School racial segregation and long-term cardiovascular health among Black adults in the US: A quasi-experimental study

Abstract

Background Cardiovascular disease (CVD) disproportionately affects United States black adults. This is increasingly acknowledged to be due to inequitable distribution of health-promoting resources. One potential contributor is inequities in educational opportunities, although it is unclear what aspects of education are most salient. School racial segregation may affect cardiovascular health by increasing stress, constraining socioeconomic opportunities, and altering health behaviors. We investigated the association between school segregation and black adults’ CVD risk. Methods and findings We leveraged a natural experiment created by quasi-random (i.e., arbitrary) timing of local court decisions since 1991 that released school districts from court-ordered desegregation. We used the Panel Study of Income Dynamics (PSID) (1991 to 2017), linked with district-level school segregation measures and desegregation court order status. The sample included 1,053 black participants who ever resided in school districts that were under a court desegregation order in 1991. The exposure was mean school segregation during observed schooling years. Outcomes included several adult CVD risk factors and outcomes. We fitted standard ordinary least squares (OLS) multivariable linear regression models, then conducted instrumental variables (IV) analysis, using the proportion of schooling years spent in districts that had been released from court-ordered desegregation as an instrument. We adjusted for individual- and district-level preexposure confounders, birth year, and state fixed effects. In standard linear models, school segregation was associated with a lower probability of good self-rated health (−0.05 percentage points per SD of the segregation index; 95% CI: −0.08, −0.03; p < 0.001) and a higher probability of binge drinking (0.04 percentage points; 95% CI: 0.002, 0.07; p = 0.04) and heart disease (0.01 percentage points; 95% CI: 0.002, 0.15; p = 0.007). IV analyses also found that school segregation was associated with a lower probability of good self-rated health (−0.09 percentage points; 95% CI: −0.17, −0.02, p = 0.02) and a higher probability of binge drinking (0.17 percentage points; 95% CI: 0.04, 0.30, p = 0.008). For IV estimates, only binge drinking was robust to adjustments for multiple hypothesis testing. Limitations included self-reported outcomes and potential residual confounding and exposure misclassification. Conclusions School segregation exposure in childhood may have longstanding impacts on black adults’ cardiovascular health. Future research should replicate these analyses in larger samples and explore potential mechanisms. Given the recent rise in school segregation, this study has implications for policies and programs to address racial inequities in CVD.

Assessing Early-Life Contributions to Racial Disparities in Cognition for Older Americans: The Importance of Educational Quality and Experience

“…37 For example, attending minority (e.g., segregated) schools may expose Black participants to discrimination and racism that contributed to stress, traumatized brain development, and behavioral problems. 38,39 Overall, our results suggest that policies implemented to improve equitable education may generate long-lasting impacts on reducing racial disparities in cognitive outcomes into older ages. 40,41…”

Early-Life Circumstances and Racial Disparities in Cognition Among Older Adults in the US

“…Educational factors may work through a set of channels to affect racial disparities, such as brain development, employment and income, access to health care, health literacy, and lifestyle choices . For example, attending segregated schools may expose Black children to discrimination and racism that contribute to stress, traumatized brain development, and are associated with behavioral problems . Moreover, attending segregated schools may adversely affect late-life cognition by diminishing school resources, such as spending per pupil, student-teacher ratio, term length, combined grade levels in classrooms, and teacher training experience, as shown in prior studies .…”

Uses of Social Determinants of Health Data to Address Cardiovascular Disease and Health Equity: A Scoping Review

“…This scoping review has examined 3 broad domains of data, social determinants of health, and CVD. Numerous studies have demonstrated the association between CVD and the 5 SDOH domains: economic stability, 5 education access and quality, 18 , 19 , 85 social and community context, 20 health care access and quality, 21 and the neighborhood and built environment, 17 and practicing clinicians have called for the use of big data on SDOH to address CVD and health equity. 8 , 9 , 10 , 11 This review identified 50 articles that have used SDOH data to address these outcomes.…”

“… 12 Further research has linked the effects of these domains to CVD outcomes. 5 , 8 , 9 , 10 , 11 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 …”