Black-white Differences Research Articles

Low Job Control and Racial Disparities in Breastfeeding.

Low job control may predict shorter breastfeeding (BF) among working mothers and may contribute to racial disparities in BF. We used demographic, employment, and health data for n = 631 observations from the Panel Study of Income Dynamics. Job control scores came from a job-exposure matrix.Using path analysis, we assessed whether job control predicted BF and mediated Black-White BF differences. We controlled for education, working hours, marital status, and low birthweight. Lower job control predicted decreased odds of BF for at least 6 months (odds ratio, 0.61; 95% confidence interval, 0.31-0.90; reference, no BF). Low job control explained 31% of the Black-White difference for both shorter-term and longer-term BF. Low job contributes to shorter BF and to BF disparities by race. Intervening to enhance job control could improve BF.

Racial/Ethnic Variation in Family Support: African Americans, Black Caribbeans and Non-Latino Whites.

This study examined racial and ethnic differences in the receipt and provision of instrumental family support. Extended families provide significant levels of emotional and instrumental support across the life course. Despite their importance, extended family relationships and the assistance they provide are largely neglected in the literature. Further, questions remain concerning cultural variation in family support relationships and inconsistent findings on racial differences in family support in prior investigations. This study relied on data from the National Survey of American Life-Reinterview (n=3,483) to investigate the provision and receipt of instrumental support from extended family among African Americans, Black Caribbeans, and non-Latino Whites and within high- and low-income categories for each group. Eight key measures of instrumental family support are examined: receiving and providing transportation, help with chores, financial assistance, and help during an illness. African Americans and Black Caribbeans share similar profiles of providing and receiving instrumental family support. Both populations receive and provide assistance more frequently than do non-Latino Whites. Similarly, analyses stratified by income indicated that for low-income and high-income groups, African American and Black Caribbeans are similar to one another, and at each income category, both groups received and provided support more frequently than non-Latino Whites. Study findings are discussed in relation to conceptual and methodological differences in assessing Black-White differences across studies of family support. Attention to these issues and the specific contexts for receiving/providing family support (emergency vs. routine; intergenerational vs. extended) will help clarify inconsistent findings across studies.

Resting energy expenditure of a diverse group of South African men and women.

In South Africa, overweight/obesity is a public health concern, disproportionally affecting Black females. A contributory role of a lower resting energy expenditure (REE) is suggested for African Americans. The present study assessed the REE of Black and White South African adults aiming to better understand the underlying predictors to overweight/obesity and transform this into locally appropriate recommendations. In 328 (63% female; 39% Black) healthy South African adults, REE was measured with indirect calorimetry and body composition with multifrequency bioelectrical impedance analysis. The REE was estimated with 30 sets of published equations. Black-White differences in REE, as measured and adjusted (analysis of covariance), were determined with quantile regression. Reliability/agreement of estimated (against measured) REE was determined with intra-class correlations (ICCs) and Bland-Altman analysis. A new equation was developed by median regression followed by preliminary validation. Measured REE (adjusted for age along with fat-free mass [FFM], FFM index, FFM plus fat mass, FFM index plus fat mass index) in White subjects was significantly higher (p < 0.001) than in Black subjects for men and women alike, regardless of obesity class. None of the sets of estimation equations had good agreement with measured REE for Black, White, male and female subjects simultaneously. A new estimation equation, based on whole-body variables, had good reliability (ICC = 0.79) and agreement (mean difference: 27 kJ) and presents practical opportunities for groups at the local grass-roots level. The REE in Black South African adults is lower than in White adults. Tailored REE equations may improve REE estimation of racially/ethnically diverse South African groups and contribute to improved obesity management.

Understanding Black-White Differences in Support for the Racial Invariance Thesis: Lessons Learned From Philadelphia Area Residents

The racial invariance thesis contends causes of offending are similar across race/ethnicity. Black Criminology perceives some tension with this claim, suggesting instead that Black people share a unique worldview due to the racial oppression they face. This worldview may make Black people more receptive to criminological explanations identifying race-specific pathways to committing crime. In the post-Civil Rights era, many white people explain social phenomena like crime in colorblind ways. This study used a random sample of Philadelphia area residents to explore whether Black people were less likely than white people to support the racial invariance thesis. Logistic regression analyses revealed the odds of Black Philadelphians agreeing with the racial invariance thesis were 85% higher than the odds for white Philadelphians.

Factors Associated With Advance Care Planning by Race.

This study aims to quantify and interpret Black-White differences in the factors associated with advance care planning (ACP), with specific attention to self-reported presence of chronic conditions and healthcare stereotype threat (HCST) in medical settings. Black and White individuals aged 50 and older (N = 499) were recruited from community centers and assisted living facilities in southern California and on Amazon Mechanical Turk. Six sequential logistic regressions assessed the effect of age, presence of chronic conditions, income, and HCST on predicting 3 components of ACP by race. Findings suggest that the awareness of ongoing chronic conditions predicts all 3 aspects of ACP for Whites, but not for Blacks. HCST positively predicts the appointment of a durable power of attorney, but only for Black respondents. These findings offer a novel perspective on racial disparities in ACP that may inform health care providers and community practices.

Racial disparity in ART adherence is closed in states with high social trust: Results from the Medical Monitoring Project (MMP), 2015.

Racial/ethnic disparities persist in antiretroviral therapy (ART) adherence and viral suppression. We examined associations between state-level social trust and individual-level ART adherence and viral suppression and assessed whether these relationships varied by race/ethnicity. The Medical Monitoring Project (MMP) annually reports nationally representative estimates of the behavioral and clinical characteristics of HIV-positive adults in primary care. A total of 3298 adults diagnosed with HIV between 2015 and 2016 from 16 US states were included. We used weighted logistic regression to model the association between state-level social trust, race/ethnicity (Non-Hispanic Black, White, and Hispanic/Latino), and cross-product interactions with ART adherence (a binary measure derived from three self-reported questions), and viral suppression (a binary measure corresponding to plasma HIV RNA < 200 copies/ml). Social trust was the percentage of people in each state who agreed that most people in their neighborhood could be trusted. A high level of social trust was associated with a higher likelihood of ART adherence (PR [prevalence ratio] = 1.17; 95% confidence interval [CI]: 1.05-1.30). In covariate-adjusted analyses, the association between state-level social trust and individual-level ART adherence significantly varied by race/ethnicity (Wald χ2 F = 9.8 [df = 4], p = 0.044). Social trust was positively associated with ART, but the effect was smaller for Blacks than for Whites (PR = 0.66; 95% CI: 0.57-0.82) in states with the lowest social trust. Black-White differences were closed and no longer significant above mean social trust (PP [predicted probability] = 0.50 vs. 0.53, at two standard deviations). Racial/ethnic disparities in ART adherence were closed among individuals living in states with high social trust. Understanding the mechanisms that promote social trust among neighbors may have downstream impacts on reducing disparities in ART adherence among people with HIV (PWH).

Measuring Racial Inequities In The Quality Of Care Across Oncology Practices In The US.

Racial inequities in clinical performance diminish overall health care system performance; however, quality assessments have rarely incorporated reliable measures of racial inequities. We studied care for more than one million Medicare fee-for-service beneficiaries with cancer to assess the feasibility of calculating reliable practice-level measures of racial inequities in chemotherapy-associated emergency department (ED) visits and hospitalizations. Specifically, we used hierarchical models to estimate adjusted practice-level Black-White differences in these events and described differences across practices. We calculated reliable inequity measures for 426 and 322 practices, depending on the measure. These practices reflected fewer than 10percent of practices treating Medicare beneficiaries with chemotherapy, but they treated approximately half of all White and Black Medicare beneficiaries receiving chemotherapy and two-thirds of Black Medicare beneficiaries receiving chemotherapy. Black patients experienced chemotherapy-associated ED visits and hospitalizations at higher rates (54.2percent and 35.8percent, respectively) than White patients (45.7percent and 31.9percent, respectively). The median within-practice Black-White difference was 8.1percentage points for chemotherapy-associated ED visits and 2.7percentage points for chemotherapy-associated hospitalizations. Additional research is needed to identify other reliable measures of racial inequities in health care quality, measure care inequities in smaller practices, and assess whether providing practice-level feedback could improve equity.

Assessing the role of socioeconomic status and discrimination exposure for racial disparities in inflammation

Socioeconomic status (SES) and discrimination have been implicated as social determinants of health and health disparities. Yet, very little research has been done to assess their contributing role in Black-White disparities in inflammation. Using data from the Midlife in the United States (2004–2006), we conducted Oaxaca-Blinder decomposition analysis to quantify the extent to which three indicators of SES (i.e., education, household income, and employment status) and three forms of discrimination exposures (i.e., everyday, lifetime, and workplace discrimination) explained Black-White differences in inflammation. Education, particularly having a college degree or more, explained 16.88% of the differences between Blacks and Whites. There was no evidence that household income and employment status explained Black-White inflammation differences. Lifetime discrimination significantly explained 18.18% of Black-White difference in inflammation burden. There was no evidence that everyday and workplace discrimination explained Black-White difference in inflammation burden. Together, the predictors explained 44.16% of inflammation differences between Black and White participants. Education and lifetime exposure to discrimination may play a role in inflammation disparities. Further research is needed to examine other dimensions of SES (e.g., wealth) and discrimination (e.g., racial segregation) that are associated with health to better understand the contributions of these key social determinants of Black-White inflammation disparities.

On the Continued Misinterpretation of Stereotype Threat as Accounting for Black-White Differences on Cognitive Tests

Steele and Aronson (1995) showed that stereotype threat affects the test performance of stereotyped groups. A careful reading shows that threat affects test performance but does not eliminate Black–White mean score gaps. Sackett et al. (2004) reviewed characterization of this research in scholarly articles, textbooks, and popular press, and found that many mistakenly inferred that removing stereotype threats eliminated the Black– White performance gap. We examined whether the rate of mischaracterization of Steele and Aronson had decreased in the 15 years since Sackett et al. highlighted the common misinterpretation. We found that the misinterpretation rate dropped from 90.9% to 62.8% in journal articles and from 55.6% to 41.18% in textbooks, though this is only statistically significant in journal articles.

Community disadvantage, family socioeconomic status, and racial/ethnic differences in maltreatment reporting risk during infancy

BackgroundChildren are reported for maltreatment during infancy at elevated rates; research has established persistent racial/ethnic differences in the likelihood of reporting to the child protection system (CPS). ObjectiveTo model the influence of race/ethnicity and community disadvantage in CPS reporting during infancy. Participants/settingA population-based dataset consisting of more than 1.2 million children born in California between 2012 and 2014. Vital birth records were probabilistically linked to administrative CPS records. American Community Survey data were used to measure community disadvantage. MethodsFor each child, we coded sociodemographic information from the birth record, assigned the child to a community using their residential address at birth, and captured maltreatment reports from child protection records. We employed a modified Poisson regression model to examine an infant's likelihood of being reported to CPS by race/ethnicity across levels of community disadvantage and after adjusting for individual-level covariates. ResultsInfants born in neighborhoods with the most concentrated disadvantage were reported to CPS at 7 times the rate of children born in the most advantaged neighborhoods (12.3% vs. 1.8%). After adjusting for individual-level covariates, we found that both Black and Hispanic infants born on public insurance were significantly less likely than White infants to be reported for maltreatment overall — and Black and Hispanic infants had a statistically equivalent or lower likelihood of reporting at the two extremes of neighborhood disadvantage. Among privately insured families, Hispanic infants continued to have a lower likelihood of reporting, but Black infants were reported at higher rates than White infants. This Black-White difference persisted in the most advantaged neighborhoods, but disappeared in the most disadvantaged neighborhoods. ConclusionsCapturing individual-level differences in socioeconomic status and associated risk factors is critical to understanding sources of racial/ethnic differences in CPS reporting, including when there is unwarranted variation or disparate treatment. Our findings suggest an elevated likelihood of maltreatment reporting among privately insured Black infants not explained by differences in observed risk or neighborhood, but no such differences were documented for Black or Hispanic infants on public insurance.

A0821 - Metabolomics of Black-White differences in risk of prostate cancer biochemical recurrence

A0821 - Metabolomics of Black-White differences in risk of prostate cancer biochemical recurrence

Association Between Patient Diversity in Hospitals and Racial/Ethnic Differences in Patient Length of Stay.

Hospitals serving a disproportionate share of racial/ethnic minorities have been shown to have poorer quality outcomes. It is unknown whether efficiencies in inpatient care, measured by length of stay (LOS), differ based on the proportion patients served by a hospital who are minorities. To examine the association between the racial/ethnic diversity of a hospital's patients and disparities in LOS. Retrospective cross-sectional study. One million five hundred forty-six thousand nine hundred fifty-five admissions using the 2017 New York State Inpatient Database from the Healthcare Cost and Utilization Project. Differences in mean adjusted LOS (ALOS) between White and Black, Hispanic, and Other (Asian, Pacific Islander, Native American, and Other) admissions by Racial/Ethnic Diversity Index (proportion of non-White patients admitted to total patients admitted to that same hospital) in quintiles (Q1 to Q5), stratified by discharge destination. Mean LOS was adjusted for patient demographic, clinical, and admission characteristics and for individual intercepts for each hospital. In both unadjusted and adjusted analysis, Black-White and Other-White mean LOS differences were smallest in the most diverse hospitals (Black-White: unadjusted, -0.07 days [-0.1 to -0.04], and adjusted, 0.16 days [95% CI: 0.16 to 0.16]; Other-White: unadjusted, -0.74 days [95% CI: -0.77 to -0.71], and adjusted, 0.01 days [95% CI: 0.01 to 0.02]). For Hispanic patients, in unadjusted analysis, the mean LOS difference was greatest in the most diverse hospitals (-0.92 days, 95% CI: -0.95 to -0.89) but after adjustment, this was no longer the case. Similar patterns across all racial/ethnic groups were observed after analyses were stratified by discharge destination. Mean adjusted LOS differences between White and Black patients, and White and patients of Other race was smallest in most diverse hospitals, but not differences between Hispanic and White patients. These findings may reflect specific structural factors which affect racial/ethnic differences in patient LOS.

Reducing Implicit Bias in Maternity Care: A Framework for Action

Reducing Implicit Bias in Maternity Care: A Framework for Action

The Effects of Mid-life Stress Exposure on Black-White Differences in Cognitive Decline

Cognitive decline is a precursor to cognitive impairment and dementia. Recent research suggests that cognitive decline may begin earlier in the life course for Blacks and that Black-white disparities in cognitive function emerge in midlife. Disproportionate exposure to chronic and acute stressors during mid-life may explain Black-white differences in trajectories of cognitive function over time. In this study we use data from approximately 3,700 Black and white respondents age 51-64 from the Health and Retirement Study to examine race differences in cognitive decline and the role mid-life stress exposure play in these differences. Initial findings suggest that mid-life Blacks have lower levels of cognitive function, but their rates of cognitive decline do not differ significantly from mid-life whites. Financial strain and everyday experiences of discrimination are inversely associated with cognitive decline and only partially explain differences in cognitive decline between mid-life Blacks and whites.

Predictors of Racial Differences in Depression and Affect among Older adult, Long-term Cancer Survivors

Research has long documented the psycho-social sequelae experienced by those who have been treated for and survived cancer. Depression, affect and other indicators of mood state have been an important focus of that research However, there is little research on racial differences in depression and affect outcomes or the specific cancer and age-related factors that predict them. The research to be presented is based on a 10 year, six wave NCI funded study of 471 older adult (age 60+), long-term cancer survivors randomly selected from the tumor registry of a comprehensive cancer treatment center. Key outcome measures were depression (CES-D) scale) and both positive and negative affect (PANAS). Covariance analyses and nested OLS Regression were used to identify Black-white differences these outcomes and the relative importance of both cancer and non-cancer predictors. Blacks reported lower levels of depression and negative affect when compared to whites. In a separate regression analysis of the black sub-sample, continuing cancer-related symptoms were by far the strongest predictors (beta =.16) of negative affect. In the white sub-sample, while cancer-related symptoms continued to be a significant predictor (beta=.16), non-cancer symptoms were substantially more important (beta=. 22). These results will hopefully help practitioners to have a better understanding of the nuanced racialized experiences and mental health among cancer survivors, and how these may impact after-care for older adult cancer survivors.

Entrepreneurship and Labor Absorption: Blacks and Whites in Northern U.S. Cities During the Great Depression

An extensive literature on newly developing societies shows that the urban economy's entrepreneurial sector can absorb a sizable share of persons who are unemployed and searching for work. Surprisingly, however, little research on the United States has examined entrepreneurship's labor absorption capacity. The present study fills this gap by analyzing Blacks and Whites in northern U.S. cities during the Great Depression, a time of widespread joblessness, particularly among Blacks. The results suggest that, if not for Blacks’ uniquely severe resource deprivation, Black entrepreneurship could have absorbed a large number of jobless Blacks. Labor absorption estimates, calculated with 1940 Census data, indicate that one-third of the Black-White unemployment difference is attributable to racial inequality of entrepreneurial outcomes. This historical evidence advances social-scientific understanding of racial inequality during the Great Depression and informs a longstanding debate about the merits of promoting Black business ownership as a strategy for improving Blacks’ labor market prospects.

Spatially varying racial inequities in cardiovascular health and the contribution of individual- and neighborhood-level characteristics across the United States: The REasons for geographic and racial differences in stroke (REGARDS) study

Black-White inequities in cardiovascular health (CVH) pose a significant public health challenge, with these disparities also varying geographically across the US. There remains limited evidence of the impact of social determinants of health on these inequities. Using a national population-based cohort from the REasons for Geographic and Racial Differences in Stroke study, we assessed the spatial heterogeneity in Black-White differences in CVH and determined the extent to which individual- and neighborhood-level characteristics explain these inequities. We utilized a Bayesian hierarchical statistical framework to fit spatially varying coefficient models. Results showed overall and spatially varying inequities, where Black participants had significantly poorer CVH. The maps of the state level random effects also highlighted how inequities vary. The evidence produced in this study further highlights the importance of multilevel approaches – at the individual- and neighborhood-levels – that need to be in place to address these geographic and racial differences in CVH.

Cross-State Differences in the Processes Generating Black-White Disparities in Neonatal Mortality.

The U.S. Black neonatal mortality rate is more than twice the White rate. This dramatic disparity can be decomposed into two components: (1) disparities due to differences in the distribution of birth weights, and (2) disparities due to differences in birth weight-specific mortality. I utilize this distinction to explore how the social context into which infants are born contributes to gaps in mortality between Black and White neonates. I analyze variation in Black-White differences in neonatal mortality across 33 states using 1995-2010 data. For each state, I calculate the contribution of differences in birth weight distribution versus differences in birth weight-specific mortality to the total disparity in mortality between White and Black neonates. Disparities are largely a product of different birth weight distributions between Black and White newborns (mirroring the pattern for the United States as a whole). However, in at least nine states, differences in birth weight-specific mortality make a notable contribution. This pattern is observed even among those from advantaged sociodemographic backgrounds and is driven by differences in mortality among very low birth weight neonates. This calls attention to inequality in medical care at birth as an importantcontributor to racial disparities in neonatal mortality.

Testing Black-White Disparities in Biological Aging Among Older Adults in the United States: Analysis of DNA-Methylation and Blood-Chemistry Methods.

Biological aging is a proposed mechanism through which social determinants drive health disparities. We conducted proof-of-concept testing of 8 DNA-methylation (DNAm) and blood-chemistry quantifications of biological aging as mediators of disparities in healthspan between Black and White participants in the 2016 wave of the Health and Retirement Study (n = 9,005). We quantified biological aging from 4 DNAm "clocks" (Horvath, Hannum, PhenoAge, and GrimAge clock), a DNAm pace-of-aging measure (DunedinPoAm), and 3 blood-chemistry measures (PhenoAge, Klemera-Doubal method biological age, and homeostatic dysregulation). We quantified Black-White disparities in healthspan from cross-sectional and longitudinal data on physical performance tests, self-reported limitations in activities of daily living, and physician-diagnosed chronic diseases, self-rated health, and survival. DNAm and blood-chemistry quantifications of biological aging were moderately correlated (Pearson's r = 0.1-0.4). The GrimAge clock, DunedinPoAm, and all 3 blood-chemistry measures were associated with healthspan characteristics (e.g., mortality effect-size hazard ratios were 1.71-2.32 per standard deviation of biological aging) and showed evidence of more advanced/faster biological aging in Black participants than in White participants (Cohen's d = 0.4-0.5). These measures accounted for 13%-95% of Black-White differences in healthspan-related characteristics. Findings suggest that reducing disparities in biological aging can contribute to building health equity.

Black-White Differences in Ischemic Stroke Risk Factor Burden in Young Adults.

Although the US Black population has a higher incidence of stroke compared with the US White population, few studies have addressed Black-White differences in the contribution of vascular risk factors to the population burden of ischemic stroke in young adults. A population-based case-control study of early-onset ischemic stroke, ages 15 to 49 years, was conducted in the Baltimore-Washington DC region between 1992 and 2007. Risk factor data was obtained by in-person interview in both cases and controls. The prevalence, odds ratio, and population-attributable risk percent (PAR%) of smoking, diabetes, and hypertension was determined among Black patients and White patients, stratified by sex. The study included 1044 cases and 1099 controls. Of the cases, 47% were Black patients, 54% were men, and the mean (±SD) age was 41.0 (±6.8) years. For smoking, the population-attributable risk percent were White men 19.7%, White women 32.5%, Black men 10.1%, and Black women 23.8%. For diabetes, the population-attributable risk percent were White men 10.5%, White women 7.4%, Black men 17.2%, and Black women 13.4%. For hypertension, the population-attributable risk percent were White men 17.2%, White women 19.3%, Black men 45.8%, and Black women 26.4%. Modifiable vascular risk factors account for a large proportion of ischemic stroke in young adults. Cigarette smoking was the strongest contributor to stroke among White patients while hypertension was the strongest contributor to stroke among Black patients. These results support early primary prevention efforts focused on smoking cessation and hypertension detection and treatment.