Race and Economic Well-Being in the United States

Race, Genomics, and Philosophy of Science

Race, Genomics, and Philosophy of Science

Purpose: Racism is an essential factor to understand racial health disparities in infection and mortality due to COVID-19 and must be thoroughly integrated into any successful public health response. But highlighting the effect of racism generally does not go far enough toward understanding racial/ethnic health disparities or advocating for change; we must interrogate the various forms of racism in the United States, including behaviors and practices that are not recognized by many as racism.Methods: In this article, we explore the prevalence and demographic distribution of various forms of racism in the United States and how these diverse racial ideologies are potentially associated with racialized responses to the COVID-19 crisis.Results: We find that among white Americans, more than a quarter express traditional racist attitudes, whereas more than half endorse more contemporary and implicit forms of racist ideology. Each of these types of racism helps us explain profound disparities related to COVID-19.Conclusions: Despite a robust literature documenting persistent patterns of racial disparities in the United States, a focus on the role that various forms of racism play in perpetuating these disparities is absent. These distinctions are essential to realizing health equity and countering disparities in COVID-19 and other health outcomes among people of color in the United States.

Racial/ethnic minority populations in the United States have increased rates of diabetes compared with White populations. The 2021 guidelines from the U.S. Preventive Services Task Force recommend diabetes screening for adults aged 35 to 70 years with a body mass index (BMI) of 25 kg/m2 or greater. To determine the BMI threshold for diabetes screening in major racial/ethnic minority populations with benefits and harms equivalent to those of the current diabetes screening threshold in White adults. Cross-sectional study. NHANES (National Health and Nutrition Examination Survey), 2011 to 2018. Nonpregnant U.S. adults aged 18 to 70 years (n= 19335). A logistic regression model was used to estimate diabetes prevalence at various BMIs for White, Asian, Black, and Hispanic Americans. For each racial/ethnic minority group, the equivalent BMI threshold was defined as the BMI at which the prevalence of diabetes in 35-year-old persons in that group is equal to that in 35-year-old White adults at a BMI of 25 kg/m2. Ranges were estimated to account for the uncertainty in prevalence estimates for White and racial/ethnic minority populations. Among adults aged 35 years with a BMI of 25 kg/m2, the prevalence of diabetes in Asian Americans (3.8% [95% CI, 2.8% to 5.1%]), Black Americans (3.5% [CI, 2.7% to 4.7%]), and Hispanic Americans (3.0% [CI, 2.1% to 4.2%]) was significantly higher than that in White Americans (1.4% [CI, 1.0% to 2.0%]). Compared with a BMI threshold of 25 kg/m2 in White Americans, the equivalent BMI thresholds for diabetes prevalence were 20 kg/m2 (range, <18.5 to 23 kg/m2) for Asian Americans, less than 18.5 kg/m2 (range, <18.5 to 23 kg/m2) for Black Americans, and 18.5 kg/m2 (range, <18.5 to 24 kg/m2) for Hispanic Americans. Sample size limitations precluded assessment of heterogeneity within racial/ethnic groups. Among U.S. adults aged 35 years or older, offering diabetes screening to Black Americans and Hispanic Americans with a BMI of 18.5 kg/m2 or greater and Asian Americans with a BMI of 20 kg/m2 or greater would be equivalent to screening White adults with a BMI of 25 kg/m2 or greater. Using screening thresholds specific to race/ethnicity has the potential to reduce disparities in diabetes diagnosis. Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology.

Introduction: Cancer represents the second leading cause of death in the United States and disproportionately affects Black Americans. In recent years, cancer-related mortality rates have declined for both Black and White Americans. However, mortality rates and rate ratios alone are insufficient for characterizing the burden of cancer disparities between racial groups. Among the most prevalent cancers in the US, we evaluated trends in excess mortality and years of potential life lost between Black and White Americans. Methods: This was a serial cross-sectional study using US national level data from CDC Wonder between the years 1999-2020. We included White and non-Hispanic Black Americans with a cause of death from breast, prostate, lung, colon, bladder, or uterine cancer. We measured age-adjusted excess death as well as excess years of potential life lost for each cancer site among Black and White Americans, stratified by sex when applicable. Annual mortality rates for each cancer site were sourced from the CDC Cancer Statistic Data Visualization tool. Results: The age adjusted mortality rate for all cancers declined between 1999-2020 for Black (257.2 to 166.8 per 100,000) and White Americans (200.9 to 149.3 per 100,000). Site specific cancer mortality rates declined in Black and White Americans for breast, prostate, lung, colon, and bladder cancer, but increased for uterine cancer. Among the most prevalent cancer sites, there were a total of 115,43 excess deaths with 2,093,327 excess years potential life lost for Black men and 59,134 excess deaths with 1,508,052 excess years potential life lost for Black women over a 22-year period. The trend of annual excess death and years potential life lost has slowly increased for Black men with colon cancer as well as Black women with breast and uterine cancer. Annual excess death and years potential life lost in Black men with prostate cancer decreased until 2013 after which it has slowly increased. Conclusion: Despite declining mortality rates in most cancers in the United States, Black Americans still experience a staggering number of excess deaths and years potential life lost due to cancer. Furthermore, the discordance between declining mortality rates and increasing excess death or years potential life lost in breast, prostate, colon, and uterine cancer highlight that racial disparities in cancer care and outcomes are likely worsening among Black Americans. Action is needed to support interventions and organizations committed to addressing cancer health inequities among Black Americans. Citation Format: Daniel S. Carson, Navya Gunaje, Sarah K. Holt, Nana Frimpong, Jenney R. Lee, Liz Sage, Erika M Wolff, Yaw A. Nyame. Cancer related excess death and potential life years lost among Black Americans [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C139.

Black Americans have lower wealth, income, and education and higher mortality rates than White Americans, especially during childhood. To document the extent and persistence of excess infant and childhood mortality in Black Americans between 1950 and 2019. Population-based surveillance study. The United States of America. The entire population of the United States. The investigators analyzed mortality data collected by the Centers for Disease Control and Prevention and the U.S. Census Bureau from 1950 to 2019 and calculated mortality rates, life expectancy, and years of potential life lost for White and Black Americans to estimate the absolute and relative sex- and age-specific excess mortality burden among Black Americans compared with White Americans. The gaps in absolute life expectancy and age-standardized mortality between Black and White Americans decreased over the 70-year period beginning in 1950, but relative mortality in infants and children increased during this same period. The mortality rates in the 1950s for White and Black infants were 2703 and 5181 deaths per 100 000 persons, respectively, for an excess mortality ratio of 1.92 (95% CI, 1.91 to 1.93). In the 2010s, the mortality rates were 499 deaths per 100 000 persons in White infants and 1073 deaths per 100 000 persons in Black infants, for an excess mortality ratio of 2.15 (CI, 2.13 to 2.17). A total of 5.0 million excess deaths of Black Americans (including 522 617 infants) could have been avoided during these 7 decades if their mortality rates were equal to those of White Americans. The effect of health inequities was measured without inquiring about the causes of these differences. Black infants, children, and adults have experienced persistent excess mortality in the United States since the 1950s relative to the White population. None.

Although there is a large gap between Black and White American life expectancies, the gap fell 48.9% between 1990 and 2018, mainly due to mortality declines among Black Americans. We examine age-specific mortality trends and racial gaps in life expectancy in high- and low-income US areas and with reference to six European countries. Inequalities in life expectancy are starker in the United States than in Europe. In 1990, White Americans and Europeans in high-income areas had similar overall life expectancy, while life expectancy for White Americans in low-income areas was lower. However, since then, even high-income White Americans have lost ground relative to Europeans. Meanwhile, the gap in life expectancy between Black Americans and Europeans decreased by 8.3%. Black American life expectancy increased more than White American life expectancy in all US areas, but improvements in lower-income areas had the greatest impact on the racial life expectancy gap. The causes that contributed the most to Black Americans' mortality reductions included cancer, homicide, HIV, and causes originating in the fetal or infant period. Life expectancy for both Black and White Americans plateaued or slightly declined after 2012, but this stalling was most evident among Black Americans even prior to the COVID-19 pandemic. If improvements had continued at the 1990 to 2012 rate, the racial gap in life expectancy would have closed by 2036. European life expectancy also stalled after 2014. Still, the comparison with Europe suggests that mortality rates of both Black and White Americans could fall much further across all ages and in both high-income and low-income areas.

Although there is a large gap between Black and White American life expectancies, the gap fell 48.9% between 1990 and 2018, mainly due to mortality declines among Black Americans. We examine age-specific mortality trends and racial gaps in life expectancy in high- and low-income US areas and with reference to six European countries. Inequalities in life expectancy are starker in the United States than in Europe. In 1990, White Americans and Europeans in high-income areas had similar overall life expectancy, while life expectancy for White Americans in low-income areas was lower. However, since then, even high-income White Americans have lost ground relative to Europeans. Meanwhile, the gap in life expectancy between Black Americans and Europeans decreased by 8.3%. Black American life expectancy increased more than White American life expectancy in all US areas, but improvements in lower-income areas had the greatest impact on the racial life expectancy gap. The causes that contributed the most to Black Americans' mortality reductions included cancer, homicide, HIV, and causes originating in the fetal or infant period. Life expectancy for both Black and White Americans plateaued or slightly declined after 2012, but this stalling was most evident among Black Americans even prior to the COVID-19 pandemic. If improvements had continued at the 1990 to 2012 rate, the racial gap in life expectancy would have closed by 2036. European life expectancy also stalled after 2014. Still, the comparison with Europe suggests that mortality rates of both Black and White Americans could fall much further across all ages and in both high-income and low-income areas.

The COVID-19 pandemic spotlighted Black Americans' inequitable health care experiences. Across two studies, we tested the associations between health care experiences, historical knowledge of medical mistreatment, medical trust, and COVID-19 vaccination intention and uptake in Black and White Americans. We hypothesized that Black Americans' worse current health care experiences (rather than historical knowledge) and lower medical trust would be associated with lower COVID-19 vaccination intention (Study 1) and that feeling less cared for by their personal physician would be associated with Black Americans' lower medical trust (Study 2). In convenience (Study 1, December 2020) and nationally representative samples (Study 2, March-April 2021), participants completed online surveys. In Study 1 (N = 297), Black (relative to White) Americans reported lower vaccination intention (Cohen's d = -.55, p < .001) and lower medical trust (Cohen's d = -.72, p < .001). Additionally, less positive health care experiences among Black participants (Cohen's d = -.33, p = .022) were associated with less medical trust and in turn lower vaccination intention. Tuskegee Study knowledge was not associated with vaccination intention or medical trust. Study 2 (N = 12,757) data revealed no statistically significant racial differences in COVID-19 vaccination receipt or intention. Black (relative to White) Americans reported feeling less cared for by their personal physician (Cohen's d = -.44, p < .001), which was associated with lower medical trust (Cohen's d = -.51, p < .001). Findings highlight factors that may contribute to Black Americans' vaccination hesitancy and medical trust. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Translating Race on the French Stage

Disproportionate Use of Psychiatric Emergency Services by African Americans

Mental Health in the Context of Health Disparities

Caribbean Americans and African Americans, two of the largest Black ethnic groups in the United States, differ in cardiovascular-disease-related mortality rates. Cardiovascular reactivity to psychological stress may be an important marker or mediator of risk for cardiovascular disease development in Blacks in the United States, yet little attention has been paid to ethnicity among Blacks in reactivity research. This study examined cardiovascular reactivity to psychological stress in African American, Caribbean American, and White American participants. Forty-five women and 43 men performed mental arithmetic and hand cold pressor (CP) tasks. Caribbean Americans displayed larger decreases in heart period variability during mental arithmetic than White Americans (p =.02). White Americans exhibited a pre-ejection period decrease, whereas African Americans and Caribbean Americans displayed pre-ejection period increases during CP (p =.023). African Americans exhibited greater decreases in interbeat interval during CP than White Americans (p =.013). Caribbean Americans displayed greater decreases in cardiac output than White Americans during CP (p =.009). White Americans exhibited significantly greater increases in systolic blood pressure than Caribbean Americans during CP (p =.014). These findings suggest that differences in reactivity to psychological stress exist among Black ethnic groups in the United States and underscore the need to consider ethnicity as a factor in reactivity research with Black Americans.

Although there is a large gap between Black and White American life expectancies, the gap fell 48.9% between 1990-2018, mainly due to mortality declines among Black Americans. We examine age-specific mortality trends and racial gaps in life expectancy in rich and poor U.S. areas and with reference to six European countries.Inequalities in life expectancy are starker in the U.S. than in Europe. In 1990 White Americans and Europeans in rich areas had similar overall life expectancy, while life expectancy for White Americans in poor areas was lower. But since then even rich White Americans have lost ground relative to Europeans. Meanwhile, the gap in life expectancy between Black Americans and Europeans decreased by 8.3%.Black life expectancy increased more than White life expectancy in all U.S. areas, but improvements in poorer areas had the greatest impact on the racial life expectancy gap. The causes that contributed the most to Black mortality reductions included: Cancer, homicide, HIV, and causes originating in the fetal or infant period.Life expectancy for both Black and White Americans plateaued or slightly declined after 2012, but this stalling was most evident among Black Americans even prior to the COVID-19 pandemic. If improvements had continued at the 1990-2012 rate, the racial gap in life expectancy would have closed by 2036. European life expectancy also stalled after 2014. Still, the comparison with Europe suggests that mortality rates of both Black and White Americans could fall much further across all ages and in both rich and poor areas.Significance StatementFrom 1990-2018, the Black-White life expectancy gap fell 48.9% though progress stalled after 2012 as life expectancy plateaued or declined. If improvements had continued at the 1990-2012 rate, the racial gap in life expectancy would have closed by 2036. Black life expectancy in 1990 started below European or White American levels but grew at a faster rate: the gap between Europeans and Black Americans decreased by 8.3% between 1990-2018. In 1990 White Americans and Europeans in rich areas had similar life expectancy, while White Americans in poor areas had lower life expectancy than poor Europeans. But all White Americans have lost ground relative to Europeans. Current incomebased life expectancy gaps are starker in the U.S. than in comparable European countries.

Identification of Risk Factors for Myeloma Progression in African American Patients