Evaluating Race in Air Pollution and Health Research: Race, PM2.5 Air Pollution Exposure, and Mortality as a Case Study

PURPOSE OF REVIEW

Racial inequities in air pollution exposure have been documented. There is also interest in documenting the modifying role of race in the link between air pollution and health. However, the empirical literature in this area has yielded mixed results with potentially unclear policy implications. We critically evaluate recent empirical papers on the interactive association between race and air pollution exposure on adult mortality in the USA as a case study of the race, pollution, and health literature. Specifically, we evaluate these studies for the conceptualization and discussion of race and the use of race variables that may contribute to the ambiguous results and policy implications both in this specific literature and in the broader literature.

RECENT FINDINGS

We evaluate ten empirical studies from 2016 to 2022 on the modifying role of race in the association between short- and long-term PM2.5 exposure and specific types of adult mortality (all cause, non-accidental, and heart or cardiovascular diseases) in the USA. In addition to comparing and contrasting the empirical results, we focus our review on the conceptualization, measurement, modeling, and discussion of race and the race variables. Overall, the results indicate no consistent role of race in the association between PM2.5 exposure and mortality. Moreover, conceptualization and discussion of race was often brief and incomplete, even when the empirical results were unexpected or counterintuitive. To build on recent discussions in the epidemiology and environmental epidemiology literature more specifically, we provide a detailed discussion of the meaning of race, the race variables, and the cultural and structural racism that some argue are proxied by race variables. We use theoretical scholarship from the humanities and social sciences along with empirical work from the environmental literature to provide recommendations for future research that can provide an evidence base to inform both social and environmental policy.

Ethnic/Racial Disparity in Mortality from COVID-19: Data for the Year 2020 in Brazil

The study aimed to investigate ethnic/racial disparities in COVID-19 mortality in Brazilian federative units and their respective capitals in 2020. Population data and number of COVID-19 deaths were extracted by skin color (white, black, brown and indigenous) from all Brazilian states and their respective capitals. The mortality rate of COVID-19 by ethnicity in Brazilian states was higher between people from brown skin color, followed by indigenous and black. Only in one state, in the Federal District and in the federal capital, age-standardized mortality rates were higher among white's people. There is a high percentage of deaths from COVID-19 higher than expected among non-white individuals, especially in south-central states and capitals of the country. Mortality from COVID-19 affect ethnic-racial groups unevenly in Brazil and the number of excess deaths among non-whites was over 9000. Urgent government measures are needed to reduce the racial disparity in health indicators in Brazil.

The Case for Decolonising the Dental Curricula in the UK

Students across disciplines in UK universities are demanding decolonisation of their education. These demands aim to resist the white European colonial endeavour that create racist inequalities. To address racial inequalities, the dental discipline has predominantly focused on diversity rather than decolonisation. By using two inter-related referents of decolonisation to dental caries and cosmetic dentistry, this article demonstrates the epistemic violence exerted through the objective hierarchised knowledge practices in dentistry. First, by starting from the position of racisms, empire and slavery, the enduring colonial patterns of power and hierarchies come into view. We see how knowledge production in dentistry has neglected the interconnected histories of colonialism, racial capitalism and patriarchy that continue to shape oral health inequalities and work towards promoting white supremacist beauty ideals. Moreover, the interconnected character of inequalities - race, class and gender - begin to emerge. Second, by proceeding from the place of colonialism, the limits of dental knowledge and the violence embedded in knowledge practices emerge. This highlights the need for new ways of knowing. To decolonise is to confront and weaken the dental discipline's entanglement with the enduring colonial patterns of power and hierarchies that are complicit in maintaining inequalities. Diversity without decolonisation will simply subsume marginalised voices into the existing hierarchised knowledge paradigm and continue to reproduce a hierarchised, unequal world. I argue that if dental schools want to address racial and intersectional inequalities, they need new transformative ways of learning and knowing to equip students to work towards social justice in the outside world.

A descriptive study of racial inequalities in mortality from hepatocellular cancer before and after licensure of lifesaving drugs for hepatitis C virus in the United States

BACKGROUND

Since 1979, mortality from hepatocellular cancer (HCC) has doubled in the United States (US). Lifesaving drugs, prohibitively expensive for some, were approved and marketed to treat hepatitis C virus (HCV), a major risk factor for HCC, beginning in 1997. After the prior introduction of other lifesaving innovations, including active retroviral drug therapy for human immunodeficiency virus and surfactant for respiratory distress syndrome of the newborn, racial inequalities in their mortalities increased in the US. In this descriptive study, we explored racial inequalities in mortality from HCC before and after licensure of HCV drugs in the US.

METHODS

The US Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (WONDER) were used to describe HCC mortality rates from 1979 to 2016 in those 55 years of age and older, because they suffer the largest disease burden. Joinpoint regression was used to analyze trends. To estimate excess deaths, we applied White age-sex-specific rates to corresponding Black populations.

FINDINGS

From 1979 to 1998, racial inequalities in mortality from HCC in the US were declining but from 1998 to 2016 racial inequalities steadily increased. From 1998 to 2016, of the 16,770 deaths from HCC among Blacks, the excess relative to Whites increased from 27.8% to 45.4%, and the trends were more prominent in men. Concurrently, racial inequalities in mortality decreased for major risk factors for HCC, including alcohol, obesity and diabetes.

INTERPRETATION

These descriptive data, useful to formulate but not test hypotheses, demonstrate decreasing racial inequalities in mortality from HCC which were followed by increases after introduction of lifesaving drugs for HCV in the US. Among many plausible hypotheses generated are social side effects, including unequal accessibility, acceptability and/or utilization. Analytic epidemiological studies designed a priori to do so are necessary to test these and other hypotheses.

Lower Mortality Rates from Cryptococcosis in Women and Whites with Human Immunodeficiency Virus in the United States

Cryptococcosis is an opportunistic mycotic infection often found in pigeon droppings and other bird excrement. This serious disease is often fatal and, not unexpectedly, far more common in patients with immune deficiency, including those with human immunodeficiency virus (HIV). It has been hypothesized that women with cryptococcosis and HIV have a more favorable mortality experience than men. In addition, the availability of highly active anti-retroviral therapy (ART) for HIV in the United States (US) has been associated with greater racial disparities in mortality. The US Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (WONDER) database afforded a unique opportunity to explore mortality rates due to cryptococcosis by gender and race in the US among patients with HIV from 1999 to 2016. Mortality rate ratios from cryptococcosis were significantly lower in women and whites with HIV. These descriptive data lead to the formulation of hypotheses requiring testing in analytic studies designed a priori to do so and pose clinical and public health challenges in reducing mortality from cryptococcosis in patients with HIV.

Biogeographical ancestry is associated with socioenvironmental conditions and infections in a Latin American urban population

Racial inequalities are observed for different diseases and are mainly caused by differences in socioeconomic status between ethnoracial groups. Genetic factors have also been implicated, and recently, several studies have investigated the association between biogeographical ancestry (BGA) and complex diseases. However, the role of BGA as a proxy for non-genetic health determinants has been little investigated. Similarly, studies comparing the association of BGA and self-reported skin colour with these determinants are scarce. Here, we report the association of BGA and self-reported skin colour with socioenvironmental conditions and infections. We studied 1246 children living in a Brazilian urban poor area. The BGA was estimated using 370,539 genome-wide autosomal markers. Standardised questionnaires were administered to the children’s guardians to evaluate socioenvironmental conditions. Infection (or pathogen exposure) was defined by the presence of positive serologic test results for IgG to seven pathogens (Toxocara spp, Toxoplasma gondii, Helicobacter pylori, and hepatitis A, herpes simplex, herpes zoster and Epstein-Barr viruses) and the presence of intestinal helminth eggs in stool samples (Ascaris lumbricoides and Trichiuris trichiura). African ancestry was negatively associated with maternal education and household income and positively associated with infections and variables, indicating poorer housing and living conditions. The self-reported skin colour was associated with infections only. In stratified analyses, the proportion of African ancestry was associated with most of the outcomes investigated, particularly among admixed individuals. In conclusion, BGA was associated with socioenvironmental conditions and infections even in a low-income and highly admixed population, capturing differences that self-reported skin colour miss. Importantly, our findings suggest caution in interpreting significant associations between BGA and diseases as indicative of the genetic factors involved.

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We studied the relationship between BGA and social determinants of health.

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We compared the BGA and the self-reported skin color as proxies for these determinants.

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African ancestry was associated with poor socioenvironmental conditions and infections.

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The self-reported skin color was associated with infections only.

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Social stratification related to BGA persists even in a poor and highly admixed population.

The weight of racism: Vigilance and racial inequalities in weight-related measures

In the United States, racial/ethnic inequalities in obesity are well-documented, particularly among women. Using the Chicago Community Adult Health Study, a probability-based sample in 2001-2003 (N = 3105), we examined the roles of discrimination and vigilance in racial inequalities in two weight-related measures, body mass index (BMI) and waist circumference (WC), viewed through a cultural racism lens. Cultural racism creates a social environment in which Black Americans bear the stigma burden of their racial group while White Americans are allowed to view themselves as individuals. We propose that in this context, interpersonal discrimination holds a different meaning for Blacks and Whites, while vigilance captures the coping style for Blacks who carry the stigma burden of the racial group. By placing discrimination and vigilance within the context of cultural racism, we operationalize existing survey measures and utilize statistical models to clarify the ambiguous associations between discrimination and weight-related inequalities in the extant literature. Multivariate models were estimated for BMI and WC separately and were stratified by gender. Black women had higher mean BMI and WC than any other group, as well as highest levels of vigilance. White women did not show an association between vigilance and WC but did show a strong positive association between discrimination and WC. Conversely, Black women displayed an association between vigilance and WC, but not between discrimination and WC. These results demonstrate that vigilance and discrimination may hold different meanings for obesity by ethnoracial group that are concealed when all women are examined together and viewed without considering a cultural racism lens.

Do racial inequities in infant mortality correspond to variations in societal conditions? A study of state-level income inequality in the U.S., 1992-2007

BACKGROUND

Prior studies have examined the association between income inequality and overall infant mortality rates (IMR). We examine effects of income inequality on racial inequities in IMR over the period 1992-2007 in the U.S.

METHODS

Race-specific state IMR data were obtained from 1992 to 2007, from which absolute and relative IMR inequities were calculated. Fixed and random effects models, adjusted for state-level median income, percent poverty, percent high school graduates, and unemployment rate, were used to determine contemporaneous and lagged state-level associations between income inequality and racial IMR inequities.

RESULTS

Racial IMR inequities varied significantly across the U.S. Contemporaneous income inequality was negatively associated with white IMR only. Two-year lagged income inequality was negatively associated with black IMR and had the most pronounced effect on racial inequities in IMR.

DISCUSSION

Future studies should consider lagged effects of income inequality on IMR and other health outcomes, and should examine other potential societal conditions that may account for state-level variations in racial IMR inequities.