A team of health equity researchers from several institutions used a complex network of data to test a hypothesis: that structural racism is associated with neighborhood-level resources and structures that are strongly associated with poor health. What they found in an analysis of highly localized community-level data shows how racism is deeply intertwined with poor health outcomes.
Dinushika Mohottige, MD, MPH, Assistant Professor of Population Science and Policy and Medicine (Nephrology), at the Icahn School of Medicine at Mount Sinai, served as first author of a paper published today in the journalJAMA Network Open which describes the study in detail.
Dr. Mohottige and her senior author and longtime mentor, L. Ebony Boulware, MD, MPH, Dean of Wake Forest University School of Medicine, detail how the prevalence of chronic kidney disease (CKD), diabetes, and hypertension. is strongly associated with an increased burden of indicators of structural racism.
The research team conducted a cross-sectional observational study in Durham County, North Carolina, using public data sources and evidence-based electronic health records to explore how a comprehensive collection of data points correlates with the presence of structural racism and the prevalence of these three neighborhood health chronics. conditions.
“It was important to look at these three conditions because they are interconnected and strongly associated with heart disease, as well as quality and length of life. Importantly, black people share a disproportionate burden of these three diseases,” said Dr. Mohottige. member of Mount Sinai’s Icahn Institute for Health Equity Research specializing in kidney health equity and previously practiced at Duke University with Dr. Boulware. They collaborated with colleagues from Duke, the University of North Carolina at Chapel Hill, North Carolina State University and the Feinstein Institutes for Medical Research.
The authors explain that structural racism is defined as how societies encourage discrimination through a range of reinforcing systems, such as housing, education and unemployment. “These systems break down into biased beliefs, values, and resource allocation,” says Dr. Boulware.
“Dr. Mohottige and I agreed that it was important to leverage the extraordinary data elements available at Durham to learn how we can improve the health of communities and individuals by identifying the factors that may be most likely to affect their health. Our goal was to use the data to help us identify potential interventions,” says Dr. Boulware. “Data that measure health outcomes such as kidney disease and diabetes — and that also measure social determinants of health, including information on the built environment and reported neighborhood violence — help us understand how the conditions people live in affect their well-being.This is especially true for groups that, because of their race or ethnicity, historically experience worse health outcomes compared to others”.
The result of their work, which incorporates thousands of data points related to where people live at the most localized level, says Dr. Boulware, is a first-of-its-kind observational study of associations of structural racism with resident health. in these neighborhoods. “This study fills an important evidence gap and helps us identify factors we can target to address community health disparities,” says Dr. Mohottige.
The researchers studied aggregate chronic disease prevalence data for each of 150 residential neighborhoods in Durham using the Durham Neighborhood Compass, a unique data element created by public health officials. a corresponding website, the Durham Community Health Indicators Project, provides a user-friendly interface in layman’s language.
Along with Compass’s uniquely detailed and comprehensive data, the researchers drew data from two key bins. Through global/composite indicators such as the Area Deprivation Index, they gathered data revealing the extent of Durham’s neighborhood stark advantage and disadvantage. The discrete indicators they drew from revealed factors widely believed to represent sociopolitical manifestations of structural racism, including reported crimes, evictions, police shootings, and turnout. “There is very limited evidence linking these structural constructs of racism to the overall health of individuals in a given neighborhood using electronic health data and rigorous assessments of chronic conditions,” says Dr. Mohottige.
The team found that:
- Residential neighborhoods with the highest prevalence of CKD, diabetes, and hypertension tended to be in neighborhoods with the lowest percentages of white residents, and vice versa.
- Neighborhoods with the highest prevalence of CKD, diabetes and hypertension tended to be in areas with the lowest income and greatest area deprivation. They also had the lowest rates of college education.
- Higher loadings on most discrete indicators of structural racism (examples include reported violent crime, eviction rates, turnout, income, and poverty) were associated with higher neighborhood prevalence of the three diseases.