Racial and Economic Neighborhood Segregation, Site of Delivery, and Morbidity and Mortality in Neonates Born Very Preterm

Janević, Teresa; Zeitlin, Jennifer; Egorova, Natalia; Hebert, Paul L.; Balbierz, Amy; Stroustrup, Anne Marie; Howell, Elizabeth A.

doi:10.1016/j.jpeds.2021.03.049

Cited by 32 publications

(27 citation statements)

References 38 publications

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“…Controlling for maternal race attenuated the effect size to a 17% increased risk (ICE Race-Income ), indicating that the harmful effects of racialized economic segregation extend to all races within the deprived area. Similar to Janevic et al [38], the authors also found that pre-pregnancy chronic comorbidities (diabetes and/or hypertension) mediated the observed association. Specifically, women in lowincome majority-Black CTs were more than twice as likely as residents in high-income majority-white CTs to die from pregnancy-related issues that resulted from their chronic conditions (RR IndirectEffect , RR = 2.68, 95% CI 2.59, 2.84).…”

Section: Plos Onesupporting

confidence: 82%

“…Adjusting for all covariates, these differences attenuated PLOS ONE considerably (ICE Race , RD = 0.3, 95% CI 0.1, 0.6; ICE Income , RD = 0.4, 95% CI 0.2, 0.6; ICE Race-Income , RD = 0.4, 95% CI 0.2, 0.6). Dovetailing with Janevic et al [38], decomposition analyses indicated that the location of hospital of delivery accounted for 34.8% of the association between ICE Race-Income and SMM, with women in privileged or deprived areas more likely than not to deliver at local hospitals. Further, the presence of comorbidities accounted for nearly 50% of the variance in SMM.…”

Section: Plos Onesupporting

confidence: 52%

“…Janevic et al [39] found that pre-existing comorbidities partially explained the observed relationship between ICE Race-Income and SMM during pregnancy. Similarly, the results in Janevic et al [34] suggest that the approximately seven-fold increased incidence of pre-pregnancy and gestational hypertension and diabetes in the most disadvantaged populations accounted for much of the correlation between ICE Race-Income and birth outcomes. Consistent with Janevic et al's studies, Dyer et al [37] also found that pre-pregnancy diabetes and hypertension mediated the association between ICE Race-Income and pregnancy-related maternal mortality.…”

Section: Themes and Variations In The Evidencementioning

confidence: 84%

“…In another paper on PTB and infant mortality, Janevic et al [34] found that infants born to women in majority-Black neighborhoods had 60% greater odds of neonatal mortality and/or morbidity compared to women in majority-white neighborhoods (ICE Race ). Further, the odds of neonatal mortality and/or morbidity were 40% higher in low-income compared to highincome neighborhoods (ICE Income ) and 59% higher in low-income majority-Black neighborhoods compared to high-income majority-white neighborhoods (ICE Race-Income ).…”

Section: Racialized Economic Segregation and Adverse Birth/pregnancy Outcomesmentioning

confidence: 99%

“…Two studies by Janevic et al [34,39] included the most extensive analysis of the pathways between racialized economic segregation and health. Their results demonstrated that the positive relationship between the ICE measures and both infant and maternal mortality and morbidity was mediated by the location of hospital of delivery.…”

Section: Themes and Variations In The Evidencementioning

confidence: 99%

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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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Section: Plos Onesupporting

confidence: 82%

Section: Plos Onesupporting

confidence: 52%

Section: Themes and Variations In The Evidencementioning

confidence: 84%

Section: Racialized Economic Segregation and Adverse Birth/pregnancy Outcomesmentioning

confidence: 99%

Section: Themes and Variations In The Evidencementioning

confidence: 99%

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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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Neighborhood Segregation and Access to Live Donor Kidney Transplantation

Li,

Menon,

Kim

et al. 2024

JAMA Intern Med

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ImportanceIdentifying the mechanisms of structural racism, such as racial and ethnic segregation, is a crucial first step in addressing the persistent disparities in access to live donor kidney transplantation (LDKT).ObjectiveTo assess whether segregation at the candidate’s residential neighborhood and transplant center neighborhood is associated with access to LDKT.Design, Setting, and ParticipantsIn this cohort study spanning January 1995 to December 2021, participants included non-Hispanic Black or White adult candidates for first-time LDKT reported in the US national transplant registry. The median (IQR) follow-up time for each participant was 1.9 (0.6-3.0) years.Main Outcome and MeasuresSegregation, measured using the Theil H method to calculate segregation tertiles in zip code tabulation areas based on the American Community Survey 5-year estimates, reflects the heterogeneity in neighborhood racial and ethnic composition. To quantify the likelihood of LDKT by neighborhood segregation, cause-specific hazard models were adjusted for individual-level and neighborhood-level factors and included an interaction between segregation tertiles and race.ResultsAmong 162 587 candidates for kidney transplant, the mean (SD) age was 51.6 (13.2) years, 65 141 (40.1%) were female, 80 023 (49.2%) were Black, and 82 564 (50.8%) were White. Among Black candidates, living in a high-segregation neighborhood was associated with 10% (adjusted hazard ratio [AHR], 0.90 [95% CI, 0.84-0.97]) lower access to LDKT relative to residence in low-segregation neighborhoods; no such association was observed among White candidates (P for interaction = .01). Both Black candidates (AHR, 0.94 [95% CI, 0.89-1.00]) and White candidates (AHR, 0.92 [95% CI, 0.88-0.97]) listed at transplant centers in high-segregation neighborhoods had lower access to LDKT relative to their counterparts listed at centers in low-segregation neighborhoods (P for interaction = .64). Within high-segregation transplant center neighborhoods, candidates listed at predominantly minority neighborhoods had 17% lower access to LDKT relative to candidates listed at predominantly White neighborhoods (AHR, 0.83 [95% CI, 0.75-0.92]). Black candidates residing in or listed at transplant centers in predominantly minority neighborhoods had significantly lower likelihood of LDKT relative to White candidates residing in or listed at transplant centers located in predominantly White neighborhoods (65% and 64%, respectively).ConclusionsSegregated residential and transplant center neighborhoods likely serve as a mechanism of structural racism, contributing to persistent racial disparities in access to LDKT. To promote equitable access, studies should assess targeted interventions (eg, community outreach clinics) to improve support for potential candidates and donors and ultimately mitigate the effects of segregation.

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Inequities in Filled Overactive Bladder Medication Prescriptions in the US

et al. 2023

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ImportanceAnticholinergic medications to treat overactive bladder (OAB) have been associated with increased risk of cognitive decline, whereas β3-adrenoceptor agonists (hereafter, β3-agonists) have comparable efficacy and do not carry the same risk. Yet, anticholinergics remain the predominant OAB medication prescribed in the US.ObjectiveTo evaluate whether patient race, ethnicity, and sociodemographic characteristics are associated with receipt of anticholinergic vs β3-agonist OAB medications.Design, Setting, and ParticipantsThis study is a cross-sectional analysis of the 2019 Medical Expenditure Panel Survey, a representative sample of US households. Participants included individuals with a filled OAB medication prescription. Data analysis was performed from March to August 2022.ExposureA prescription for medication to treat OAB.Main Outcomes and MeasuresThe primary outcomes were receipt of a β3-agonist or an anticholinergic OAB medication.ResultsAn estimated 2 971 449 individuals (mean age, 66.4 years; 95% CI, 64.8-68.2 years) filled prescriptions for OAB medications in 2019; 2 185 214 (73.5%; 95% CI, 62.6%-84.5%) identified as female, 2 326 901 (78.3%; 95% CI, 66.3%-90.3%) self-identified as non-Hispanic White, 260 685 (8.8%; 95% CI, 5.0%-12.5%) identified as non-Hispanic Black, 167 210 (5.6%; 95% CI, 3.1%-8.2%) identified as Hispanic, 158 507 (5.3%; 95% CI, 2.3%-8.4%) identified as non-Hispanic other race, and 58 147 (2.0%; 95% CI, 0.3%-3.6%) identified as non-Hispanic Asian. A total of 2 229 297 individuals (75.0%) filled an anticholinergic prescription, and 590 255 (19.9%) filled a β3-agonist prescription, with 151 897 (5.1%) filling prescriptions for both medication classes. β3-agonists had a median out-of-pocket cost of $45.00 (95% CI, $42.11-$47.89) per prescription compared with $9.78 (95% CI, $9.16-$10.42) for anticholinergics. After controlling for insurance status, individual sociodemographic factors, and medical contraindications, non-Hispanic Black individuals were 54% less likely than non-Hispanic White individuals to fill a prescription for a β3-agonist vs an anticholinergic medication (adjusted odds ratio, 0.46; 95% CI, 0.22-0.98). In interaction analysis, non-Hispanic Black women had an even lower odds of filing a β3-agonist prescription (adjusted odds ratio, 0.10; 95% CI, 0.04-0.27).Conclusions and RelevanceIn this cross-sectional study of a representative sample of US households, non-Hispanic Black individuals were significantly less likely than non-Hispanic White individuals to have filled a β3-agonist prescription compared with an anticholinergic OAB prescription. These differences may reflect an inequity in prescribing behaviors promulgating health care disparities. Targeted research should assess the relative contribution of a variety of individual and societal factors.

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Racial and Economic Neighborhood Segregation, Site of Delivery, and Morbidity and Mortality in Neonates Born Very Preterm

Cited by 32 publications

References 38 publications

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

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

Neighborhood Segregation and Access to Live Donor Kidney Transplantation

Inequities in Filled Overactive Bladder Medication Prescriptions in the US

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