Study: Indicators of structural racism tied to prevalence of chronic health conditions
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Key takeaways:
- Neighborhoods with economic shortcomings had a higher prevalence of chronic health conditions.
- Areas with higher area deprivation also showed a higher prevalence of chronic health conditions.
Several indicators of structural racism were linked with a higher prevalence of chronic health conditions in residential neighborhoods, according to a recently published study.
Researchers led by Dinushika Mohottige, MD, MPH, of the nephrology division and departments of population health and medicine at Icahn School of Medicine at Mount Sinai, studied 150 neighborhoods in Durham County, North Carolina, to explore the relationship between structural racism indicators and the prevalence of chronic kidney disease, diabetes and hypertension.
“Durham was an ideal place for [the study] for several reasons. It is highly diverse in terms of race, ethnicity, education and socioeconomic status,” Mohottige told Healio. “It is rapidly gentrifying, with neighborhoods that reflect extremes of wealth, income and poverty.”
People who “experience minoritization due to historic and present-day sociopolitical power differentials (eg, American Indian, Black, and Hispanic or Latino individuals) experience substantially greater prevalence of chronic conditions,” the researchers wrote in the study. They added, “Efforts to elucidate potential targets for interventions designed to mitigate residential neighborhood health inequities are nascent.”
Public data
For the study, researchers used public data from 2012 to 2018 and deidentified electronic health records from 2017 to 2018. The Durham County neighborhoods had 1,109 to 2,489 residents, of which a median of 26% were Asian, 30% were Black, 10% were Hispanic or Latino, 0% were Indigenous and 44% were white. Median residential income was $54,531. Data were analyzed from 2021 to 2023.
Investigators examined various global and discrete indicators such as the percentage of white residents in the neighborhood, economic-racial segregation and area deprivation as global indicators. Discrete indicators included the presence of childcare centers, bus stops, tree cover, reported violent crime, impervious areas, evictions, election participation, income, poverty, education, unemployment, health insurance and police shootings.
Results revealed a higher burden of structural racism indicators was associated with a greater prevalence of the primary outcomes. Neighborhoods with a lower percentage of white residents, lower economic and racial spatial advantage and higher area deprivation showed a higher prevalence of chronic health conditions. Researchers also found that neighborhoods with higher measures of reported violent crimes, evictions, poverty, unemployment, uninsurance, and childcare center density, as well as lower election participation, income and education, also had a higher prevalence of these health conditions.
“We studied the relation between structural racism and the health of entire neighborhoods,” Mohottige told Healio. “We did not specifically study how structural racism in a neighborhood might have a different association with the health of white individuals vs. others. However, we did find that neighborhoods with fewer white residents had far greater burden of structural racism indicators. The greater the burden a neighborhood’s structural racism was, the worse that neighborhood’s health was,” Mohottige said. “Future studies are needed to demonstrate how structural racism may impact white individuals, specifically.”
Structural conditions
The study results highlight opportunities for cities like Durham to take steps aimed at removing structural conditions that impact health, L. Ebony Boulware, MD, MPH, of the Wake Forest University School of Medicine in Winston Salem, North Carolina, and senior study author, told Healio. “We need concerted multi-sector policy efforts to change some of these structural conditions that underlie these neighborhood differences in health, specifically policies that work to undo a history of poor investment in minoritized neighborhoods,” Boulware said. “Many policies are needed, including [those] that improve the equity of education and employment, improve recreational green spaces and promote community members’ capacities to be involved in local policies.”
Editor’s note: This article was updated on Feb. 26, 2024, to correct typographical errors. The editors regret these errors.
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