Women's and Children's Center, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
Epidemiol Rev. 2009;31:178-94. doi: 10.1093/epirev/mxp001. Epub 2009 May 23.
For decades, racial residential segregation has been observed to vary with health outcomes for African Americans, although only recently has interest increased in the public health literature. Utilizing a systematic review of the health and social science literature, the authors consider the segregation-health association through the lens of 4 questions of interest to epidemiologists: How is segregation best measured? Is the segregation-health association socially or biologically plausible? What evidence is there of segregation-health associations? Is segregation a modifiable risk factor? Thirty-nine identified studies test an association between segregation and health outcomes. The health effects of segregation are relatively consistent, but complex. Isolation segregation is associated with poor pregnancy outcomes and increased mortality for blacks, but several studies report health-protective effects of living in clustered black neighborhoods net of social and economic isolation. The majority of reviewed studies are cross-sectional and use coarse measures of segregation. Future work should extend recent developments in measuring and conceptualizing segregation in a multilevel framework, build upon the findings and challenges in the neighborhood-effects literature, and utilize longitudinal data sources to illuminate opportunities for public health action to reduce racial disparities in disease.
几十年来，人们观察到，种族居住隔离与非裔美国人的健康结果有关，尽管最近才引起公共卫生文献的兴趣。作者利用对健康和社会科学文献的系统回顾，从对流行病学家感兴趣的 4 个问题的角度来考虑隔离与健康的关联：隔离程度如何衡量？隔离与健康的关联在社会上或生物学上是否合理？有哪些关于隔离与健康关联的证据？隔离是否是一个可改变的风险因素？39 项已确定的研究检验了隔离与健康结果之间的关联。隔离对健康的影响相对一致，但很复杂。隔离程度与黑人较差的妊娠结局和死亡率增加有关，但有几项研究报告称，在社会和经济隔离之外，居住在集中的黑人社区对健康有保护作用。大多数综述研究是横断面的，使用的是隔离程度的粗略衡量标准。未来的工作应该在多层次框架中扩展衡量和概念化隔离的最新进展，借鉴邻里效应文献中的发现和挑战，并利用纵向数据源来阐明减少疾病中种族差异的公共卫生行动机会。
