Structural racism in the built environment: Segregation and the overconcentration of alcohol outlets

Scott, Jennifer; Danos, Denise; Collins, Robert M.; Simonsen, Neal; Leonardi, Claudia; Scribner, Richard; Herd, Denise

doi:10.1016/j.healthplace.2020.102385

Cited by 28 publications

(11 citation statements)

References 64 publications

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“…That is, through a series of historical laws and policies (e.g., “redlining”), the US, state, and local governments forcibly segregated communities by race and denied these marginalized communities access to financing and other forms of investment, a residential pattern that largely persists through present day [ 65 – 67 ]. The effect of these segregationist policies can be measured in terms of disparate exposures (e.g., increased concentration of alcohol retailers) [ 68 , 69 ], poorer access to healthy food [ 70 ], and ultimately worse cancer and other health outcomes [ 71 – 73 ]. Indeed, we observed higher counts of alcohol and fast-food retailers, and correspondingly higher rates of AUD and obesity, in census tracts that were categorized into the most disadvantaged ICE-Race quintile and had the highest odds of TNBC.…”

Section: Discussionmentioning

confidence: 99%

Racial disparities in triple negative breast cancer: toward a causal architecture approach

et al. 2022

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Background Triple negative breast cancer (TNBC) is an aggressive subtype of invasive breast cancer that disproportionately affects Black women and contributes to racial disparities in breast cancer mortality. Prior research has suggested that neighborhood effects may contribute to this disparity beyond individual risk factors. Methods The sample included a cohort of 3316 breast cancer cases diagnosed between 2012 and 2020 in New Castle County, Delaware, a geographic region of the US with elevated rates of TNBC. Multilevel methods and geospatial mapping evaluated whether the race, income, and race/income versions of the neighborhood Index of Concentration at the Extremes (ICE) metric could efficiently identify census tracts (CT) with higher odds of TNBC relative to other forms of invasive breast cancer. Odds ratios (OR) and 95% confidence intervals (CI) were reported; p-values < 0.05 were significant. Additional analyses examined area-level differences in exposure to metabolic risk factors, including unhealthy alcohol use and obesity. Results The ICE-Race, -Income-, and Race/Income metrics were each associated with greater census tract odds of TNBC on a bivariate basis. However, only ICE-Race was significantly associated with higher odds of TNBC after adjustment for patient-level age and race (most disadvantaged CT: OR = 2.09; 95% CI 1.40–3.13), providing support for neighborhood effects. Higher counts of alcohol and fast-food retailers, and correspondingly higher rates of unhealthy alcohol use and obesity, were observed in CTs that were classified into the most disadvantaged ICE-Race quintile and had the highest odds of TNBC. Conclusion The use of ICE can facilitate the monitoring of cancer inequities and advance the study of racial disparities in breast cancer.

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Section: Discussionmentioning

confidence: 99%

Racial disparities in triple negative breast cancer: toward a causal architecture approach

et al. 2022

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“…As previously mentioned, social ecological studies have shown dramatic differences between majority-white and racial/ethnic minority-concentrated areas on a range of variables in the social and built environment. These include food environment [58], exercise opportunities [59], alcohol outlet density [68], environmental pollution [27], crime [69], social cohesion [70], and access to green areas [60] and health care resources [4]-all of which may represent mechanisms through which structural racism produces population health disparities. In order to get a full picture of the segregation-health relationship, future research is needed to test process models that assess these and any other potential pathways.…”

Section: Plos Onementioning

confidence: 99%

Racialized economic segregation and health outcomes: A systematic review of studies that use the Index of Concentration at the Extremes for race, income, and their interaction

et al. 2022

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Extensive research shows that residential segregation has severe health consequences for racial and ethnic minorities. Most research to date has operationalized segregation in terms of either poverty or race/ethnicity rather than a synergy of these factors. A novel version of the Index of Concentration at the Extremes (ICERace-Income) specifically assesses racialized economic segregation in terms of spatial concentrations of racial and economic privilege (e.g., wealthy white people) versus disadvantage (e.g., poor Black people) within a given area. This multidimensional measure advances a more comprehensive understanding of residential segregation and its consequences for racial and ethnic minorities. The aim of this paper is to critically review the evidence on the association between ICERace-Income and health outcomes. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct a rigorous search of academic databases for papers linking ICERace-Income with health. Twenty articles were included in the review. Studies focused on the association of ICERace-Income with adverse birth outcomes, cancer, premature and all-cause mortality, and communicable diseases. Most of the evidence indicates a strong association between ICERace-Income and each health outcome, underscoring income as a key mechanism by which segregation produces health inequality along racial and ethnic lines. Two of the reviewed studies examined racial disparities in comorbidities and health care access as potential explanatory factors underlying this relationship. We discuss our findings in the context of the extant literature on segregation and health and propose new directions for future research and applications of the ICERace-Income measure.

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“…One indicator measuring structural racism is residential segregation, the degree to which two or more social groups (e.g., race/ethnic, economic) live geographically separated [78,116]. Residential racial segregation, particularly White from Black neighborhoods, is associated with income and wealth disparities [116], overconcentration of payday lenders [41], alcohol outlets [13,97], and fast-food restaurants [13,66], as well as limited healthy food options [33] and disproportionately high air pollution [117]. Segregation has also been linked to health disparities like preterm births [3,8] and infant mortality [49].…”

Section: Built Environment Residential Segregation and Healthmentioning

confidence: 99%

Place, Race, and Case: Examining Racialized Economic Segregation and COVID-19 in Louisiana

Scott

Lee-Johnson

Danos

2022

J. Racial and Ethnic Health Disparities

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Early COVID-19 pandemic data suggested racial/ethnic minority and low-income earning people bore the greatest burden of infection. Structural racism, the reinforcement of racial and ethnic discrimination via policy, provides a framework for understanding disparities in health outcomes like COVID-19 infection. Residential racial and economic segregation is one indicator of structural racism. Little attention has been paid to the relationship of infection to relative overall concentrations of risk (i.e., segregation of the most privileged from the most disadvantaged). We used ordinary least squares and geographically weighted regression models to evaluate the relationship between racial and economic segregation, measured by the Index of Concentration at the Extremes, and COVID-19 cases in Louisiana. We found a significant global association between racial segregation and cumulative COVID-19 case rate in Louisiana and variation across the state during the study period. The northwest and central regions exhibited a strong negative relationship indicating greater risk in areas with high concentrations of Black residents. On the other hand, the southeastern part of the state exhibited more neutral or positive relationships indicating greater risk in areas with high concentrations of White residents. Our findings that the relationship between racial segregation and COVID-19 cases varied within a state further support evidence that social and political determinants, not biological, drive racial disparities. Small area measures and measures of polarization provide localized information better suited to tailoring public health policy according to the dynamics of communities at the census tract level, which may lead to better health outcomes.

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Structural racism in the built environment: Segregation and the overconcentration of alcohol outlets

Cited by 28 publications

References 64 publications

Racial disparities in triple negative breast cancer: toward a causal architecture approach

Racial disparities in triple negative breast cancer: toward a causal architecture approach

Racialized economic segregation and health outcomes: A systematic review of studies that use the Index of Concentration at the Extremes for race, income, and their interaction

Place, Race, and Case: Examining Racialized Economic Segregation and COVID-19 in Louisiana

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