Racial Disparities in Context: A Multilevel Analysis of Neighborhood Variations in Poverty and Excess Mortality Among Black Populations in Massachusetts

Abstract

Neighborhood heterogeneity in the relationship between mortality and race/ethnicity in Massachusetts is statistically significant and is closely related to CT-level variation in poverty.

Mapping and Measuring Social Disparities in Premature Mortality: The Impact of Census Tract Poverty within and across Boston Neighborhoods, 1999–2001

“…First, our analysis confirms previously published observations of a socioeconomic gradient in premature mortality in the U.S., as reported in both the handful of other analyses using CT poverty, 7,14,23 as well as those employing economic indicators based on larger geographic areas (e.g., neighborhoods, metropolitan areas, and counties). [4][5][6] Only two of these prior studies used a multilevel analysis 7,23 ; the rest used the more conventional approach of comparing rates based on aggregating the death and population data into strata defined by area-based socioeconomic position. Although this latter approach, by ignoring spatial variation, could potentially yield biased estimates, we note in our study that this did not occur, as shown by the similarity of the socioeconomic gradients estimated in Tables 1 and 2.…”

“…Furthermore, in previous analyses for which we had individual as well as CT-level socioeconomic data, we have found that the direction of the socioeconomic gradient was the same, and also of similar magnitude, for both the individual-level and CT-level socioeconomic measures. 11,21,23 The modifiable areal unit problem pertains to the sensitivity of spatial patterns to the choice of area level units in the analysis. 43 The multilevel approach we have used addresses one aspect of this problem, as it permits modeling of spatial variation in premature mortality at each of the three levels (age cell, CT, and neighborhood) at which we have data.…”

“…These models, which provide a framework for validly combining data from different spatial scales (e.g., neighborhood and CT) and also permit adjustment for multiple individual and area-level covariates, have been used in the spatial analysis of relationships between social environmental exposures and a wide variety of health outcomes. [21][22][23][24][25][26][27] However, to date these types of models have rarely been used by U.S. state and local health departments to analyze social disparities in routinely collected public health surveillance data. 28 Instead, in order to communicate associations between social variables and health outcomes, the cartographic approach used by some health departments and health researchers is to present two maps side by side, one showing area-variation in health outcomes, the other area variation in socioeconomic conditions.…”

The Relationship of Neighborhood Socioeconomic Differences and Racial Residential Segregation to Childhood Blood Lead Levels in Metropolitan Detroit

“…Thus, health disparities and declines in health are racial and spatial issues occurring most significantly in black neighborhoods of very low socioeconomic status. [15][16][17][18][19][20][21][22] Past geographic research has also revealed that childhood lead poisoning too has been shown to be influenced by neighborhood socioeconomic characteristics and race because the major sources of lead are historically and today located in impoverished urban neighborhoods. These neighborhoods typically contain older homes with lead-based paint and pipes and are in geographic proximity to industrial emissions and roads laden with historic leaded gasoline deposits.…”

“…2,23 Consequently, childhood lead exposure has been found to be greatest among black children compared to other racial or ethnic groups. 20,[24][25][26][27] It is also associated with poverty. 22,[26][27][28][29][30] Neighborhoods with higher median household incomes and/or newer housing significantly protect children from elevated BLLs.…”