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Citation

Mohottige, Dinushika; Davenport, Clemontina A.; Bhavsar, Nrupen; Schappe, Tyler; Lyn, Michelle J.; Maxson, Pamela; Johnson, Fred; Planey, Arrianna Marie; McElroy, Lisa M.; & Wang, Virginia, et al. (2023). Residential Structural Racism and Prevalence of Chronic Health Conditions. JAMA Network Open, 6(12), e2348914. PMCID: PMC10739116

Abstract

IMPORTANCE: Studies elucidating determinants of residential neighborhood-level health inequities are needed. OBJECTIVE: To quantify associations of structural racism indicators with neighborhood prevalence of chronic kidney disease (CKD), diabetes, and hypertension.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used public data (2012-2018) and deidentified electronic health records (2017-2018) to describe the burden of structural racism and the prevalence of CKD, diabetes, and hypertension in 150 residential neighborhoods in Durham County, North Carolina, from US census block groups and quantified their associations using bayesian models accounting for spatial correlations and residents' age. Data were analyzed from January 2021 to May 2023.
EXPOSURES: Global (neighborhood percentage of White residents, economic-racial segregation, and area deprivation) and discrete (neighborhood child care centers, bus stops, tree cover, reported violent crime, impervious areas, evictions, election participation, income, poverty, education, unemployment, health insurance coverage, and police shootings) indicators of structural racism.
MAIN OUTCOMES AND MEASURES: Outcomes of interest were neighborhood prevalence of CKD, diabetes, and hypertension.
RESULTS: A total of 150 neighborhoods with a median (IQR) of 1708 (1109-2489) residents; median (IQR) of 2% (0%-6%) Asian residents, 30% (16%-56%) Black residents, 10% (4%-20%) Hispanic or Latino residents, 0% (0%-1%) Indigenous residents, and 44% (18%-70%) White residents; and median (IQR) residential income of $54 531 ($37 729.25-$78 895.25) were included in analyses. In models evaluating global indicators, greater burden of structural racism was associated with greater prevalence of CKD, diabetes, and hypertension (eg, per 1-SD decrease in neighborhood White population percentage: CKD prevalence ratio [PR], 1.27; 95% highest density interval [HDI], 1.18-1.35; diabetes PR, 1.43; 95% HDI, 1.37-1.52; hypertension PR, 1.19; 95% HDI, 1.14-1.25). Similarly in models evaluating discrete indicators, greater burden of structural racism was associated with greater neighborhood prevalence of CKD, diabetes, and hypertension (eg, per 1-SD increase in reported violent crime: CKD PR, 1.15; 95% HDI, 1.07-1.23; diabetes PR, 1.20; 95% HDI, 1.13-1.28; hypertension PR, 1.08; 95% HDI, 1.02-1.14).
CONCLUSIONS AND RELEVANCE: This cross-sectional study found several global and discrete structural racism indicators associated with increased prevalence of health conditions in residential neighborhoods. Although inferences from this cross-sectional and ecological study warrant caution, they may help guide the development of future community health interventions.

URL

http://dx.doi.org/10.1001/jamanetworkopen.2023.48914

Reference Type

Journal Article

Year Published

2023

Journal Title

JAMA Network Open

Author(s)

Mohottige, Dinushika
Davenport, Clemontina A.
Bhavsar, Nrupen
Schappe, Tyler
Lyn, Michelle J.
Maxson, Pamela
Johnson, Fred
Planey, Arrianna Marie
McElroy, Lisa M.
Wang, Virginia
Cabacungan, Ashley N.
Ephraim, Patti
Lantos, Paul M.
Peskoe, Sarah
Lunyera, Joseph
Bentley-Edwards, Keisha
Diamantidis, Clarissa J.
Reich, Brian J.
Boulware, L. Ebony

Article Type

Regular

PMCID

PMC10739116

Continent/Country

United States

State

North Carolina

Race/Ethnicity

Asian
Black
White
Hispanic
Indigenous

ORCiD

Planey - 0000-0003-4739-090X