Black Residents Research Articles

The Material World of Eyre Hall: Four Centuries of Chesapeake History ed. by Carl R. Lounsbury

Reviewed by: The Material World of Eyre Hall: Four Centuries of Chesapeake History ed. by Carl R. Lounsbury Shelby M. Balik The Material World of Eyre Hall: Four Centuries of Chesapeake History. Edited by Carl R. Lounsbury. (Baltimore: Maryland Center for History and Culture, 2021. Pp. 447. $89.95, ISBN 978-1-911282-91-4.) When we picture an eighteenth-century plantation, we might imagine stately architecture and elegant grounds. Or we might consider the terrors of slavery poorly concealed by a veneer of grandeur. But do we consider what preceded or followed that historical moment? How do we assess the broader currents—war, economic swings, new technologies, and social change—that transformed the place and its residents? In The Material World of Eyre Hall: Four Centuries of Chesapeake History, editor Carl R. Lounsbury and a host of authors ask these questions of a private estate on Virginia’s Eastern Shore where one family has lived since the seventeenth century (the house itself was built in 1759). The book documents the family, their property, and their possessions over nearly four centuries, telling the intertwined stories of all who have lived there—not just the descendants of Thomas and Susanna Eyre, who settled on the Eastern [End Page 339] Shore around 1650, but also the enslaved Africans whose labor made the Eyres wealthy, and their free Black descendants, many of whom continued to live and work on or near the property. Eyre Hall is among the few southern estates that have never transferred ownership; that continuity allows us to examine change over time in a controlled setting. Readers can trace the house, its occupants, its landscapes, and the objects that have filled its rooms across generations. This book interweaves several scholarly projects: a family chronicle, an oral history, a study of a built environment, and a catalog of books, artwork, ceramics, silver, furniture, and other objects. In the lengthy historical narrative, the authors use a wealth of sources, most significantly wills and probate records, as a “Rosetta Stone” to understand the family’s changing material life, and they provide contextual discussions of the family’s social, cultural, and economic milieu as well as vignettes to highlight archaeological finds (p. 25). Oral histories shed light on more recent generations, particularly the Black families who lived around the estate in the twentieth century. Studies of architecture and landscapes—both aesthetic and functional—show how work and leisure intersected. The book’s “catalogue raisonné” details objects the family used over time and offers historical context to explain how these items reflected a wider material culture (p. 17). Throughout, high-quality photographs, diagrams, architectural drawings, and maps offer essential visual aids. It is difficult to ask more of a book that packs so much into 450 large-format pages, but if any part of this history might have been better developed, it is that of Eyre Hall’s Black occupants. To be sure, the authors pay careful attention to these families; lists of enslaved people, an account of an 1852 escape, and descriptions of outbuildings where they worked illuminate their experiences. But in a work of material culture, the imbalance between the stories of Black and white families is visible. This disparity is expected, to a degree; the objects that enslaved and impoverished people (including free Blacks) used were often ephemeral and rarely kept as heirlooms. Eyre Hall might bear scant record of this history. But historians and archaeologists studying the Chesapeake have uncovered evidence of farming and domestic implements, building styles, burial customs, clothing, and spiritual objects used by generations of Black families. The Material World of Eyre Hall’s authors might have used this research to cast a wider (albeit more speculative) lens on the daily lives of Black residents, thereby making them more central to the estate’s story. This critique, however, should not diminish the book’s contributions. Using many lenses though which to examine Eyre Hall’s material history, the authors have presented a rich and complex picture of the estate. Connecting objects, people, and landscapes across time, this volume offers a new model of how scholars might understand the culture of place. Shelby M. Balik Metropolitan State University of...

Selling Black Brazil: Race, Nation, and Visual Culture in Salvador, Bahia

Selling Black Brazil: Race, Nation, and Visual Culture in Salvador, Bahia

“Why Can’t We Have Some Kind of Unity?” Cultural Contention Amongst Puerto Rican and Black Residents in Southern Suburbia

This study examines Puerto Rican-Black intergroup relations in Poinciana, Florida, a new immigrant destination in the suburban south led by the country’s largest homeowners association. Drawing on ethnographic fieldwork and interviews with 47 residents, I interrogate interpersonal relationships, feelings of belonging, and how residents’ lack of sociopolitical agency contribute to perceptions of intergroup relations. Past research evidences both coalition and tensions between Puerto Rican and Black co-residents, including shared marginalization experiences leading to increased coalition, or economic competition leading to contention. As migration to new immigrant destinations continues to rise, this study suggests minoritized groups may hold discordant conceptualizations of their relationship, what I refer to as “cultural contention.” While Puerto Ricans describe a shared sense of marginalization and unity with their Black neighbors, Black residents express concerns over displacement. With the precarious status of the community, there are few opportunities for residents to coalesce, and further fragmentation is possible.

Conceptualizing Gentrification-Induced Social and Cultural Displacement and Place Identity Among Longstanding Black Residents

Scholars have increasingly recognized the sociocultural impacts of gentrification on Black residents. However, the gentrification literature lacks a theoretical model on the nuanced ways gentrification socially and culturally displaces longstanding Black residents. Limited attention has been given to factors that moderate social and cultural displacement. This article introduces a Theoretical Model of Gentrification-Induced Social and Cultural Displacement and Place Identity among longstanding Black residents based on extant theories and literature. Black neighborhoods’ changing character was theorized as a precipitating factor leading to residents’ negative experiences. Five types of experiences were theorized as contributing to social and cultural displacement: (1) confronting changing neighborhood norms, (2) “othering,” (3) losing social connections, (4) encroaching, and (5) witnessing the erasure of what was. The theoretical model further advances knowledge by explicating how place identity may moderate longstanding Black residents’ social and cultural displacement experiences. Implications for future research and equitable development for historically Black communities are provided.

Changes over time in POLST use and content by race and ethnicity among California nursing home residents.

Physician Orders for Life-Sustaining Treatment (POLST) are commonly used for nursing home (NH) residents. Treatment orders differ across race and ethnicity, presumably related to cultural and socioeconomic variation and levels of access to care and trust. Because national efforts focus on addressing the underpinnings of racial and ethnic differences in treatment (i.e., access to care and trust), we describe POLST use and content by race and ethnicity. California requires NHs to document POLST completion and content in the Minimum Data Set. We describe POLST completion and content for all California NH residents from 2011 to 2016 (N = 1,120,376). Adjusting for resident characteristics, we compared changes in completion rate and differences by race and ethnicity in POLST content-orders for cardiopulmonary resuscitation (CPR), do not resuscitate (DNR), CPR with full treatment, DNR with selective treatment or comfort orders, and if unsigned. POLST completion increased across all racial and ethnic groups from 2011 to 2016; by 2016, NH residents had a POLST two-thirds or more of the time. In 2011, Black residents had a POLST with a CPR order 30.4% of the time, Hispanic residents 25.6%, and White residents 19.7%. By 2016, this grew to 42.5%, 38.2%, and 28.1%, respectively, with Black and Hispanic residents demonstrating larger increases than White residents (p < 0.001). Increases over time in POLST with CPR and full treatment were greater for Black and Hispanic residents compared to White residents. The increase in POLST with DNR and DNR with Selective treatment and Comfort orders was greater for White compared to Black patients (p < 0.001). Unsigned POLST with CPR and DNR orders decreased across all racial and ethnic groups. Racial and ethnic differences in POLST intensity of care orders increased between 2011 and 2016 suggesting that efforts to mitigate factors underlying differences were ineffective. Studies of newer POLST data are imperative.

Where do colleges advertise? Demographic targeting by U.S. colleges

In this paper, we assess the correlation between advertising spending by U.S. higher education institutions and metropolitan area demographics. We explore whether demographic targeting by colleges differs by sector (for-profit, not-for-profit, and public colleges), as well as for predominantly online institutions and multi-campus chains. Our data include spending on television, radio, Internet, print, and outdoor advertising by degree-granting institutions in the United States. We find that advertising spending is positively correlated with the share of Black residents in a local area for all types of institutions. For-profit institutions advertise in communities with larger shares of military service members and Hispanic residents, relative to their public and private not-for-profit counterparts. Campus location plays an important mediating role in college advertising, but cannot fully account for the patterns we observe. More research is needed to understand the welfare implications of our findings, but they raise concerns in light of research showing relatively poor outcomes for students in for-profit institutions.

Successful management of poisoning with ivermectin (Mectizan) in the Obala health district (Centre Region, Cameroon): a case report

BackgroundIvermectin (Mectizan) is an anthelmintic drug that plays a major role in the fight against two major filarial diseases, onchocerciasis and lymphatic filariasis. Unlike previous drugs that had serious and sometimes fatal side effects, ivermectin has been considered to be safe and, therefore, is widely used. Data reporting the clinical presentation of poisoning with ivermectin are very scanty, even in experimental studies.Case presentationIn this paper, we report the case of a 19-year-old Black African female student residing in Obala (Centre Region, Cameroon) who was admitted to a health facility in Central Cameroon for a neurological disorder after intoxication with about 400 tablets of ivermectin 3 mg (~100 times the standard doses). This neurological disorder was characterized by somnolence, kinetic ataxia, increase of tendon reflex, and central visual disturbance. Management of this intoxication consisted of symptomatic treatment and monitoring of hemodynamic parameters for 5 days, with a favorable course.ConclusionsThis is the first report of a poisoning with ivermectin at ~100 times the recommended dose. This case report confirms the safety and tolerability of ivermectin, even at exceptionally high dose.

Power, place, and access: Why history is at the center of black D.C. residents of wards 7 and 8 decisions to receive the COVID-19 vaccine

Vaccines have played an essential role in curbing case and mortality rates due to SARS-CoV-2 in the United Sates. Still, many communities display high rates of unwillingness or inability to get a COVID-19 vaccine, limiting overall vaccination efforts and contributing to viral spread. Black Americans have expressed skepticism towards vaccines because of limited access to the technology, mistrust in its safety and efficacy, and a lack of confidence in the healthcare authorities that distribute it. This article investigates how Black residents of Wards 7 and 8 in Washington, D.C. thought about COVID-19 vaccination and why or why not they decided to vaccinate. These Wards’ vaccination rates were markedly lower than those from Wards 1–6, which have substantially higher populations of White residents, affluence, access, and resources. This study involved 31 interviews with Ward 7 and 8 residents recruited through snowball sampling. We found that residents navigated the dual perceived risks of coronavirus infection and vaccination through three key frames: their relationship to their place or location, their desires to maintain autonomy over their health, and their abilities to access COVID-19 vaccines. This case study advances knowledge of vaccine utilization among marginalized communities, and how this phenomenon varies depending on local social, cultural, and political dynamics. Moreover, this research has implications for vaccine rollout efforts and the D.C. health system, as it reveals gaps in confidence and care that undermine health outcomes for Black residents.

Racial disparities in access to health care infrastructure across US counties: A geographic information systems analysis.

Infrastructure system in the U.S. have been shown to be linked to social and health inequities. We calculated driving distance to the closest health care facility for a representative sample of the U.S. population using ArcGIS Network Analyst and a national transportation dataset, and identified areas where Black residents have a longer driving distance to the closest facility than White residents. Our data demonstrated that racial disparities in access to health care facilities presented large geographic variation. Counties with significant racial disparities were concentrated in the Southeast and did not correspond to counties with a greater proportion of the overall population >5 miles to the closest facility, which were concentrated in the Midwest. This geographic variation demonstrates the need to adopt a spatially explicit data driven approach in the design of equitable health care facility establishment that address the specific limitations of the local infrastructure.

Exploring the association of Brownfield remediation status with socioeconomic conditions in Wayne County, MI

Urban neighborhoods with locations of environmental contamination, known as brownfields, impact entire neighborhoods, but corrective environmental remedial action on brownfields is often tracked on an individual property basis, neglecting the larger neighborhood-level impact. This study addresses this impact by examining spatial differences between brownfields with unmitigated environmental concerns (open site) and sites that are considered fully mitigated or closed in urban neighborhoods (closed site) on the US census tract scale in Wayne County, MI. Michigan’s Department of Environment, Great Lakes, and Energy’s leaking underground storage tank (LUST) database provided brownfield information for Wayne County. Local indicators of spatial association (LISA) produced maps of spatial clustering and outliers. A McNemar’s test demonstrated significant discordances in LISA categories between LUST open and closed sites (p < 0.001). Geographically weighted regressions (GWR) evaluated the association between open and closed site spatial density (open-closed) with socioeconomic variables (population density, proportion of White or Black residents, proportion of college educated populations, the percentage of owner-occupied units, vacant units, rented units, and median household value). Final multivariate GWR showed that population density, being Black, college education, vacant units, and renter occupied units were significantly associated (p < 0.05) with open-closed, and that those associations varied across Wayne County. Increases in Black population was associated with increased open-closed. Increases in vacant units, renter-occupied units, and college education were associated with decreased open-closed. These results provide input for environmental justice research to identify inequalities and discover the distribution of environmental hazards among urban neighborhoods.

Measuring the Digital Divide: A Neighborhood-Level Analysis of Racial Inequality in Internet Speed during the COVID-19 Pandemic

Since the beginning of the COVID-19 pandemic, internet access has been vital to ensuring individuals can work from home, attend online school and maintain contact with loved ones. While research has already shown that inequalities exist regarding who has access to the internet, less research has used actual internet speed test data to examine neighborhood inequalities in internet access, and even less research has explored trends related to this during the COVID-19 pandemic. Using a dataset containing over 100 million internet speed tests in the United States, we analyze neighborhood-level variation in internet speed. We find that neighborhoods with higher proportions of Black residents tend to have better download speeds but worse upload speeds. Notably, upload speeds are especially important for video communication, which massively proliferated during the pandemic. Further, upload speeds in Black neighborhoods have consistently fallen relative to white neighborhoods during the pandemic. This trend has substantial implications for racial inequality in the digital age.

Recruitment and Enrollment of Low-income, Minority Residents of Urban Public Housing into Research.

Research participation among vulnerable populations is often limited by the same socioeconomic factors that contribute to poor health. Identifying best practices for inclusion is critical to addressing health disparities. Urban public housing communities bear a disproportionate burden of chronic disease and may represent an opportunity to directly engage historically vulnerable populations in research designed to ultimately reduce that burden. We used mixed-method data to analyze recruitment effectiveness among a random sample of households (N = 380) across two public housing developments in Boston, MA who were approached for participation in a pre-COVID oral health study. Quantitative data from detailed recruitment tracking methods was analyzed to assess the relative efficiency of the methods employed. Field journals of study staff were qualitatively analyzed to identify community-specific recruitment barriers and facilitators. The participation rate among randomly sampled households was 28.6% (N = 131), with participation from primarily Hispanic (59.5%) or Black (26%) residents. Door-to-door knocking with response yielded the highest participation (44.8%), followed by responses to informational study flyers (31%). Primary barriers to enrollment included references to unemployment and employment variations, shift work, childcare responsibilities, time demands, and managing multiple appointments and social services. This study finds active, door-to-door knocking and return visits resolved barriers to participation, and reduced safety concerns and historic distrust. It's time to consider how best to adapt effective pre-COVID recruitment practices for utilization under current and future exposure conditions as effective recruitment of populations such as urban public housing residents into research is only becoming more important.

159 Bearing a higher burden: Black and Latinx community perspectives on the Impact of COVID-19

OBJECTIVES/GOALS: During earlier periods of the pandemic, Black and Latinx populations in Michigan have suffered higher rates of infection, hospitalization, and deaths when compared to Whites. We conducted this study to understand how Black and Latinx residents perceived this disproportionate burden. METHODS/STUDY POPULATION: In 2021, 40 semi-structured interviews were conducted virtually in English or Spanish with Black (n=24) and Latinx (n=16) residents in Michigan areas highly impacted by COVID-19: Genesee, Kent, Washtenaw, and Wayne counties. Using a Community-Based Participatory Research (CBPR) approach, we partnered with leaders from 15 community-based organizations and health and human service agencies to develop research questions, an interview protocol, and to interpret the data. We used the data analysis software Dedoose (ver 4.12) for inductive coding (IRR=0.81). This study is a part of the NIH Community Engagement Alliance (CEAL) Against COVID-19 initiative. RESULTS/ANTICIPATED RESULTS: Participants described the significant impact of the pandemic in terms of physical and mental health, job security, and the sheer number of deaths among loved ones. They attributed the impact to comorbidities and social determinants of health disparities exacerbated by the pandemic, including income, housing, access to healthcare, as well as systemic racism. They noted being overrepresented among frontline workers with higher exposure to COVID-19, limited or misinformation about the virus, language barriers, and difficulty with social distancing. Cultural norms that promote being in close proximity, such as intergenerational households, and loss of trusted community leaders were also noted. DISCUSSION/SIGNIFICANCE: Findings reflect the needs of Black and Latinx community members in Michigan and the discussions they feel are important to highlight. We must work strategically with partners and the community to provide transparency and effective leadership, and prioritize addressing systemic disparities in SDoH.

Nursing Home to Nursing Home Transfers during the Early COVID-19 Pandemic.

To examine the nursing home to nursing home transfer rates before and during the early COVID-19 pandemic and to identify risk factors associated with those transfers in a state with a policy to create COVID-19-care nursing homes. Cross-sectional cohorts of nursing home residents in prepandemic (2019) and COVID-19 (2020) periods. Michigan long-term nursing home residents were identified from the Minimum Data Set. Each year, we identified transfer events as a resident's first nursing home to nursing home transfer between March and December. We included residents' characteristics, health status, and nursing home characteristics to identify risk factors for transfer. Logistic regression models were conducted to determine risk factors for each period and changes in transfer rates between the 2 periods. Compared to the prepandemic period, the COVID-19 period had a higher transfer rate per 100 (7.7 vs 5.3, P < .05). Age≥80 years, female sex, and Medicaid enrollment were associated with a lower likelihood of transfer for both periods. During the COVID-19 period, residents who were Black, with severe cognitive impairment, or had COVID-19 infection were associated with a higher risk of transfer [adjusted odds ratio (AOR) (95% CI): 1.46 (1.01-2.11), 1.88 (1.11-3.16), and 4.70 (3.30-6.68), respectively]. After adjusting for resident characteristics, health status, and nursing home characteristics, residents had 46% higher odds [AOR (95% CI): 1.46 (1.14-1.88)] of being transferred to another nursing home during the COVID-19 period compared to the prepandemic period. In the early COVID-19 pandemic, Michigan designated 38 nursing homes to care for residents with COVID-19. We found a higher transfer rate during the pandemic than during the prepandemic period, especially among Black residents, residents with COVID-19 infection, or residents with severe cognitive impairment. Further investigation is warranted to understand the transfer practice better and if any policies would mitigate the transfer risk for these subgroups.

Rebecca K. Marchiel. After Redlining: The Urban Reinvestment Movement in the Era of Financial Deregulation.

After Redlining is an important contribution to the robust literature on twentieth century US housing policy and divestment from America’s cities. Focusing on the period between the late 1960s and mid-1980s—between the urban uprisings and the triumph of financial deregulation—Rebecca K. Marchiel explores how the National People’s Action (NPA), a loose federation of neighborhood organizations composed of white, Black, and Latinx working- and middle-class residents, sought “better versions” of federal housing programs (89), first through base-building, power-mapping, and social movement campaigns, and later by lobbying their allies in Congress. The book is also about the changing banking landscape in post-1970s America. Marchiel traces the development of “financial common sense,” the belief that because banks were different from “typical for-profit firms” (5), they had an obligation to extend credit to communities in which they did business. Inculcated by the New Deal and reinforced by postwar popular culture, by the late 1960s, this financial common sense ran up against the vanishing act of local banks and their unwillingness to issue new mortgages. As neighborhoods began to “transition,” a euphemism for the arrival of Black and brown residents in white urban enclaves, local savings and loan associations either reneged on their obligation or decided that since access to “their services … hinged on whiteness,” the compact had been broken by the settlement of clients they were never intended to serve (42, 45).

Clarence Taylor. Fight the Power: African Americans and the Long History of Police Brutality in New York City.

Arguing that “the fight against police brutality has been one of the longest civil rights struggles in American history” (6), Clarence Taylor’s Fight the Power examines efforts by Black residents of New York City and their allies to improve local policing from the 1930s to the present. While the author narrates countless high-profile acts of police brutality throughout, the heart of the book centers around Black people fighting back. Indeed, Taylor’s purpose is to examine “the activist groups that carried out long campaigns … to end racially targeted police brutality” long before the rise of the Black Lives Matter movement of the 2010s and the explosion of civil unrest in 2020 (4). In addition to chronicling residents’ demands for liberal reform and community control of police, however, Taylor also explores how police officers, administrators, elected officials, and other police advocates resisted reform, shored up police power, and cracked down on crime. Even as sensational acts of racist police violence stirred community action, members of the New York Police Department (NYPD)—with the help of politicians and journalists—exploited citizens’ fears of crime in order to deny or justify brutality in the name of law and order. If the pattern of police scandal, community protest, and limited reform outlined by Taylor seems timeless—even repetitive—it speaks to the “extraordinary resistance by the police and their allies to altering the power dynamics between people of color and law enforcement” (6). As Taylor concludes, “despite the gains made by the anti-police brutality movement, such abuse continues to plague New York City” (246). Taylor hopes to “bring attention to this long fight,” give voice to survivors, and empower communities in the ongoing fight for racial justice (245).

Collaborative survival in the city: Envisioning alternative urban futures through Black agrarian praxis

Urban inhabitants exist within hybrid spaces of continual transformation and metabolism where human labor is woven into the work of the trees, the grass, the water cycle. The built environment – concrete, houses, skyscrapers – butts up against urban riparian zones and wetlands. The postindustrial landscape exposes both the possibilities and the limits of building resilience in the context of constant metabolism and change. This article asks about the potential for collaborative survival in these spaces of deindustrialization, where the abundance of so-called vacant parcels represent a pathway toward more self-determined food systems and the potential for reimagined urban futures. I play with the concept of collaborative survival to consider a plurality of epistemologies, knowledge systems, and traditions, as well as histories and geographies of exclusion that contribute to this reimagining. I examine the work of Black gardeners and farmers in Cleveland, OH as an example of collaborative survival: their work within a changing environment to grow food for themselves and their community, producing the city around them as a socio-ecological hybrid. Urban food production, in this case, serves as a praxis and a knowledge frame for liberation and emancipation. This paper explores urban agrarianism among Black residents in light of two historical moments that have deeply impacted Cleveland, and that I argue have shaped and informed Black agrarian praxis and growers' urban imaginaries. Collaborative survival recognizes that processes of urban development are ongoing and immanent and contests developmentalist narratives that marginalize epistemologies embracing alternative urban futures. Examining Black growers' experiences with attention to a framing around survival and resilience highlights the continuity of structural and systemic racism and violence against Black and brown bodies, as well as the innovations that individuals and groups deploy to contest that violence.

Neighborhood factors and triple negative breast cancer: The role of cumulative exposure to area-level risk factors.

Despite similar incidence rates among Black and White women, breast cancer mortality rates are 40% higher among Black women. More than half of the racial difference in breast cancer mortality can be attributed to triple negative breast cancer (TNBC), an aggressive subtype of invasive breast cancer that disproportionately affects Black women. Recent research has implicated neighborhood conditions in the etiology of TNBC. This study investigated the relationship between cumulative neighborhood-level exposures and TNBC risk. This single-institution retrospective study was conducted on a cohort of 3316 breast cancer cases from New Castle County, Delaware (from 2012 to 2020), an area of the country with elevated TNBC rates. Cases were stratified into TNBC and "Non-TNBC" diagnosis and geocoded by residential address. Neighborhood exposures included census tract-level measures of unhealthy alcohol use, metabolic dysfunction, breastfeeding, and environmental hazards. An overall cumulative risk score was calculated based on tract-level exposures. Univariate analyses showed each tract-level exposure was associated with greater TNBC odds. In multivariate analyses that controlled for patient-level race and age, tract-level exposures were not associated with TNBC odds. However, in a second multivariate model that included patient-level variables and considered tract-level risk factors as a cumulative exposure risk score, each one unit increase in cumulative exposure was significantly associated with a 10% increase in TNBC odds. Higher cumulative exposure risk scores were found in census tracts with relatively high proportions of Black residents. Cumulative exposure to neighborhood-level risk factors that disproportionately affect Black communities was associated with greater TNBC risk.

The Intersection of Race and Rurality and its Effect on Colorectal Cancer Survival.

Outcomes in colorectal cancer treatment are historically worse in Black people and residents of rural areas. Purported reasons include factors such as systemic racism, poverty, lack of access to care, and social determinants of health. We sought to determine whether outcomes worsened when race and rural residence intersected. The National Cancer Database was queried for individuals with stage II-III colorectal cancer (2004-2018). To examine the intersectionality of race/rurality on outcomes, race (Black/White) and rurality (based on county) were combined into a single variable. Main outcome of interest was 5-year survival. Cox hazard regression analysis was performed to determine variables independently associating with survival. Control variables included age at diagnosis, sex, race, Charlson-Deyo score, insurance status, stage, and facility type. Of 463948 patients, 5717 were Black-Rural, 50742 were Black-Urban, 72241 were White-Rural, and 335271 were White-Urban. Five-year mortality rate was 31.6%. Univariate Kaplan-Meier survival analysis demonstrated race-rurality was associated with overall survival (P < .001), with White-Urban having the greatest mean survival length (47.9months) and Black-Rural with the lowest (46.7months). Multivariable analysis found that Black-Rural (1.26, 95% confidence interval [1.20-1.32]), Black-Urban (1.16, [1.16-1.18]), and White-Rural (HR: 1.05; (1.04-1.07) had increased mortality when compared to White-Urban individuals (P < .001). Although White-Rural individuals fared worse than White-Urban, Black individuals fared worst of all, with the poorest outcomes observed in Black individuals in rural areas. This suggests that both Black race and rurality negatively affect survival, and act synergistically to further worsen outcomes.

Racial and sex disparities in the selection of chief residents in obstetrics and gynecology

Racial and ethnically minoritized individuals and women are underrepresented in leadership roles in academic medicine. Little is known about whether and to what extent these racial and sex disparities exist in graduate medical education. This study aimed to determine whether race-ethnicity or the intersection of race-ethnicity and sex impact the likelihood of being selected as chief resident in obstetrics and gynecology residency programs. We performed cross-sectional analyses using data from Graduate Medical Education Track, a national resident database and tracking system. Those included in this analysis were final-year obstetrics and gynecology residents in US-based residency programs from 2015 to 2018. The exposure variables were self-reported race-ethnicity and sex. The outcome was being selected as chief resident. A logistic regression was used to estimate the odds of being selected as chief resident. We tested the following variables for potential confounding: survey year, United States citizenship, medical school type, geographic region of residency, and Alpha Omega Alpha status. There were 5128 residents included. Black residents were 21% less likely to be selected as chief resident than White residents (odds ratio, 0.79; 95% confidence interval, 0.65-0.96). Females were 19% more likely to be chief resident than males (odds ratio, 1.19; 95% confidence interval, 1.02-1.38). When examining the intersection of race-ethnicity and sex, the results revealed some heterogeneity. Among males, Black individuals had the lowest odds of being selected as chief resident (odds ratio, 0.32; 95% confidence interval, 0.17-0.63; referent White males), whereas among females, Hispanic individuals were the least likely to be selected as chief resident (odds ratio, 0.69; 95% confidence interval, 0.52-0.92; referent White females). White females were almost 4 times more likely to be selected as chief resident than Black males (odds ratio, 3.79; 95% confidence interval, 1.97-7.29). The odds of being selected as chief resident differ significantly by race-ethnicity, sex, and the intersection of these factors.