Residential Structural Racism and Prevalence of Chronic Health Conditions

Mohottige, Dinushika; Davenport, Clemontina A.; Bhavsar, Nrupen; Schappe, Tyler; Lyn, Michelle J.; Maxson, Pamela; Johnson, Fred; Planey, Arrianna M.; McElroy, Lisa M.; Wang, Virginia; Cabacungan, Ashley N.; Ephraim, Patti; Lantos, Paul; Peskoe, Sarah; Lunyera, Joseph; Bentley-Edwards, Keisha; Diamantidis, Clarissa J.; Reich, Brian; Boulware, L. Ebony

doi:10.1001/jamanetworkopen.2023.48914

Cited by 14 publications

(3 citation statements)

References 83 publications

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“…37 Our findings are consistent with a recent cross-sectional analysis in North Carolina by Mohottige et al, which identified an increased burden of structural racism indicators associated with higher neighborhood prevalence of hypertension, including lower percentages of White individuals in the neighborhood, high poverty rates, and higher ADI. 38…”

Section: Discussionmentioning

confidence: 99%

School Neighborhood Deprivation is Associated with a Higher Prevalence of Hypertension

Onugha,

Banerjee,

Nobleza

et al. 2024

Preprint

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Hypertension, a major modifiable risk factor for cardiovascular disease, is increasing among adolescents. While socioeconomic factors contribute to hypertension risk in adults, similar data in children is lacking. We examined the association between socioeconomic characteristics of school neighborhoods and the prevalence of hypertension in adolescents. School neighborhood socioeconomic status (SES) was assessed via the area deprivation index (ADI), a composite measure of area-level socioeconomic deprivation. Using data from a school BP surveillance program implemented in the Houston metropolitan area, we performed a cross-sectional analysis using both univariate and multivariable regression analyses. Among 21,392 students aged 10 to 19 years during the 2000 through 2017 academic years, the prevalence of sustained hypertension was 2.6%. Although 85% of students attended schools located in neighborhoods in quartiles 1 (Q1) and 2 (Q2) (higher ADI represents more deprivation), Hispanics and African Americans were overrepresented in the schools located inside more deprived neighborhoods. The highest sustained hypertension rate (4.6%) was observed among students attending Q 3 and Q4 schools compared to 2.3% in Q 1 and Q2 schools (p < 0.001). Multivariable regression analysis showed that being male, obese, and attending school in a disadvantaged neighborhood were significantly associated with an increased prevalence of hypertension. Attending school in neighborhoods with lower SES may account for the increased hypertension prevalence in minority adolescents. Characteristics of school neighborhoods play an important role in disparities observed in hypertension prevalence, providing direct opportunities to encourage improved dietary intake and physical activity, both of which are important determinants of hypertension.

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Section: Discussionmentioning

confidence: 99%

School Neighborhood Deprivation is Associated with a Higher Prevalence of Hypertension

Onugha,

Banerjee,

Nobleza

et al. 2024

Preprint

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“…Among the domains associated with increased risk of sepsis, Black people have a higher burden of comorbidities [38,39], and alcohol dependence is more common in Black and Hispanic people [40] compared to White people. Residential racial segregation has been long-standing in the US and remains prevalent [41], with greater social deprivation in minority-predominant communities, especially of Black and Hispanic people [42,43]. In addition to its broad association with increased risk of sepsis [10], community-level social deprivation has been shown to be associated with greater prevalence of chronic health conditions, including those associated with sepsis [43,44].…”

Section: Discussionmentioning

confidence: 99%

“…Residential racial segregation has been long-standing in the US and remains prevalent [41], with greater social deprivation in minority-predominant communities, especially of Black and Hispanic people [42,43]. In addition to its broad association with increased risk of sepsis [10], community-level social deprivation has been shown to be associated with greater prevalence of chronic health conditions, including those associated with sepsis [43,44]. Furthermore, Black people tend to reside more commonly in medically underserved areas [11], with neighborhoods with a high proportion of Black people having less access to primary care [45], and Black and Hispanic people have been increasingly facing barriers to timely medical care compared to White people [46].…”

Section: Discussionmentioning

confidence: 99%

Trajectories of State-Level Sepsis-Related Mortality by Race and Ethnicity Group in the United States

Oud,

Garza

2024

JCM

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Background: Recent reports on the national temporal trends of sepsis-related mortality in the United States (US) suggested improvement of outcomes in several race and ethnicity groups. However, it is unknown whether national data reflect state-level trajectories. Methods: We used the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Multiple Cause of Death data set to identify all decedents with sepsis in the US during 2010–2019. Negative binomial regression models were fit to estimate national and state-level trends of age-adjusted sepsis-related mortality rates within race and ethnicity groups. Results: There were 1,852,610 sepsis-related deaths in the US during 2010–2019. Nationally, sepsis-related mortality rates decreased among Blacks and Asians, were unchanged among Hispanics and Native Americans, and rose among Whites. The percent of states with similar trends were 30.0% among Blacks, 32.1% among Asians, 74.3% among Hispanics, 75.0% among Native Americans, and 66.7%% among Whites, while trending in opposite direction from 3.6% among Asians to 15.0% among Blacks. Conclusions: National trends in sepsis-related mortality in the US did not represent state-level trajectories in race ethnicity groups. Gains in sepsis outcomes among race and ethnicity groups at the national level were not shared equitably at the state level.

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Racial and Ethnic Disparities in Patient Restraint in Emergency Departments by Police Transport Status

Chang-Sing,

Smith,

Gagliardi

et al. 2024

JAMA Netw Open

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ImportanceBlack patients are more likely than White patients to be restrained during behavioral crises in emergency departments (EDs). Although the perils of policing mental health for Black individuals are recognized, it is unclear whether or to what extent police transport mediates the association between Black race and use of physical restraint in EDs.ObjectiveTo evaluate the degree to which police transport mediates the association between Black race and use of physical restraint in EDs.Design, Setting, and ParticipantsThis retrospective, cross-sectional study used electronic health record data from ED visits by adults (aged ≥18 years) to 3 hospitals in the southeastern US and 10 in the northeastern US between January 1, 2015, and December 31, 2022. Data were analyzed from September 1, 2022, to May 30, 2023.ExposuresRace, ethnicity, and police transport to the hospital.Main Outcomes and MeasuresThe primary outcome variable was the presence of an order for restraints during an ED visit.ResultsA total of 4 263 437 ED visits by 1 257 339 patients (55.5% of visits by female and 44.5% by male patients; 26.1% by patients 65 years or older) were included in the study. Black patients accounted for 27.5% of visits; Hispanic patients, 17.6%; White patients, 50.3%; and other or unknown race or ethnicity, 4.6%. In models adjusted for age, sex, site, previous behavioral or psychiatric history, and visit diagnoses, Black patients were at increased odds of experiencing restraint compared with White patients (adjusted odds ratio [AOR], 1.33 [95% CI, 1.28-1.37]). Within the mediation analysis, Black patients had higher odds of being brought to the hospital by police compared with all other patients (AOR, 1.38 [95% CI, 1.34-1.42]). Patients brought to the ED under police transport had increased odds of experiencing restraint compared with all other modes of transport (AOR, 5.51 [95% CI, 5.21-5.82]). The estimated proportion of use of restraints for Black patients mediated by police transport was 10.70% (95% CI, 9.26%-12.53%).Conclusions and RelevanceIn this cross-sectional study of ED visits across 13 hospitals, police transport may have mediated the association between Black race and use of physical restraint. These findings suggest a need to further explore the mechanisms by which transport to emergency care may influence disparate restrictive interventions for patients experiencing behavioral emergencies.

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Residential Structural Racism and Prevalence of Chronic Health Conditions

Cited by 14 publications

References 83 publications

School Neighborhood Deprivation is Associated with a Higher Prevalence of Hypertension

School Neighborhood Deprivation is Associated with a Higher Prevalence of Hypertension

Trajectories of State-Level Sepsis-Related Mortality by Race and Ethnicity Group in the United States

Racial and Ethnic Disparities in Patient Restraint in Emergency Departments by Police Transport Status

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