Structural racism, socio-economic marginalization, and infant mortality

Bishop‐Royse, Jessica; Lange‐Maia, Brittney S.; Murray, Leslie J.; Shah, Raj C.; DeMaio, Fernando

doi:10.1016/j.puhe.2020.10.027

Cited by 41 publications

(26 citation statements)

References 32 publications

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“…While effect sizes for ICE Race or ICE Income were slightly higher than ICE Race-Income in six studies, the difference was mostly negligible and often unstable (e.g., varying by geographical level) [24,29,[31][32][33]45]. Further, ICE Race-Income also outperformed other poverty measures applied to predict health outcomes in segregated populations, including the Hardship Index [35,43] and other similar established measures of financial adversity [28,31,33,42]. Altogether, the majority of the evidence suggests that conceptualizing residential segregation in multidimensional terms of overlapping concentrations of racial/ethnic minorities and poverty (rather than one or the other) may present a more complete and accurate account of this phenomenon and its relationship to health.…”

Section: Plos Onementioning

confidence: 82%

“…Complementing the results in Janevic et al, Bishop-Royse, Lange-Maia, Murray, Shah, and DeMaio [35] conducted a study on infant mortality in 77 community areas in Chicago, IL. Here, majority-white communities had a 54% lower risk of infant mortality than majority-Black communities (ICE Race ).…”

Section: Plos Onementioning

confidence: 96%

“…In each spatial context, the ICE comprised an informative measure of segregation and its impact on health outcomes with comparable results at all levels of comparison. Further, six studies compared the statistical accuracy of the ICE to other traditional scales of disadvantage, including the Hardship Index [35,43] and measures created from ACS data, reflecting the federal poverty line [28,31,42]. In nearly all of these comparisons, the ICE either matched or outperformed the other poverty measure (see Table 2).…”

Section: Plos Onementioning

confidence: 99%

See 2 more Smart Citations

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 Onementioning

confidence: 82%

Section: Plos Onementioning

confidence: 96%

Section: Plos Onementioning

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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“…Poverty can also have indirect implications for health (5,71). Race-based economic disadvantages can influence other social determinants as the intersection with poverty can further limit housing, educational, and employment opportunities, and these have also been linked to worse health outcomes (58,(72)(73)(74). Poverty can also influence individual perceptions and behaviors (75).…”

Section: Perniciousness Of Persistent Povertymentioning

confidence: 99%

“…Maternal and child health: Poverty has been strongly linked with poor reproductive outcomes, both independently and in combination with exposure to discrimination ( 58 – 61 ). Maternal and child health among low-income and racial/ethnic minority groups are particularly susceptible to psychological stress, nutrition, substance use, and more ( 58 , 62 , 63 ).…”

Section: Perniciousness Of Persistent Povertymentioning

confidence: 99%

Poverty, Racism, and the Public Health Crisis in America

Beech

Ford

Thorpe

et al. 2021

Front. Public Health

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The purpose of this article is to discuss poverty as a multidimensional factor influencing health. We will also explicate how racism contributes to and perpetuates the economic and financial inequality that diminishes prospects for population health improvement among marginalized racial and ethnic groups. Poverty is one of the most significant challenges for our society in this millennium. Over 40% of the world lives in poverty. The U.S. has one of the highest rates of poverty in the developed world, despite its collective wealth, and the burden falls disproportionately on communities of color. A common narrative for the relatively high prevalence of poverty among marginalized minority communities is predicated on racist notions of racial inferiority and frequent denial of the structural forms of racism and classism that have contributed to public health crises in the United States and across the globe. Importantly, poverty is much more than just a low-income household. It reflects economic well-being, the ability to negotiate society relative to education of an individual, socioeconomic or health status, as well as social exclusion based on institutional policies, practices, and behaviors. Until structural racism and economic injustice can be resolved, the use of evidence-based prevention and early intervention initiatives to mitigate untoward effects of socioeconomic deprivation in communities of color such as the use of social media/culturally concordant health education, social support, such as social networks, primary intervention strategies, and more will be critical to address the persistent racial/ethnic disparities in chronic diseases.

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How Should Clinicians Respond to Race-Based Algorithms as Sources of Iatrogenic Harm?

Kane

Bervell

Zhang

et al. 2022

AMA Journal of Ethics

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Some clinical algorithms use race as an epidemiological shorthand to "correct" for health determinants that are clinically influential but also variable because they are historical, social, cultural, or economic in origin. Such "correction factors" are both clinically and ethically relevant when their use reinforces racial essentialism and exacerbates racial health inequity. This commentary on a case in which the original vaginal birth after cesarean calculator is used argues that this and similar racebased algorithms should be considered sources of iatrogenic harm by undermining decision sharing in patient-clinician relationships and Black birthing peoples' rights to self-determination.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity. CaseDr OB is a resident physician in a high-volume obstetrics unit at a county hospital serving predominantly Black and urban Indigenous community members. Like other resident physicians, Dr OB often uses a mobile phone application to calculate, via algorithm, vaginal birth risk for birthing people who have delivered a prior child via cesarean section (C-section). 1 This vaginal birth after cesarean (VBAC) calculator has 2 race-based correction factors. 1 Scores yielded by the calculator are used to inform clinical management decisions-specifically, about which delivery options to offer patients in the unit-and to motivate standard of care. For individuals who have delivered by C-section before, the score is clinically and ethically important, since vaginal delivery complication risk for a person who has had a C-section is lower than C-section delivery complication risk for a person who has had a C-section. Strangely, though, Dr OB notices that most patients in the unit who have had a C-section are not offered an option to attempt labor and vaginal delivery.Dr OB enters a patient's race as White instead of Black a few times and notices score changes substantial enough to influence whether a patient who has had a C-section will be offered an option to try labor and vaginal delivery. Dr OB wonders about the validity of

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Structural racism, socio-economic marginalization, and infant mortality

Cited by 41 publications

References 32 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

Poverty, Racism, and the Public Health Crisis in America

How Should Clinicians Respond to Race-Based Algorithms as Sources of Iatrogenic Harm?

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