Fisher Victoria, Boretsky Allison, Alkhouri Nicole, Abuelezam Nadia N
Michigan State University College of Human Medicine.
Boston College Connell School of Nursing.
Crit Public Health. 2025;35(1). doi: 10.1080/09581596.2025.2492798. Epub 2025 Apr 21.
Racist urban development policies and capitalist municipal management have continued the cycle of poverty experienced by many in the US. Modeling this disadvantage often relies on composite, or "umbrella", socioeconomic variables. We argue that this approach obfuscates the temporal nature of social determinants. We propose organizing downstream consequences of structural racism by exposure duration-historical disenfranchisement and contemporary disadvantage-to assess their differential effect on excess all-cause mortality in an U.S. urban environment during the COVID-19 pandemic.
ZIP-code tabulation area (ZCTA) 2020 and 2021 demographics were used to create an historical disenfranchisement index, a contemporary disadvantage index, and combined index (our proxy for a "umbrella" variable) for 210 ZCTAs in the Kansas City Metropolitan Area. Indices were dichotomized into "above" and "below" average, as well as a quadrant matrix index categorizing ZCTAs by "above average" in both, one index only, or neither. General linear models assessed the relationship between the indices and excess all-cause mortality. Model fit was compared by AIC.
Across all models, ZCTAs that experienced above average structural racism had significantly greater excess all-cause mortality than those with below average structural racism markers. The quadrant model (AIC = 3441) performed significantly better than the combined index (AIC = 3468.3) with a reduction in AIC of 27.2.
Composite metrics of disadvantage may mask important distinctions in how mechanisms of structural racism are associated with health outcomes. This analysis provides support for place-based, historically sensitive health research.
种族主义城市发展政策和资本主义市政管理延续了美国许多人所经历的贫困循环。对这种不利状况进行建模通常依赖于综合的或“总括性”的社会经济变量。我们认为，这种方法掩盖了社会决定因素的时间性质。我们建议通过暴露持续时间——历史上的选举权剥夺和当代的不利状况——来梳理结构性种族主义的下游后果，以评估它们在新冠疫情期间对美国城市环境中全因死亡率过高的差异影响。
利用2020年和2021年邮政编码分区统计区域（ZCTA）的人口统计数据，为堪萨斯城大都市区的210个ZCTA创建一个历史选举权剥夺指数、一个当代不利状况指数和综合指数（我们用作“总括性”变量的代理指标）。这些指数被分为“高于”和“低于”平均水平，以及一个象限矩阵指数，该指数根据ZCTA在两个指数、仅一个指数或两个指数都“高于平均水平”对其进行分类。一般线性模型评估了这些指数与全因死亡率过高之间的关系。通过AIC比较模型拟合度。
在所有模型中，经历高于平均水平结构性种族主义的ZCTA的全因死亡率过高情况显著高于那些结构性种族主义指标低于平均水平的ZCTA。象限模型（AIC = 3441）的表现明显优于综合指数（AIC = 3468.3），AIC降低了27.2。
不利状况的综合指标可能掩盖了结构性种族主义机制与健康结果之间关联方式的重要差异。该分析为基于地点、对历史敏感的健康研究提供了支持。
