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

Abstract

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.

Association of Residential Racial and Economic Segregation With Cancer Mortality in the US

“…Previous studies examining the association between residential segregation and cancer outcomes used older data or limited segregation measures and examined restricted geographic areas or few cancer sites (ie, breast, prostate, lung, and colorectal cancer). In this ecological study, we investigated the association between county-level residential racial and economic segregation using the Index of Concentration at the Extremes (ICE), a well-validated metric of residential racial and economic segregation, and mortality rates for all cancer sites combined and the 13 cancer sites with the highest number of deaths among males or females in the US.…”

“…Strengths of our study include contemporary nationwide data, evaluation of all cancers combined and the most common causes of cancer death, and use of the ICE to measure residential segregation. The ICE outperforms other metrics of residential segregation because it captures the synergistic effect of both racial and economic segregation, shows the directionality from deprivation to privilege, and avoids the collinearity issue with race and income in the multivariable analyses . To our knowledge, our study is the first to assess the association between segregation measured by the ICE and cancer mortality comprehensively; however, it also has limitations.…”

Mediators of county‐level racial and economic privilege in cancer screening

“…As a result, residents of certain geographical regions of the United States have disproportionate access to healthcare, education, employment, and homeownership leading to intergenerational poverty 49,50 . This interplay of racial and economic deprivation is a driver of persistent health disparities that affect access to and utilization of healthcare resources 31,32 . Public health and policy efforts that consider this broader social and environmental context may be more effective, since social determinants such as racial and economic privilege can have a major impact on an individual's health 10,44,51,52 .…”

“…While there is an increasing recognition of the importance of monitoring and addressing structural racism, socioeconomic status, and SDoH as a root cause of health inequities, little is known about the downstream factors that mediate disparities in population‐based cancer screening uptake 24–29 . As such, the current study sought to characterize the geographic variation among USPSTF‐recommended breast, cervical, and colorectal cancer screening rates and the association of screening with “privilege” based on the Index of Concentration of Extremes (ICE) joint measure of racial/ethnic and economic spatial concentration 30–32 . In addition, via mediation analysis, we analyzed the potential role of structural factors that underlie racial and economic disparities in cancer screening.…”

Risk Perception and Health Precautions Towards COVID-19 Among Older Culturally and Linguistically Diverse Adults in South Australia: A Cross-Sectional Survey

“… 49 The older adults in CALD communities are more likely to have chronic diseases and comorbidities in Australia; 16 , 17 consistent with global health data where especially older, non-white adults in Anglophone countries have poorer health status. 50 , 51 According to ABS (2021), 24% of people living alone are older Australians and, of those, about three-quarters are women. 52 Having a high prevalence of chronic conditions, including depression and anxiety, together with living alone influence their psychological and emotional well-being, especially for those older CALD adults who are aged 80 years and over, and without education.…”