Dougherty Geoff B, Golden Sherita H, Gross Alden L, Colantuoni Elizabeth, Dean Lorraine T
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
Am J Prev Med. 2020 Oct;59(4):530-537. doi: 10.1016/j.amepre.2020.05.019. Epub 2020 Aug 27.
Structural racism has attracted increasing interest as an explanation for racial disparities in health, including differences in adiposity. Structural racism has been measured most often with single-indicator proxies (e.g., housing discrimination), which may leave important aspects of structural racism unaccounted for. This paper develops a multi-indicator scale measuring county structural racism in the U.S. and evaluates its association with BMI.
County structural racism was estimated with a confirmatory factor model including indicators reflecting education, housing, employment, criminal justice, and health care. Using Behavioral Risk Factor Surveillance Survey data (2011-2012) and a mixed-effects model, individual BMI was regressed on county structural racism, controlling for county characteristics (mean age, percentage black, percentage female, percentage rural, median income, and region). Analysis occurred 2017-2019.
The study included 324,572 U.S. adults. A 7-indicator county structural racism model demonstrated acceptable fit. County structural racism was associated with lower BMI. Structural racism and black race exhibited a qualitative interaction with BMI, such that racism was associated with lower BMI in whites and higher BMI in blacks. In a further interaction analysis, county structural racism was associated with larger increases in BMI among black men than black women. County structural racism was associated with reduced BMI for white men and no change for white women.
The results confirm structural racism as a latent construct and demonstrate that structural racism can be measured in U.S. counties using publicly available data with methods offering a strong conceptual underpinning and content validity. Further study is necessary to determine whether addressing structural racism may reduce BMI among blacks.
作为健康方面种族差异（包括肥胖差异）的一种解释，结构性种族主义已引起越来越多的关注。结构性种族主义最常通过单一指标代理变量（如住房歧视）来衡量，这可能会遗漏结构性种族主义的重要方面。本文开发了一种衡量美国各县结构性种族主义的多指标量表，并评估其与体重指数（BMI）的关联。
通过一个验证性因素模型估计各县的结构性种族主义，该模型包括反映教育、住房、就业、刑事司法和医疗保健的指标。利用行为风险因素监测调查数据（2011 - 2012年）和混合效应模型，将个体BMI对各县的结构性种族主义进行回归分析，同时控制各县特征（平均年龄、黑人百分比、女性百分比、农村百分比、收入中位数和地区）。分析于2017 - 2019年进行。
该研究纳入了324,572名美国成年人。一个包含7个指标的县结构性种族主义模型显示出可接受的拟合度。县结构性种族主义与较低的BMI相关。结构性种族主义和黑人种族在BMI方面表现出定性交互作用，即种族主义与白人较低的BMI以及黑人较高的BMI相关。在进一步的交互分析中，县结构性种族主义与黑人男性BMI的增加幅度大于黑人女性。县结构性种族主义与白人男性BMI降低相关，与白人女性BMI无变化相关。
结果证实了结构性种族主义是一个潜在结构，并表明可以使用具有强大概念基础和内容效度的方法，利用公开可用数据在美国各县衡量结构性种族主义。有必要进行进一步研究以确定解决结构性种族主义是否可能降低黑人的BMI。
