Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
J Natl Med Assoc. 2023 Apr;115(2):207-222. doi: 10.1016/j.jnma.2023.01.010. Epub 2023 Feb 15.
While several studies have examined the impact of individual indicators of structural racism on single health outcomes, few have explicitly modeled racial disparities in a wide range of health outcomes using a multidimensional, composite structural racism index. This paper builds on the previous research by examining the relationship between state-level structural racism and a wider array of health outcomes, focusing on racial disparities in mortality from firearm homicide, infant mortality, stroke, diabetes, hypertension, asthma, HIV, obesity, and kidney disease.
We used a previously developed state structural racism index that consists of a composite score derived by averaging eight indicators across five domains: (1) residential segregation; (2) incarceration; (3) employment; (4) economic status/wealth; and (5) education. Indicators were obtained for each of the 50 states using Census data from 2020. We estimated the Black-White disparity in each health outcome in each state by dividing the age-adjusted mortality rate for the non-Hispanic Black population by the age-adjusted mortality rate for the non-Hispanic White population. These rates were obtained from the CDC WONDER Multiple Cause of Death database for the combined years 1999-2020. We conducted linear regression analyses to examine the relationship between the state structural racism index and the Black-White disparity in each health outcome across the states. In multiple regression analyses, we controlled for a wide range of potential confounding variables.
Our calculations revealed striking geographic differences in the magnitude of structural racism, with the highest values generally being observed in the Midwest and Northeast. Higher levels of structural racism were significantly associated with greater racial disparities in mortality for all but two of the health outcomes.
There is a robust relationship between structural racism and Black-White disparities in multiple health outcomes across states. Programs and policies to reduce racial heath disparities must include strategies to help dismantle structural racism and its consequences.
虽然有几项研究考察了结构性种族主义的个别指标对单一健康结果的影响，但很少有研究使用多维综合结构性种族主义指数明确模拟广泛健康结果的种族差异。本文通过考察州级结构性种族主义与更广泛的健康结果之间的关系，进一步研究了这一问题，重点关注了在枪支凶杀、婴儿死亡率、中风、糖尿病、高血压、哮喘、艾滋病毒、肥胖症和肾病等死亡率方面的种族差异。
我们使用了一个先前开发的州级结构性种族主义指数，该指数由五个领域的八个指标的平均值组成：（1）居住隔离；（2）监禁；（3）就业；（4）经济地位/财富；和（5）教育。利用 2020 年的人口普查数据，我们为 50 个州中的每一个州获取了这些指标。我们通过将非西班牙裔黑人人口的年龄调整死亡率除以非西班牙裔白人人口的年龄调整死亡率，计算出每个州中每种健康结果的黑人和白人之间的差异。这些比率是从 CDC WONDER 多因死亡数据库中获得的，数据涵盖了 1999 年至 2020 年的时间。我们进行线性回归分析，以检验州结构性种族主义指数与各州各种健康结果中黑人和白人之间的差异之间的关系。在多元回归分析中，我们控制了广泛的潜在混杂变量。
我们的计算结果显示，结构性种族主义的严重程度在地理上存在显著差异，中西部和东北部的数值通常最高。较高水平的结构性种族主义与除两个健康结果之外的所有结果的死亡率种族差异显著相关。
结构性种族主义与各州多种健康结果中的黑人和白人之间的差异之间存在强有力的关系。减少种族健康差异的项目和政策必须包括帮助消除结构性种族主义及其后果的策略。
