Being overburdened and medically underserved: assessment of this double disparity for populations in the state of Maryland

Abstract

BackgroundEnvironmental justice research has shown that many communities of color and low-income persons are differentially burdened by noxious land uses including Toxic Release Inventory (TRI) facilities. However, limited work has been performed to assess how these populations tend to be both overburdened and medically underserved. We explored this “double disparity” for the first time in Maryland.MethodsWe assessed spatial disparities in the distribution of TRI facilities in Maryland across varying levels of sociodemographic composition using 2010 US Census Health Professional Shortage Area (HPSA) data. Univariate and multivariate regression in addition to geographic information systems (GIS) were used to examine relationships between sociodemographic measures and location of TRI facilities. Buffer analysis was also used to assess spatial disparities. Four buffer categories included: 1) census tracts hosting one or more TRI facilities; 2) tracts located more than 0 and up to 0.5 km from the closest TRI facility; 3) tracts located more than 0.5 km and up to 1 km from a TRI facility; and 4) tracts located more than 1 km and up to 5 km from a TRI facility.ResultsWe found that tracts with higher proportions of non-white residents and people living in poverty were more likely to be closer to TRI facilities. A significant increase in income was observed with an increase in distance between a census tract and the closest TRI facility. In general, percent non-white was higher in HPSA tracts that host at least one TRI facility than in non-HPSA tracts that host at least one TRI facility. Additionally, percent poverty, unemployment, less than high school education, and homes built pre-1950 were higher in HPSA tracts hosting TRI facilities than in non-HPSA tracts hosting TRI facilities.ConclusionsWe found that people of color and low-income groups are differentially burdened by TRI facilities in Maryland. We also found that both low-income groups and persons without a high school education are both overburdened and medically underserved. The results of this study provide insight into how state agencies can better address the double disparity of disproportionate environmental hazards and limited access to health care resources facing vulnerable communities in Maryland.

Hybrid Resiliency-Stressor Conceptual Framework for Informing Decision Support Tools and Addressing Environmental Injustice and Health Inequities

“…Exposures to environmental stressors modify aspects of gene expression in the epigenome that may cause individuals to deviate from a life course trajectory of optimal health [6]. Differentially burdened populations of color and economically marginalized groups are particularly vulnerable to epigenetic modifications since they often experience the greatest exposure to environmental hazards in their neighborhoods [7,8,9,10,11] and may lack health-promoting infrastructure or resiliency buffers that are necessary to offset negative exposures. Without these safeguards in place, communities of color and low-income groups overburdened by EJ issues (i.e., heavily trafficked roadways, Toxic Release Inventory [TRI] facilities, crime) may be more likely to have higher mortality rates of stroke, hypertension, cancer, diabetes, and heart disease when compared to their White and more affluent counterparts [12,13].…”

The socio-exposome: advancing exposure science and environmental justice in a postgenomic era

“…This would be unfortunate, as economically marginalized communities without access to healthcare also typically bear the heaviest burden of toxic exposure. This double jeopardy makes it especially unlikely that minority communities will benefit from the highly anticipated wave of “precision medicine initiatives” (Wilson et al 2014). …”

Cancer experiences and health-related quality of life among racial and ethnic minority survivors of young adult cancer: a mixed methods study

“…A diagnosis of cancer may be particularly disruptive for racial/ethnic minority YAs given culturally specific beliefs about cancer including negative beliefs about surgery, fatalism and medical mistrust, which have been shown to contribute to cultural differences in the cancer experiences of patients from racial/ethnic minority groups [18–21]. The literature on adult cancer survivors has shown differences in patient experiences by race/ethnicity related to interpretations of care, differences in expectations, actual provision of care, and the “same care (as non-minority peers), worse experiences” phenomenon [19–23]. In addition, higher likelihood of facing socioeconomic disadvantage may further add stress and contribute to poor health outcomes among minority cancer survivors [15–23].…”

“…The literature on adult cancer survivors has shown differences in patient experiences by race/ethnicity related to interpretations of care, differences in expectations, actual provision of care, and the “same care (as non-minority peers), worse experiences” phenomenon [19–23]. In addition, higher likelihood of facing socioeconomic disadvantage may further add stress and contribute to poor health outcomes among minority cancer survivors [15–23]. Nonetheless, other studies have documented certain protective factors related to racial/ethnic minority status derived from health-fostering beliefs, values and practices, and strong family and social networks [17,18,21].…”

“…Racial/ethnic minority YA cancer survivors face a unique set of conditions that can be considered a “double disparity” [23], wherein they face the challenges of young age and racial/ethnic minority status (e.g., advanced stage at diagnosis, less access to timely treatments, poor quality of care, and poor decision-making supports) [1,2,5,20]. Few studies have examined cancer survivors from both of these underserved groups [1,2,16,19], despite the potential benefits of better understanding this subgroup’s experiences [1,2,13–19].…”