Racial residential segregation, socioeconomic disparities, and the White-Black survival gap

Abstract

ObjectiveTo evaluate the association between racial residential segregation, a prominent manifestation of systemic racism, and the White-Black survival gap in a contemporary cohort of adults, and to assess the extent to which socioeconomic inequality explains this association.DesignThis was a cross sectional study of White and Black men and women aged 35–75 living in 102 large US Core Based Statistical Areas. The main outcome was the White-Black survival gap. We used 2009–2013 CDC mortality data for Black and White men and women to calculate age-, sex- and race adjusted White and Black mortality rates. We measured segregation using the Dissimilarity index, obtained from the Manhattan Institute. We used the 2009–2013 American Community Survey to define indicators of socioeconomic inequality. We estimated the CBSA-level White–Black gap in probability of survival using sequential linear regression models accounting for the CBSA dissimilarity index and race-specific socioeconomic indicators.ResultsBlack men and women had a 14% and 9% lower probability of survival from age 35 to 75 than their white counterparts. Residential segregation was strongly associated with the survival gap, and this relationship was partly, but not fully, explained by socioeconomic inequality. At the lowest observed level of segregation, and with the Black socioeconomic status (SES) assumed to be at the White SES level scenario, the survival gap is essentially eliminated.ConclusionWhite-Black differences in survival remain wide notwithstanding public health efforts to improve life expectancy and initiatives to reduce health disparities. Eliminating racial residential segregation and bringing Black socioeconomic status (SES) to White SES levels would eliminate the White-Black survival gap.

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“…Systemic inequities contribute to disparities in health outcomes among minoritized populations. For example, families of racial and ethnic minorities experience racism and discrimination (e.g., Brondolo, Gallo, & Myers, 2009 ) and may be less able to social distance due to increased segregation into residential housing, ( Iceland, Goyette, Nelson, & Chan, 2010 ; Popescu, Duffy, Mendelsohn, & Escarce, 2018 ), limited paid sick leave ( Bartel et al, 2019 ), and inadequate access to health insurance and health care ( Lee, Ayers, & Kronenfeld, 2009 ; Phillips, Mayer, & Aday, 2000 ). These economic and social inequities may in turn place minoritized families at greater risk for increased stress and disparate outcomes during the COVID-19 pandemic.…”

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