Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Los Angeles, CA, United States of America.
The RAND Corporation, Santa Monica, CA, United States of America.
PLoS One. 2018 Feb 23;13(2):e0193222. doi: 10.1371/journal.pone.0193222. eCollection 2018.
To evaluate the association between racial residential segregation, a prominent manifestation of systemic racism, and the White-Black survival gap in a contemporary cohort of adults, and to assess the extent to which socioeconomic inequality explains this association.
This was a cross sectional study of White and Black men and women aged 35-75 living in 102 large US Core Based Statistical Areas. The main outcome was the White-Black survival gap. We used 2009-2013 CDC mortality data for Black and White men and women to calculate age-, sex- and race adjusted White and Black mortality rates. We measured segregation using the Dissimilarity index, obtained from the Manhattan Institute. We used the 2009-2013 American Community Survey to define indicators of socioeconomic inequality. We estimated the CBSA-level White-Black gap in probability of survival using sequential linear regression models accounting for the CBSA dissimilarity index and race-specific socioeconomic indicators.
Black men and women had a 14% and 9% lower probability of survival from age 35 to 75 than their white counterparts. Residential segregation was strongly associated with the survival gap, and this relationship was partly, but not fully, explained by socioeconomic inequality. At the lowest observed level of segregation, and with the Black socioeconomic status (SES) assumed to be at the White SES level scenario, the survival gap is essentially eliminated.
White-Black differences in survival remain wide notwithstanding public health efforts to improve life expectancy and initiatives to reduce health disparities. Eliminating racial residential segregation and bringing Black socioeconomic status (SES) to White SES levels would eliminate the White-Black survival gap.
评估种族居住隔离（系统性种族主义的突出表现）与当代成年人中白人和黑人的生存差距之间的关联，并评估社会经济不平等在多大程度上解释了这种关联。
这是一项横断面研究，研究对象为年龄在 35-75 岁之间、居住在美国 102 个核心基本统计区的白人和黑人男性和女性。主要结果是白人和黑人的生存差距。我们使用了 2009-2013 年疾病预防控制中心（CDC）黑人和白人男性和女性的死亡率数据，计算了年龄、性别和种族调整后的黑人和白人死亡率。我们使用差异指数来衡量隔离程度，该指数来自曼哈顿研究所。我们使用了 2009-2013 年美国社区调查来定义社会经济不平等的指标。我们使用顺序线性回归模型估计了 CBSA 层面上白人和黑人的生存概率差距，该模型考虑了 CBSA 的差异指数和特定种族的社会经济指标。
黑人男性和女性从 35 岁到 75 岁的生存概率比他们的白人同龄人低 14%和 9%。居住隔离与生存差距密切相关，这种关系部分但不完全由社会经济不平等来解释。在观察到的最低隔离水平下，并且假设黑人社会经济地位（SES）达到白人 SES 水平的情况下，生存差距基本消除。
尽管公共卫生部门努力提高预期寿命并采取措施减少健康差距，但白人和黑人之间的生存差异仍然很大。消除种族居住隔离并使黑人社会经济地位（SES）达到白人 SES 水平将消除白人和黑人的生存差距。
