in ALE was 8.21 years; for males, it was 10.53 years. We find that cancer and heart disease mortality account for 3.03 years or 36% of the racial gap in average life expectancy among females. Differences in homicide and heart disease mortality rates comprised over 45% of the disparity among males.

CONCLUSIONS

Strategies for improving inequities in life expectancy should account for differences between males and females in cause-specific mortality rates. In urban areas with high levels of segregation, reducing inequities in ALE may be possible by dramatically reducing mortality rates from some causes.

CONTRIBUTION

This paper illustrates the state of inequities in ALE between NH Blacks and NH Whites in Chicago for the period just prior to the onset of the COVID-19 pandemic, using a well-established method of decomposing mortality differentials for sub-populations.

Racial Health Equity Plans in the 30 Largest US Cities

BACKGROUND

Racial inequities in life expectancy vary significantly across US cities, with city-level gaps ranging from zero to more than 10 years. Given that these inequities are rooted in racism and maintained through social structures and policies, population-level solutions are needed. Local health departments (LHD) are well-situated to lead these types of changes.

METHODS

We conducted an environmental scan and document review of formal health plans of the LHDs with jurisdictions covering the 30 most populous US cities. We assessed the inclusion of equity priorities and specific and measurable equity goals. Secondary outcomes related to organizational structures, data, formal declarations, and other practices were also assessed. Data were collected between January and August 2022.

RESULTS

The extent of focus on racial equity in the identified strategic health plans varied. Less than half of the cities with a formal public health plan (13 of 29) listed racial health equity as an area of focus. Only seven cities (all of which had a health plan focusing on racial health equity) had specific goals related to racial health equity. Twenty-five LHDs provided local data on racial health inequities. All but seven cities had declared racism a public health crisis. About half of the LHDs had positions or divisions focused on racial equity, or specified equity as an area of focus for Covid-19 efforts.

CONCLUSIONS

These findings reveal that few large cities translate growing support for anti-racism into their formal planning. While most LHDs acknowledge (and provide data pointing to) gaps in racial health equity in their jurisdictions, more attention is needed to incorporate specific and measurable racial health equity goals into strategic plans, and provide adequate structure and resources to attain those goals.

Life Expectancy Gaps Among Black and White Persons and Contributing Causes of Death in 3 Large US Cities, 2018-2019

IMPORTANCE

US cities have substantial, but varying, levels of racial mortality inequities, a consequence of structural racism. As committed partners increasingly pledge to eliminate health inequities, local data are required to focus and unify efforts.

OBJECTIVE

To analyze the contributions of 26 cause-of-death categories to Black to White life expectancy gaps within 3 large US cities.

DESIGN, SETTING, AND PARTICIPANTS

In this cross-sectional study, data were extracted from the 2018 and 2019 National Vital Statistics System Multiple Cause of Death Restricted Use data files for deaths by race, ethnicity, sex, age, place of residence, and underlying and contributing causes of death in Baltimore, Maryland; Houston, Texas; and Los Angeles, California. Life expectancy at birth was calculated for non-Hispanic Black and non-Hispanic White populations overall and by sex using abridged life tables with 5-year age intervals. Data analysis was performed from February to May 2022.

MAIN OUTCOMES AND MEASURES

Using the Arriaga method, the proportion of the Black to White life expectancy gap was calculated overall and by sex for each city that was attributable to 26 cause-of-death categories defined using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes for underlying and contributing causes of death.

RESULTS

A total of 66 321 death records from 2018 to 2019 were analyzed, with 29 057 individuals (44%) were identified as Black, 34 745 (52%) as male, and 46 128 (70%) as aged 65 years and older. Black to White life expectancy gaps were 7.60 years for Baltimore, 8.06 years for Houston, and 9.57 years for Los Angeles. Circulatory diseases, cancer, injuries, and diabetes and endocrine disorders were top contributors to the gaps, although the order and magnitude varied by city. The contribution of circulatory diseases was 11.3 percentage points higher in Los Angeles than in Baltimore (3.76 years [39.3%] vs 2.12 years [28.0%]). The contribution of injuries to Baltimore's racial gap (2.22 years [29.3%]) was twice as large as in Houston (1.11 years [13.8%]) and Los Angeles (1.36 years [14.2%]).

CONCLUSIONS AND RELEVANCE

By assessing the composition of Black to White life expectancy gaps for 3 large US cities and categorizing deaths at a more granular level than past studies, this study provides insight into the differing underpinnings of urban inequities. This type of local data can support local resource allocation that more effectively addresses racial inequities.

Training to Build Antiracist, Equitable Health Care Systems

All clinicians should provide high-quality, safe, and equitable care to every patient and community. Yet, in practice, health care delivery systems are designed and organized to exacerbate inequity in access and outcomes, and clinicians are incentivized to deliver unequal and inequitable care in deeply segregated academic health centers that are structured to reify white supremacy. This article investigates the nature and scope of health professions educators' obligations to acknowledge harms of segregation in health care as widespread, unjust, iatrogenic, and preventable.

Transitioning the Healthy Chicago Survey From a Telephone Mode to Self-administered by Mail Mode

CONTEXT

As response rates to health surveys conducted by telephone continue to decline and costs continue to increase, practitioners are increasingly considering a transition to self-administered mail contact modes.

OBJECTIVE

To compare empirical differences observed across adjacent administrations of the Healthy Chicago Survey (HCS) conducted by telephone versus self-administered via mail contact.

DESIGN

Data from the 2016, 2018, and 2020 administrations of the HCS are contrasted, and demographic distributions are benchmarked against the American Community Survey to investigate differences that may be linked to the HCS' transition from a telephone to self-administered mail mode between 2018 and 2020.

SETTING

All survey data were collected from adult residents of Chicago, Illinois, between 2016 and 2020.

MAIN OUTCOME MEASURES

Costs, response rates, key health statistics, demographic distributions, and measures of precision generated from the HCS.

RESULTS

The mail mode led to a response rate increase of 6.8% to 38.2% at half the cost per complete. Mail respondents are more likely to be nonminority, female, and hold a college degree. Key health statistic differences are mixed, but design effects are larger in the mail mode, which we attribute to more detailed geographic stratification and weighting employed in 2020.

CONCLUSIONS

The mail mode is a less costly data collection strategy for the HCS, but it comes with trade-offs. The quasi-random selection of an individual in the household exacerbates sociodemographic distribution disparities.

OLDER ADULT HEALTH IN THE CITY OF CHICAGO

In 2012, Chicago was designated as an Age Friendly City. However, city-wide data on the health and health disparities experienced by older adults have been scarce. In order to address this knowledge gap, the Chicago Department of Public Health (CDPH) partnered with the Center for Community Health Equity at Rush and DePaul Universities to create a report describing health status among adults age 65+. Data were from the Healthy Chicago Survey—a population-based health survey conducted by CDPH, the American Community Survey, Hospital Discharge Data, and State Vital Records. The report highlights considerable racial/ethnic diversity in Chicago, as 38% of older adults are white, 37% black, 18% Latinx, and 7% are Asian. Encouraging results exist regarding healthcare access; 96% have a personal health care provider and 89% report being able to get care needed through their health plan. Several areas of improvement are needed regarding root causes of health. More older adults live below the federal poverty level (15.9%) compared to the overall U.S (9.3%), and 45.8% would be unable to pay for an unexpected $400 expense. Disparities were evident as life expectancy at age 65 is 2.5 years longer for Latinx and white older adults (age 85) compared to African Americans (age 82.4). African American and Latinx older adults had higher rates of preventable hospitalizations per 10,000 (801.1 and 678.9, respectively) compared to white (492.4) and Asian (374.1) older adults. Findings from this report will spur Chicago’s continued progress as an Age-Friendly City for all its residents.

Nitrifying moving bed biofilm reactor (MBBR) biofilm and biomass response to long term exposure to 1 °C

This study aims to investigate moving bed biofilm reactor (MBBR) nitrification rates, nitrifying biofilm morphology, biomass viability as well as bacterial community shifts during long-term exposure to 1 °C. Long-term exposure to 1 °C is the key operational condition for potential ammonia removal upgrade units to numerous northern region treatment systems. The average laboratory MBBR ammonia removal rate after long-term exposure to 1 °C was measured to be 18 ± 5.1% as compared to the average removal rate at 20 °C. Biofilm morphology and specifically the thickness along with biomass viability at various depths in the biofilm were investigated using variable pressure electron scanning microscope (VPSEM) imaging and confocal laser scanning microscope (CLSM) imaging in combination with viability live/dead staining. The biofilm thickness along with the number of viable cells showed significant increases after long-term exposure to 1 °C. Hence, this study observed nitrifying bacteria with higher activities at warm temperatures and a slightly greater quantity of nitrifying bacteria with lower activities at cold temperatures in nitrifying MBBR biofilms. Using DNA sequencing analysis, Nitrosomonas and Nitrosospira (ammonia oxidizers) as well as Nitrospira (nitrite oxidizer) were identified and no population shift was observed between 20 °C and after long-term exposure to 1 °C.

Molecular identity of a pan cancer marker, CA215

The molecular nature of cancer-associated antigen, CA215 which reacts with RP215 monoclonal antibody and its unique epitope(s)was characterized. RP215 was initially selected and produced from one of 3,000 hybridomas which were generated from mice immunized with the cell extract of OC-3-VGH ovarian cancer cells. This cancer-associated antigen from various sources including cancer cell extract, shed culture medium and affinity-purified forms was analyzed by MALDI-TOF MS (Matrix Adsorption Laser Desorption Ionization-Time of Flight Mass Spectrometry), Western blot, carbohydrate profiling as well as enzyme immunoassays. The results of this study showed that CA215 is homologous to the heavy chains of human immunoglobulins with molecular sizes ranging from 50 to 70 KDa, when probed with RP215 or anti-human immunoglobulin G, A or M. Treatments of cancer cells with NaIO(4) drastically reduce RP215 binding to the carbohydrate-associated epitope(s) of CA215 located on the variable domain of the human immunoglobulin heavy chains. Further studies indicated that CA215 is predominantly expressed by cancer cells in both secreted and membrane-bound monomeric forms. The carbohydrate-associated epitope(s) with pH-sensitive immunoactivity appear to be present only in cancer cell-derived immunoglobulins, but not in normal human immunoglobulins. Compared to normal immunoglobulin G, CA215 contains a significantly higher percentage of N-acetyl and N-glycoyl neuraminic acid (28% vs. 8%) in the O-linked glycans, but a lower content of N-acetylglucosamine (28% vs. 41%) in the N-linked ones. It was concluded from this study that RP215 reacts specifically with carbohydrate-associated epitope(s) of immunoglobulin heavy chains expressed by various human cancer cells.