Multidimensional structural racism predicts birth outcomes for Black and White Minnesotans

Chantarat, Tongtan; Riper, David Van

doi:10.1111/1475-6773.13976

Cited by 29 publications

(18 citation statements)

References 44 publications

(115 reference statements)

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“…In particular, the ADI lacks explicit equity variables that track outcomes in a comparative framework that considers patterned distributions. Studies using a novel ecological-level multidimensional measures of structural racism found that non-Hispanic Black–non-Hispanic White segregation and inequities in education, employment, income, and homeownership mediate disparities in birth rates and vaccination rates …”

Section: Discussionmentioning

confidence: 99%

Association of Socioeconomic Position With Racial and Ethnic Disparities in Survival After Lung Transplant

et al. 2023

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ImportanceA recent National Academies of Sciences, Engineering, and Medicine study found that transplant outcomes varied greatly based on multiple factors, including race, ethnicity, and geographic location. They proposed a number of recommendations including studying opportunities to improve equity in organ allocation.ObjectiveTo evaluate the role of donor and recipient socioeconomic position and region as a mediator of observed racial and ethnic differences in posttransplant survival.Design, Setting, and ParticipantsThis cohort study included lung transplant donors and recipients with race and ethnicity information and a zip code tabulation area–defined area deprivation index (ADI) from September 1, 2011, to September 1, 2021, whose data were in the US transplant registry. Data were analyzed from June to December 2022.ExposuresRace, neighborhood disadvantage, and region of donors and recipients.Main Outcomes and MeasuresUnivariable and multivariable Cox proportional hazards regression were used to study the association of donor and recipient race with ADI on posttransplant survival. Kaplan-Meier method estimation was performed by donor and recipient ADI. Generalized linear models by race were fit, and mediation analysis was performed. Bayesian conditional autoregressive Poisson rate models (1, state-level spatial random effects; 2, model 1 with fixed effects for race and ethnicity, 3; model 2 excluding region; and 4: model 1 with fixed effects for US region) were used to characterize variation in posttransplant mortality and compared using ratios of mortality rates to the national average.ResultsOverall, 19 504 lung transplant donors (median [IQR] age, 33 [23-46] years; 3117 [16.0%] Hispanic individuals, 3667 [18.8%] non-Hispanic Black individuals, and 11 935 [61.2%] non-Hispanic White individuals) and recipients (median [IQR] age, 60 [51-66] years; 1716 [8.8%] Hispanic individuals, 1861 [9.5%] non-Hispanic Black individuals, and 15 375 [78.8%] non-Hispanic White individuals) were included. ADI did not mediate the difference in posttransplant survival between non-Hispanic Black and non-Hispanic White recipients; it mediated only 4.1% of the survival difference between non-Hispanic Black and Hispanic recipients. Spatial analysis revealed the increased risk of posttransplant death among non-Hispanic Black recipients may be associated with region of residence.Conclusions and RelevanceIn this cohort study of lung transplant donors and recipients, socioeconomic position and region of residence did not explain most of the difference in posttransplant outcomes among racial and ethnic groups, which may be due to the highly selected nature of the pretransplant population. Further research should evaluate other potentially mediating effects contributing to inequity in posttransplant survival.

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Section: Discussionmentioning

confidence: 99%

Association of Socioeconomic Position With Racial and Ethnic Disparities in Survival After Lung Transplant

et al. 2023

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“…Structural racism has been associated with poor health in both urban and non-urban areas [ 57 , 65 ] as well as with poorer maternal and infant birth outcomes for Black and Indigenous people [ 57 , 77 , 78 , 79 , 80 , 81 ]. For example, Black infants in areas with high levels of structural racism have higher odds of preterm birth and infant mortality [ 57 , 80 , 82 ].…”

Section: Discussionmentioning

confidence: 99%

Inequities in Availability of Evidence-Based Birth Supports to Improve Perinatal Health for Socially Vulnerable Rural Residents

et al. 2022

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Rural residents in the United States (US) have disproportionately high rates of maternal and infant mortality. Rural residents who are Black, Indigenous, and People of Color (BIPOC) face multiple social risk factors and have some of the worst maternal and infant health outcomes in the U.S. The purpose of this study was to determine the rural availability of evidence-based supports and services that promote maternal and infant health. We developed and conducted a national survey of a sample of rural hospitals. We determined for each responding hospital the county-level scores on the 2018 CDC Social Vulnerability Index (SVI). The sample’s (n = 93) median SVI score [IQR] was 0.55 [0.25–0.88]; for majority-BIPOC counties (n = 29) the median SVI score was 0.93 [0.88–0.98] compared with 0.38 [0.19–0.64] for majority-White counties (n = 64). Among counties where responding hospitals were located, 86.2% located in majority-BIPOC counties ranked in the most socially vulnerable quartile of counties nationally (SVI ≥ 0.75), compared with 14.1% of majority-White counties. In analyses adjusted for geography and hospital size, certified lactation support (aOR 0.36, 95% CI 0.13–0.97), midwifery care (aOR 0.35, 95% CI 0.12–0.99), doula support (aOR 0.30, 95% CI 0.11–0.84), postpartum support groups (aOR 0.25, 95% CI 0.09–0.68), and childbirth education classes (aOR 0.08, 95% CI 0.01–0.69) were significantly less available in the most vulnerable counties compared with less vulnerable counties. Residents in the most socially vulnerable rural counties, many of whom are BIPOC and thus at higher risk for poor birth outcomes, are significantly less likely to have access to evidence-based supports for maternal and infant health.

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“…Findings from a study by Brown, Kamis, and Homan showed that a multisectoral latent measure of state‐level structural racism provided a better model fit and accounted for more variation in Black–White inequities in COVID‐19 mortality than individual indicators as well as a summative index of structural racism 30 . In addition, Chantarat and colleagues have contributed to the literature by using latent class analysis to identify distinct typologies of multisectoral structural racism and linking them to racialized birth outcomes 58,59 . Collectively, these studies point to promise of latent measurement approaches for advancing the scientific literature on the impact of structural oppression on health.…”

Section: Recommendation 2: Develop Novel Theory‐driven Empirically Ba...mentioning

confidence: 99%

The Future of Social Determinants of Health: Looking Upstream to Structural Drivers

Brown

Homan

2023

Milbank Quarterly

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Policies that redress oppressive social, economic, and political conditions are essential for improving population health and achieving health equity. Efforts to remedy structural oppression and its deleterious effects should account for its multilevel, multifaceted, interconnected, systemic, and intersectional nature. The U.S. Department of Health and Human Services should facilitate the creation and maintenance of a national publicly available, user‐friendly data infrastructure on contextual measures of structural oppression. Publicly funded research on social determinants of health should be mandated to (a) analyze health inequities in relation to relevant data on structural conditions and (b) deposit the data in the publicly available data repository.

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Multidimensional structural racism predicts birth outcomes for Black and White Minnesotans

Cited by 29 publications

References 44 publications

Association of Socioeconomic Position With Racial and Ethnic Disparities in Survival After Lung Transplant

Association of Socioeconomic Position With Racial and Ethnic Disparities in Survival After Lung Transplant

Inequities in Availability of Evidence-Based Birth Supports to Improve Perinatal Health for Socially Vulnerable Rural Residents

The Future of Social Determinants of Health: Looking Upstream to Structural Drivers

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