Black-white Disparities Research Articles

Race Inequity in School Attendance Across the Jim Crow South and Its Implications for Black-White Disparities in Trajectories of Cognitive Function Among Older Adults.

Although education is a key determinant of cognitive function, its role in determining Black-White disparities in cognitive function is unclear. This may be due, in part, to data limitations that have made it difficult to account for systemic educational inequities in the Jim Crow South experienced by older cohorts, including differences in the number of days Black students attended school compared to their White counterparts or Black peers in better-funded southern states. We determine if accounting for differential rates of school attendance across race, years, and states in the Jim Crow South better illuminates Black-White disparities in trajectories of cognitive function. We linked historical state-level data on school attendance from the 1919/1920 to 1953/1954 Biennial Surveys of Education to the Health and Retirement Study, a nationally representative, longitudinal study of U.S. adults older than age 50. We restricted our sample to Black and White older adults who attended school in the Jim Crow South and began primary school in/after 1919/1920 and completed primary/secondary school by 1953/1954 (n = 4,343). We used linear mixed models to estimate trajectories of total cognitive function, episodic memory, and working memory. Self-reported years of schooling explained 28%-33% of the Black-White disparity in level of cognitive function, episodic memory, and working memory. Duration of school, a measure that accounted for differential rates of school attendance, explained 41%-55% of the Black-White disparity in these outcomes. Our study highlights the importance of using a more refined measure of schooling for understanding the education-cognitive health relationship.

C-reactive Protein and Racial Differences in Type 2 Diabetes Incidence: The REGARDS Study.

Black adults experience more type 2 diabetes mellitus and higher inflammatory markers, including C-reactive protein (CRP), than White adults. Inflammatory markers are associated with risk of incident diabetes but the impact of inflammation on racial differences in incident diabetes is unknown. We assessed whether CRP mediated the Black-White incident diabetes disparity. The REasons for Geographic And Racial Differences in Stroke (REGARDS) study enrolled 30 239 US Black and White adults aged ≥45 years in 2003-2007 with a second visit approximately 10 years later. Among participants without baseline diabetes, adjusted sex- and race-stratified risk ratios for incident diabetes at the second visit by CRP level were calculated using modified Poisson regression. Inverse odds weighting estimated the percent mediation of the racial disparity by CRP. Of 11 073 participants without baseline diabetes (33% Black, 67% White), 1389 (12.5%) developed diabetes. Black participants had higher CRP at baseline and greater incident diabetes than White participants. Relative to CRP < 3 mg/L, CRP ≥ 3 mg/L was associated with greater risk of diabetes in all race-sex strata. Black participants had higher risk of diabetes at CRP < 3 mg/L, but not at CRP ≥ 3 mg/L. In women, CRP mediated 10.0% of the racial difference in incident diabetes. This mediation was not seen in men. Higher CRP is a risk factor for incident diabetes, but the excess burden of diabetes in Black adults was only seen in those with lower CRP, suggesting that inflammation is unlikely to be the main driver of this racial disparity.

Abstract 142: Lives Lost Due To Disparities Quantified: Black-White And Rural-Urban Disparities In Cerebrovascular Mortality Among Middle-Aged Adults

Introduction: We aimed to quantify and trend excess cerebrovascular deaths among middle-aged adults that could be attributed to Black-white and rural-urban disparity in the US. Methods: Annual age-adjusted mortality rates (AAMR) for ischemic stroke (IS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) among middle aged adults (ages 35-64) were obtained from Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research database from 1999 to 2019. AAMR difference between African-Americans and whites (Black-white disparity), as well as residents of Non-Metro and Large Metro counties (Rural-Urban disparity) was used to estimate excess event- and gender- specific annual deaths attributable to each disparity. Linear AAMR epochs and parallelism were assessed with Joinpoint. Results: Lives lost to Black-white disparity decreased from 3850 in 1999 to 2750 in 2013 and stagnated since. The finding was driven by decline in SAH and ICH mortality between 1999 and 2019, and recent increase in excess deaths due to IS (105 in 2014, 240 in 2019). Lives lost to Rural-urban disparity increased from 360 in 1999 to 740 in 2019, driven by excess deaths due to ICH (-30 in 1999, 100 in 2019) and recently IS (50 in 2013, 130 in 2019). Conclusion: Black-white disparity accounting for ~2750 excess deaths among blacks per year remains the leading inequity in cerebrovascular mortality. This is 3.7 times more deaths than Rural-Urban disparity in 2019.

Anti-Blackness and Racial Disproportionality in Gifted Education

Black–White disparities in gifted enrollment persist across U.S. school systems. In this study, we examined whether these disparities depend on county-level rates of anti-Black bias. We drew data from the Civil Rights Data Collection, the Education Opportunity Project, and the Race Implicit Association Database. Based on a series of heteroskedastic fractional probit regression models, we found that county-level rates of anti-Black bias predict Black–White disparities in gifted and talented enrollment, with gaps being largest in counties with elevated rates of anti-Black bias and virtually non-existent in counties with low levels of anti-Black bias. These findings persist after accounting for achievement and other observable differences across counties, unobserved variation in state-level gifted and talented policies and are consistent for county-level estimates of both explicit and implicit measures of anti-Black bias.

Race and obesity disparities among adults living in gentrifying neighborhoods.

There is a paucity of research seeking to understand race disparities in obesity among individuals living in a gentrifying neighborhood. American Community Survey data were used to identify gentrifying neighborhoods. In a cross-sectional analysis, these data were then linked to the 2014 Medical Expenditure Panel Survey, yielding an analytic sample of 887 Black and White adults. Obesity was based on body mass index ≥ 30kg/m2. After controlling for potential confounders, Black adults living in gentrifying neighborhoods had a higher prevalence of obesity (PR: 1.39; 95% CI: 1.03, 1.88) than White adults living in gentrifying neighborhoods. Gentrification may have no impact on reducing Black-White obesity disparities in the US.

Abstract PO-263: Racial equity and oral cancer: Exploring the relationship between dentist supply and the Black-White disparity in late stage diagnosis

Abstract Background: Oral cancer is one of the most common cancers for Black men in America, and a leading cause of cancer mortality. Like many other cancers, survival in Black adults lags behind Non-Hispanic White adults. One explanation for the mortality and survival gap may be due to the propensity for Black adults to be diagnosed at later stages. The prognosis for early stage oral cancer can be quite positive. Despite inconsistent screening reccomendations, dental professionals have established oral cancer screening as a standard of care for all comprehensive evaluations. However, in addition to the lack of access to dental coverage, limited availability of dental professionals may be, in part, driving the disparity in late stage diagnoses for Black Americans. Objective: This study aims to estimate the relationship between the Black-White disparity in late stage oral cancer diagnoses and the supply of dentists. Methodology: Data for this study comes from the Center for Disease Control (CDC) Wonder portal and the Agency for Healthcare Research and Quality (AHRQ) provider dataset. To develop a measure of Black-White disparity in late stage oral cancer diagnoses, first, the proportion of late stage diagnoses of all oral cancer diagnoses were obtained for both Non-Hispanic Black and Non-Hispanic White adults for years 2011-2015. Data was aggregated to Health Servica Area level and restricted to states in the Southeast. The outcome of interest was derived by the difference between the Non-Hispanic Black proportion of late stage diagnoses and the Non-Hispanic White proportion. This exploratory study utilized a linear regression model to estimate the relationship between this difference and the supply of dental professionals per capita in each paired Health Service Area (HSA). Results: The mean proportion of late stage diagnoses were 70.8% and 61.9% for Non-Hispanic Black and Non-Hispanic White adults, respectively. The mean difference in late stage diagnoses, at the HSA level, was approximately 8.0%. This differnce, appeared to decline as the per capita supply of dentists increased (Est = -0.03, p &amp;lt; 0.05). Putting this association in context, to reduce the Black-White disparity in late stage diagnoses by 1-percentage point, 33 dentists per 100,000 population must be added to the HSA. Conclusion: Greater availability to dental professionals may play an important role in reducing racial disparities in oral cancer. Still, this exploratory work is only the begining for inferring a causal relationhip between increasing dental supply and decreasing differences in late stage oral cancer diagnoses. Even under the assumption of causality, policies aiming to increase dental supply in shortage areas must ensure equitable and just access for Black communities. Citation Format: Jason Semprini. Racial equity and oral cancer: Exploring the relationship between dentist supply and the Black-White disparity in late stage diagnosis [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-263.

Abstract PO-177: Does greater oncologist density reduce estimates of Black-White disparities in cancer mortality

Abstract Background: Black-White racial disparities in cancer mortality in the US are well-documented. Oncologist density, as a measure of oncology care access, has the potential to improve cancer outcomes. Given the estimated shortage of oncologists over the next decade, understanding how oncologist density might influence cancer disparities is of considerable importance. We hypothesized that greater oncologist density was associated with smaller racial disparities in cancer mortality. Methods: An ecological study of 1,048 US counties was performed. Oncologist density (per 100,000 population) was calculated where oncologists were identified from the 2013 National Plan and Provider Enumeration System. Using the age-standardized cancer mortality rate between 2014-2018 from State Cancer Profiles, the Black:White cancer mortality rate ratio was calculated for each county. Linear regression was constructed to assess the association of oncologist density with (1) Black-White cancer mortality rate ratio, and (2) cancer mortality rates overall, and separately among Black and White people. Results: The mean Black:White cancer mortality rate ratio across US counties was 1.13. Every five additional oncologists per 100,000 population was associated with 0.02 increase in the Black:White cancer mortality rate ratio (95% confidence interval [CI]: 0.007 to 0.03) in the multivariable model. The role of oncologist density on cancer mortality was different between Black and White people. Every five additional oncologists per 100,000 population was associated with a 1.59 decrease per 100,000 population in cancer mortality rates among White people (95% CI: -2.96 to -0.23), whereas oncologist density was not associated with cancer mortality rates among Black people. Conclusions: Greater oncologist density was associated with larger Black-White racial disparities in cancer mortality. Greater oncologist density was associated with significantly lower cancer mortality among White patients, but not among Black patients. Increasing oncologist density alone could exacerbate mortality disparities, thus attention to ensuring equitable care is critical. Citation Format: Yuehan Zhang, Kathryn M. Leifheit, Otis W. Brawley, Roland Thorpe, Darrell Gaskin, Lorraine Dean. Does greater oncologist density reduce estimates of Black-White disparities in cancer mortality [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-177.

Abstract PO-173: Spatial heterogeneity and rural-urban differences in the Black-White breast cancer mortality disparity in Georgia

Abstract Introduction: Breast cancer mortality in the US is 40% higher among Black than White women. Even among patients with prognostically favorable tumors, disparities persist, suggesting clinical features do not fully account for mortality differences. Area-level factors (e.g., rurality) influence health outcomes and may explain spatial variation in mortality disparities. Rurality can impact access to and quality of care, and socioeconomic status. Georgia is an ideal place to study spatial heterogeneity in race disparities because of the diverse population (&amp;gt;30% Black), large number of counties (159), and pronounced disparities in breast cancer mortality in the Atlanta area. Methods: Race-specific standardized mortality ratios (SMRs) were calculated for each county in Georgia to account for sparsely populated areas and areas with high residential segregation. Observed deaths among women diagnosed with localized or regional breast cancer between 2005 and 2013 were obtained from the Georgia Cancer Registry. To ensure equal follow-up, only deaths within five years of diagnosis were included. Expected deaths were estimated using race-specific population counts, race-specific breast cancer incidence rates, and the pooled (Black and White) mortality rate among Georgia women, with indirect age adjustment (20–44, 45–54, 55+ years). Spatial smoothing methods, including adding neighboring data to meet a threshold and Bayesian models with conditionally autoregressive priors, were used to stabilize local estimates. Counties were classified by 2013 RUC codes (urban: 1–3, rural: 4–9). Results: A total of 3,235 breast cancer deaths were observed during the study period, with 42% among Black women. The median SMR was lower for White (0.8, IQR: 0.7, 1.1) than Black women (1.4, IQR: 1.1, 2.0). Among Black women only, median SMR was greater in rural (1.7, IQR: 1.1, 2.5) than urban counties (1.3, IQR: 1.1, 1.6). After sequentially adding neighboring data to meet a race-specific threshold of 30 observed deaths, smoothed median SMRs were 0.9 (IQR: 0.8, 0.9) and 1.4 (IQR: 1.2, 1.6) for White and Black women, respectively. For Black women, median SMR was attenuated in rural counties (1.4, IQR: 1.2, 1.7) but unchanged in urban counties (1.3, IQR: 1.2, 1.5). The greatest SMRs for Black women were observed in urban counties comprising the Atlanta area and rural southeast Georgia. For example, Fulton County SMRs were 1.6 and 0.7, for Black and White women, respectively. Highest SMRs for White women were observed in southwest Georgia, but were similar to SMRs among Black women in this region. The spatial distribution of SMRs using same neighbor smoothing and Bayesian models were similar. Conclusion: Breast cancer mortality race disparities vary widely across Georgia. These results highlight specific areas for public health intervention, especially among Black women. This work presents a potential mechanism to monitor trends in small area cancer mortality race disparities over time. Future work will model the impact of area-level factors on the disparity magnitude. Citation Format: Rebecca J. Nash, Lauren E. McCullough, T.J. Pierce, Lindsay J. Collin, Anne H. Gaglioti, Kevin C. Ward, Michael Kramer, Jeffrey Switchenko. Spatial heterogeneity and rural-urban differences in the Black-White breast cancer mortality disparity in Georgia [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-173.

Abstract PR-01: Association of Affordable Care Act Medicaid expansions with healthcare access and utilization among people who smoke

Abstract Background: People who smoke have a higher risk of developing cancer and disproportionately lower incomes which worsens healthcare access and health outcomes. The Affordable Care Act expanded Medicaid eligibility to adults with income up to 138% of the federal poverty line. It is unknown if and how Medicaid expansions changed healthcare access, preventive service use, and health behaviors. Also, it is unknown whether expansions impacted income or racial/ethnic disparities in these measures, given historically lower healthcare access and utilization in lower income people and people of color. Methods: Data were from the nationally representative Behavioral Risk Factor Surveillance System surveys between 2011-2019 of adults ages 18-64 years who currently smoked cigarettes and former smokers who had quit in the past year (n=580,858). Generalized difference-in-differences (DID) analyses using logistic regression models examined the association of Medicaid expansions (staggered time-varying exposure, 34 states expanded as of December 2019) with healthcare access (insurance coverage, care affordability, usual source of care), preventive service use (routine checkup, flu shot, HIV test, breast and colorectal cancer screening, cholesterol check, dentist visit), and health/risk behaviors (heavy alcohol drinking, obesity), including cessation behaviors (past-year quit attempt, successful cessation for &amp;gt;3 months). Income and race/ethnicity differences were also tested. Results: Among people who smoke, Medicaid expansions were associated with healthcare access and preventive care utilization improvements, but not health behaviors, including cessation. Expansions resulted in narrowing of disparities in several measures across income levels and Black vs. White people in expansion states. For example, expansion associated gains in insurance coverage were significantly larger in low-income (expansion: 74.6% vs. nonexpansion: 60.8%; DID: 13.8% 95% CI: 12.8, 14.8%) than high-income (insurance: 87.5% vs. 93.7%, DID: -6.2% points 95% CI: -7.2, -5.2%); and in Black people (82.6% vs. 74.6%, DID: 7.9% points 95% CI: 6.3, 9.5%) than White people (79.5% vs. 75.7%; DID: 3.8%, 95% CI: 3, 4.6%). Medicaid expansions gains were also larger among lower than higher income people for all in preventive care utilization measures studied; and uptake of flu shots, mammograms, and HIV tests were larger in Black than White people. Significant gains in multiple measures were also observed for Hispanic and American Indian/Alaska Native people who smoke, but changes were generally no different than White people. Conclusions: Among people who smoke, Medicaid expansions improved healthcare access and preventive services use. Expansions were also associated with a reduction, but not elimination, of income and Black-White disparities in healthcare access and utilization. Despite insurance and preventive service gains, expansions were not associated with cessation behaviors, signaling the need for improving comprehensive cessation treatments in Medicaid expansion programs. Citation Format: Priti Bandi, Samuel Asare, J. Lee Westmaas, Nigar Nargis, Robin Yabroff, Ahmedin Jemal, Xuesong Han, Stacey Fedewa. Association of Affordable Care Act Medicaid expansions with healthcare access and utilization among people who smoke [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PR-01.

Reducing Implicit Bias in Maternity Care: A Framework for Action

Reducing Implicit Bias in Maternity Care: A Framework for Action

Black-White Disparities of Cesarean Section Rate in the U.S.: Trends and Determinants

Black-White Disparities of Cesarean Section Rate in the U.S.: Trends and Determinants

Black-White Disparities and Preterm Births Comparisons Following the COVID-19 Pandemic in Michigan

Racial and ethnic disparities in health care have been documented throughout decades in the United States. The COVID-19 pandemic has further shown a disproportionate burden on racial and minority groups. Black women have been disproportionately impacted among other races in terms of pregnancy outcomes. The aim of this study was to compare preterm birth outcomes between black vs white women after the COVID-19 pandemic.

Racism Is a Modifiable Risk Factor: Relationships Among Race, Ethnicity, and Colorectal Cancer Outcomes

Racism Is a Modifiable Risk Factor: Relationships Among Race, Ethnicity, and Colorectal Cancer Outcomes

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.

Race Differences in Allostatic Load Among Black and White Men: Does Age Matter?

Although Black-White disparities in health and mortality among men persist, there has been a paucity of work focusing on race differences in physiological dysregulation of biological processes resulting from the cumulative impact of stressors among men. The purpose of this study was to assess potential race differences in Allostatic Load (AL) among adult men and if such differences varied by age. Data were drawn from the 1999-2016 NHANES and the study population included 21,529 non-Hispanic Black (NHB) and 34,282 Non-Hispanic White (NHW) born in US. Adjusting for potential confounders, NHB men 25-44 and 45-64 had a higher AL score (OR = 1.19, 95% confidence interval (CI) 1.00, 1.42) and (OR = 1.14, 95% confidence interval (CI) 1.02, 1.28) NHW men. No race differences with respect to AL score were observed among the other age groups. The results suggest that age plays a role in race differences in AL

Expanding the Reach of an Evidence-Based, System-Level, Racial Equity Intervention: Translating ACCURE to the Maternal Healthcare and Education Systems.

The abundance of literature documenting the impact of racism on health disparities requires additional theoretical, statistical, and conceptual contributions to illustrate how anti-racist interventions can be an important strategy to reduce racial inequities and improve population health. Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) was an NIH-funded intervention that utilized an antiracism lens and community-based participatory research (CBPR) approaches to address Black-White disparities in cancer treatment completion. ACCURE emphasized change at the institutional level of healthcare systems through two primary principles of antiracism organizing: transparency and accountability. ACCURE was successful in eliminating the treatment completion disparity and improved completion rates for breast and lung cancer for all participants in the study. The structural nature of the ACCURE intervention creates an opportunity for applications in other health outcomes, as well as within educational institutions that represent social determinants of health. We are focusing on the maternal healthcare and K-12 education systems in particular because of the dire racial inequities faced by pregnant people and school-aged children. In this article, we hypothesize cross-systems translation of a system-level intervention exploring how key characteristics of ACCURE can be implemented in different institutions. Using core elements of ACCURE (i.e., community partners, milestone tracker, navigator, champion, and racial equity training), we present a framework that extends ACCURE's approach to the maternal healthcare and K-12 school systems. This framework provides practical, evidence-based antiracism strategies that can be applied and evaluated in other systems to address widespread structural inequities.

Racial disparities in mortality outcomes among women diagnosed with breast cancer in Maryland: Impact of cardiovascular disease and clinical characteristics.

Although racial disparities in breast cancer (BC) mortality have been well documented in the United States, little is known about the impact of coexisting cardiovascular disease (CVD) and other clinical factors on Black-White survival disparities after the diagnosis of BC. This study examined the associations of race, CVD, and clinical factors at diagnosis with the hazard of BC and CVD-related mortality among patients with BC identified from the Maryland Cancer Registry. A total of 36,088 women (25,181 Whites and 10,907 Blacks) diagnosed with incident invasive BC between 2007 and 2017 were included. Subdistribution hazard ratios (sdHRs) for CVD-related and BC mortality were estimated with Fine and Gray regression models, which accounted for the influence of competing events. After a median follow-up of 5.8 years, 8019 deaths occurred; 3896 were BC deaths, and 1167 deaths were CVD-related. Black women had a higher hazard of BC mortality (sdHR, 1.66; 95% confidence interval [CI], 1.55-1.77) and CVD mortality (sdHR, 1.33; 95% CI, 1.17-1.51) in comparison with White women. Associations with CVD mortality were significantly stronger among Black women aged 50 to 59 years (sdHR, 2.86; 95% CI, 1.84-4.44; P for interaction < .001). Among Black women with CVD, the hazard of BC death was 41% higher in comparison with White women. By treatment, a significant association with CVD mortality was observed only among Black women undergoing surgery and radiation (sdHR, 1.61; 95% CI, 1.22-2.13). Clinicians should consider the impact of younger age, preexisting CVD, and BC treatments among Black patients. Early identification of those at risk for worse survival may improve surveillance and outcomes.

Effects of Stress Exposure Versus Appraisal on Episodic Memory Trajectories: Evidence for Risk and Resilience Among Black Older Adults.

Chronic stressors, experienced disproportionately by Black older adults, are a risk factor for memory impairment. Racially patterned stress exposure may contribute to higher rates of Alzheimer's disease and related dementias (ADRD) among Black older adults compared with Whites, but less is known about the role of stress appraisal. This study examined whether chronic stress exposure mediates racial disparities in memory and whether stress appraisal moderates these associations. Participants included 16,924 older adults (Mage = 67.39, 21% Black) from the 2010 and 2012 waves of the Health and Retirement Study who completed measures of chronic stress exposure (health, financial, housing, relationships, and caregiving) and appraisal. Latent growth curves modeled longitudinal performance on a word list memory task over 6 years. Black older adults reported greater stress exposure than Whites, and greater stress exposure partially mediated Black-White disparities in initial memory (standardized indirect effect = -0.002, p = .009). However, Black older adults appraised stressors as less upsetting than Whites. While stress appraisal did not moderate links between stress exposure and memory, appraising stressors as less upsetting was independently associated with better initial memory. Thus, Black-White disparities in initial memory was partially offset by Black participants' appraisal of stressors as less upsetting (standardized indirect effect = 0.002, p = .016). Reducing chronic stress exposure may reduce racial disparities in ADRD risk. The counteractive effect of stress appraisal on Black-White disparities in episodic memory highlights resilience factors among Black older adults that should be characterized in future research to move beyond deficit models of ADRD inequality.

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.

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.