Understanding the Role of the Ethnic Density Effect: Issues of Acculturation, Discrimination and Social Support

Jurcik, Tomas; Ahmed, Rana; Yakobov, Esther; Solopieieva-Jurcikova, Ielyzaveta; Ryder, Andrew G.

doi:10.1002/jcop.21563

Cited by 61 publications

(67 citation statements)

References 47 publications

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“…Several theories have been proposed to explain this phenomenon including lower social support for black patients living in wealthier, commonly white, neighborhoods and greater racial discrimination in high SES neighborhoods. 43,44 Our study has important implications for efforts to understand and eliminate socioeconomic disparities in pediatric cardiac outcomes. Given the strong, inverse relationship between neighborhood SES and mortality after the Norwood procedure, postoperative care should focus not only on operative management strategies but also socioeconomic and environmental factors, which may be equally important determinants of patient outcomes.…”

Section: Discussionmentioning

confidence: 98%

Neighborhood Socioeconomic Status and Outcomes Following the Norwood Procedure: An Analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial Public Data Set

Bucholz

Sleeper

Newburger

2018

JAHA

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BackgroundChildren with single ventricle heart disease require frequent interventions and follow‐up. Low socioeconomic status (SES) may limit access to high‐quality care and place these children at risk for poor long‐term outcomes.Methods and ResultsData from the SVR (Pediatric Heart Network Single Ventricle Reconstruction Trial Public Use) data set were used to examine the relationship of US neighborhood SES with 30‐day and 1‐year mortality or cardiac transplantation and length of stay among neonates undergoing the Norwood procedure (n=525). Crude rates of death or transplantation at 1 year after Norwood were highest for patients living in neighborhoods with low SES (lowest tertile 37.0% versus middle tertile 31.0% versus highest tertile 23.6%, P=0.024). After adjustment for patient demographics, birth characteristics, and anatomy, patients in the highest SES tertile had significantly lower risk of death or transplant than patients in the lowest SES tertile (hazard ratio 0.62, 95% confidence interval, 0.40, 0.96). When SES was examined continuously, the hazard of 1‐year death or transplant decreased steadily with increasing neighborhood SES. Hazard ratios for 30‐day transplant‐free survival and 1‐year transplant‐free survival were similar in magnitude. There were no significant differences in length of stay following the Norwood procedure by SES.ConclusionsLow neighborhood SES is associated with worse 1‐year transplant‐free survival after the Norwood procedure, suggesting that socioeconomic and environmental factors may be important determinants of outcome in critical congenital heart disease. Future studies should investigate aspects of SES and environment amenable to intervention.Clinical Trial RegistrationURL:http://www.clinicaltrials.gov> http://www.clinicaltrials.gov. Unique identifier: NCT00115934.

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Section: Discussionmentioning

confidence: 98%

Neighborhood Socioeconomic Status and Outcomes Following the Norwood Procedure: An Analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial Public Data Set

Bucholz

Sleeper

Newburger

2018

JAHA

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“…23 This support may be particularly important in the setting of AMI when learning how to manage their condition or requiring assistance with activities of daily living. In addition, blacks living in high-income white neighborhoods may experience greater discrimination than those living in black neighborhoods, 23,24 which can, in turn, adversely affect physical and mental health. 25,26 Racial discrimination, whether perceived or actual, has been shown to increase cardiovascular disease risk and negatively impact health outcomes.…”

Section: Discussionmentioning

confidence: 99%

Race, Socioeconomic Status, and Life Expectancy After Acute Myocardial Infarction

Bucholz

Ma²,

Normand

et al. 2015

Circulation

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Background Prior studies have been unable to disentangle the negative associations of black race and low socioeconomic status (SES) with long-term outcomes of patients after acute myocardial infarction (AMI). Such information could assist in efforts to address both racial and socioeconomic disparities. Methods and Results We used data from the Cooperative Cardiovascular Project, a prospective cohort study of Medicare beneficiaries hospitalized with AMI with 17-years of follow-up, to evaluate the relationship between race, area-level SES (measured by ZIP code level median household income), and life expectancy after AMI. Life expectancy was estimated using Cox proportional hazards regression with extrapolation using exponential models. Of the 141,095 patients with AMI, 6.3% were black and 6.8% resided in low SES areas; 26% of black patients lived in low SES areas compared with 5.7% of white patients. Post-myocardial infarction life expectancy estimates were shorter for black than white patients across all socioeconomic levels in patients ≤75 years of age. After adjustment for patient and treatment characteristics, the association between race and life expectancy persisted but was attenuated. Younger black patients (<68 years) had shorter life expectancies than white patients whereas older black patients had longer life expectancies. The largest white-black gap in life expectancy occurred in patients residing in high and medium SES areas (p=0.02 interaction). Conclusions Black and white patients residing in low SES areas have similar life expectancies after AMI, which are lower than those living in higher SES areas. Racial disparities were most prominent among patients living in high SES areas.

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“…A qualitative study conducted in London (Whitley, Prince, McKenzie, & Stewart, 2006) suggested that social networks, culturally-specific services and facilities, and reduced everyday racism may help to explain the mechanisms underlying the relationship of ethnic density with mental health for ethnic minorities. Using a diverse sample of immigrant students in Montreal, Canada, Jurcik et al (2013) tested the mediating roles of discrimination and social support and found that the negative relation between perceived ethnic density and depression is mediated by discrimination but not by social support. These equivocal findings suggest that the mechanisms linking ethnic density to mental health are likely heterogeneous and operate in complex ways among different racial and ethnic groups and across national contexts.…”

Section: Introductionmentioning

confidence: 99%

Neighborhoods and mental health: Exploring ethnic density, poverty, and social cohesion among Asian Americans and Latinos

Hong

Zhang

Walton

2014

Social Science & Medicine

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This study examines the associations of neighborhood ethnic density and poverty with social cohesion and self-rated mental health among Asian Americans and Latinos. Path analysis is employed to analyze data from the 2002–2003 National Latino and Asian American Study (NLAAS) and the 2000 U.S. Census (N=2095 Asian Americans living in N=259 neighborhoods; N=2554 Latinos living in N=317 neighborhoods). Findings reveal that neighborhood ethnic density relates to poor mental health in both groups. Social cohesion partially mediates that structural relationship, but is positively related to ethnic density among Latinos and negatively related to ethnic density among Asian Americans. Although higher neighborhood poverty is negatively associated with mental health for both groups, the relationship does not hold in the path models after accounting for social cohesion and covariates. Furthermore, social cohesion fully mediates the association between neighborhood poverty and mental health among Latinos. This study highlights the necessity of reconceptualizing existing theories of social relationships to reflect complex and nuanced mechanisms linking neighborhood structure and mental health for diverse racial and ethnic groups.

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Understanding the Role of the Ethnic Density Effect: Issues of Acculturation, Discrimination and Social Support

Abstract: Ecological factors in psychological acculturation

Cited by 61 publications

References 47 publications

Neighborhood Socioeconomic Status and Outcomes Following the Norwood Procedure: An Analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial Public Data Set

Neighborhood Socioeconomic Status and Outcomes Following the Norwood Procedure: An Analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial Public Data Set

Race, Socioeconomic Status, and Life Expectancy After Acute Myocardial Infarction

Neighborhoods and mental health: Exploring ethnic density, poverty, and social cohesion among Asian Americans and Latinos

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