Faculty Scholarship Collaborative, DePaul University, Chicago, IL 60614, USA; Center for Community Health Equity, Chicago, IL, USA.
Department of Preventative Medicine, Rush University Medical Center, Chicago, IL 60612, USA; Center for Community Health Equity, Chicago, IL, USA.
Public Health. 2021 Jan;190:55-61. doi: 10.1016/j.puhe.2020.10.027. Epub 2020 Dec 18.
We examine associations between infant mortality rates (IMRs) and measures of structural racism and socio-economic marginalization in Chicago, Illinois. Our purpose was to determine whether the Index of Concentration at the Extremes (ICE) was significantly related to community-level IMRs.
We use a cross-sectional ecological public health design to examine community-level factors related to IMRs in Chicago neighborhoods.
We use data from the Chicago Department of Public Health and the American Community Survey to examine IMR inequities during the period 2012-2016. Calculations of the ICE for race and income were undertaken. In addition, we calculated racialized socio-economic status, which is the concentration of affluent Whites relative to poor Blacks in a community area. We present these ICE measures, as well as hardship, percent of births with inadequate prenatal care (PNC), and the percent of single-parent households as quintiles so that we can compare neighborhoods with the most disadvantage with neighborhoods with the least. Negative binomial regression was used to determine whether the ICE measures were independently related to community IMRs, net of hardship scores, PNC, and single-parent households.
Spearman correlation results indicate significant associations in Chicago communities between measures of racial segregation and economic marginalization and IMRs. Community areas with the lowest ICE scores (those with the largest concentrations of Black residents, compared with White) had IMRs that were 3.63 times higher than those communities with the largest concentrations of White residents. Most associations between community IMRS and measures of structural racism and socioeconomic marginalization are accounted for in fully adjusted negative binomial regression models. Only ICERace remained significantly related to IMRs.
We show that structural racism as represented by the ICE is independently related to IMRs in Chicago; community areas with the largest concentrations of Blacks residents compared with Whites are those with the highest IMRs. This relationship persists even after controlling for socio-economic marginalization, hardship, household composition/family support, and healthcare access. Interventions to improve birth outcomes must address structural determinants of health inequities.
我们研究了伊利诺伊州芝加哥市婴儿死亡率 (IMR) 与结构种族主义和社会经济边缘化措施之间的关系。我们的目的是确定极端集中指数 (ICE) 是否与社区一级的 IMR 有显著关系。
我们使用横断面生态公共卫生设计来研究与芝加哥社区 IMR 相关的社区一级因素。
我们使用芝加哥公共卫生部和美国社区调查的数据，研究了 2012-2016 年期间的 IMR 不公平现象。计算了种族和收入的 ICE。此外，我们计算了种族化的社会经济地位，即一个社区内富裕白人与贫困黑人的集中程度。我们提出了这些 ICE 措施，以及困难程度、产前保健不足的出生比例 (PNC) 和单亲家庭比例的五分位数，以便我们可以将最不利的社区与最不利的社区进行比较。我们使用负二项回归来确定 ICE 措施是否与社区 IMR 独立相关，而不受困难程度评分、PNC 和单亲家庭的影响。
Spearman 相关结果表明，芝加哥社区中种族隔离和经济边缘化的措施与 IMR 之间存在显著关联。ICE 得分最低的社区（黑人居民与白人居民相比，浓度最高的社区）的 IMR 比白人居民浓度最高的社区高 3.63 倍。社区 IMR 与结构种族主义和社会经济边缘化措施之间的大多数关联都在完全调整后的负二项回归模型中得到解释。只有 ICERace 与 IMR 仍有显著关系。
我们表明，ICE 所代表的结构性种族主义与芝加哥的 IMR 独立相关；与白人居民相比，黑人居民浓度最高的社区是 IMR 最高的社区。即使在控制了社会经济边缘化、困难程度、家庭组成/家庭支持和医疗保健获得情况后，这种关系仍然存在。改善生育结果的干预措施必须解决健康不平等的结构性决定因素。
