Abstract
ObjectiveTo evaluate the association between racial residential segregation, a prominent manifestation of systemic racism, and the White-Black survival gap in a contemporary cohort of adults, and to assess the extent to which socioeconomic inequality explains this association.DesignThis was a cross sectional study of White and Black men and women aged 35–75 living in 102 large US Core Based Statistical Areas. The main outcome was the White-Black survival gap. We used 2009–2013 CDC mortality data for Black and White men and women to calculate age-, sex- and race adjusted White and Black mortality rates. We measured segregation using the Dissimilarity index, obtained from the Manhattan Institute. We used the 2009–2013 American Community Survey to define indicators of socioeconomic inequality. We estimated the CBSA-level White–Black gap in probability of survival using sequential linear regression models accounting for the CBSA dissimilarity index and race-specific socioeconomic indicators.ResultsBlack men and women had a 14% and 9% lower probability of survival from age 35 to 75 than their white counterparts. Residential segregation was strongly associated with the survival gap, and this relationship was partly, but not fully, explained by socioeconomic inequality. At the lowest observed level of segregation, and with the Black socioeconomic status (SES) assumed to be at the White SES level scenario, the survival gap is essentially eliminated.ConclusionWhite-Black differences in survival remain wide notwithstanding public health efforts to improve life expectancy and initiatives to reduce health disparities. Eliminating racial residential segregation and bringing Black socioeconomic status (SES) to White SES levels would eliminate the White-Black survival gap.
Highlights
Despite substantial improvements in US life expectancy, White-Black disparities in survival remain wide.[1,2,3,4] The pathways underlying these disparities are not fully understood, but social determinants of health are deemed to play a primary role.[5,6,7,8] Low socioeconomic status (SES), which is more prevalent among black populations, is linked to a broad range of adverse health outcomes including higher burden of chronic disease,[9] worse self-reported health status,[10] and higher mortality rates.[11]
Residential segregation was strongly associated with the survival gap, and this relationship was partly, but not fully, explained by socioeconomic inequality
White-Black differences in survival remain wide notwithstanding public health efforts to improve life expectancy and initiatives to reduce health disparities
Summary
Despite substantial improvements in US life expectancy, White-Black disparities in survival remain wide.[1,2,3,4] The pathways underlying these disparities are not fully understood, but social determinants of health are deemed to play a primary role.[5,6,7,8] Low socioeconomic status (SES), which is more prevalent among black populations, is linked to a broad range of adverse health outcomes including higher burden of chronic disease,[9] worse self-reported health status,[10] and higher mortality rates.[11]. Residential segregation refers to the spatial separation of population groups along racial or ethnic lines. Prior to the 1960s, racial residential segregation was both legal and ubiquitous in the United States, enforced by social and public policies such as the Jim Crow laws in the South and the Federal Housing Administration’s early lending (red-lining) policies.[13] With the passage of the Civil Rights Act in 1964 and of the Fair Housing Act (FHA) in 1968 segregation officially ended. De facto segregation persists through a variety of political and social mechanisms.[14] As a consequence, Blacks currently live under a level of segregation higher than that of any other racial/ ethnic group.[15]
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