Black-white Inequality Research Articles

Effects of an Intervention on Black Family Incomes on Self-Rated Health and Obesity in Black and White Adolescents and Young Adults.

Structural racism contributes to health disparities between U.S. non-Hispanic Black and non-Hispanic white populations by differentially distributing resources used to maintain health. Policies that equitably redistribute resources may mitigate racialized health disparities. Using National Longitudinal Study of Adolescent to Adult Health data and time-to-event parametric g-formula methods, we investigate a hypothetical intervention to reduce Black-white family income inequities on racialized differences in self-rated health (N=11,312) and obesity (N=10,547). We first intervene to increase individual Black family incomes by $11,000, creating Black-white equity in median incomes in 1995. Then, we measure social multiplier effects by additionally increasing county-level Black median household incomes by $11,000. By Wave 4, individual, direct effects models comparing Black intervention to Black control groups show no risk differences in self-rated health (RD=-0.009; 95% CI: -0.026, 0.008) or obesity (RD=0.003; 95% CI: -0.017, 0.023). Social multiplier effects models suggestively reduce Black-white inequalities in obesity by increasing obesity in white intervention versus white control groups (RD=0.050=; 95% CI: -0.011, 0.110), but exacerbate Black-white disparities in self-rated health by reducing self-rated health in Black intervention versus white control groups (RD=0.184; 95% CI: 0.018, 0.351). In this cohort, income transfers may not reduce racialized disparities in obesity and self-rated health.

Increased homicide played a key role in driving Black-White disparities in life expectancy among men during the COVID-19 pandemic.

Disparities in life expectancy between Black and White Americans increased substantially during the COVID-19 pandemic. During the same period, the US experienced the largest increase in homicide on record. Yet, little research has examined the contribution of homicide to Black-White disparities in longevity in recent years. Using mortality data and population estimates, we conduct a comprehensive decomposition of the drivers of Black-White inequality in life expectancy and lifespan variability between 2019 and 2021 among men. We find that homicide is one of the principal reasons why lifespans have become shorter for Black men than White men in recent years. In 2020 and 2021, homicide was the leading contributor to inequality in both life expectancy and lifespan variability between Black and White men, accounting for far more of the racial gap in longevity and variability than deaths from COVID-19. Addressing homicides should be at the forefront of any public health discussion aimed at promoting racial health equity.

Empty chairs at the dinner table: Black-white disparities in exposure to household member deaths

As a result of Black–White inequities in life expectancy, recent research has indicated that Black individuals are disproportionately exposed to the deaths of multiple family members compared to White individuals. Black individuals are also more likely to live in coresident households—that is, households that extend beyond the nuclear family. However, it is unclear the degree to which this population may be disproportionately exposed to the loss of deaths marked by the geographic closeness of the household. In this study, I use data from the Panel Study of Income Dynamics to provide the first nationally representative estimates of Black-White disparities in exposure to household member deaths. I find that Black people are significantly more likely than White individuals to have experienced the death of a household member. Based on these findings, I argue the dual inequities of racial disparities in life expectancy and racial disparities in coresidence are an overlooked, salient source of racial disparities in exposure to death. By illuminating a broader range of network sources that contribute to racial inequities in exposure to death, this study sets forth a new conceptual unit of analysis—that of the household—to investigate the intergenerational reproduction of inequality in health and socioeconomic status due to exposure to death.

Black-white differences in chronic stress exposures to predict preterm birth: interpretable, race/ethnicity-specific machine learning model

BackgroundDifferential exposure to chronic stressors by race/ethnicity may help explain Black-White inequalities in rates of preterm birth. However, researchers have not investigated the cumulative, interactive, and population-specific nature of chronic stressor exposures and their possible nonlinear associations with preterm birth. Models capable of computing such high-dimensional associations that could differ by race/ethnicity are needed. We developed machine learning models of chronic stressors to both predict preterm birth more accurately and identify chronic stressors and other risk factors driving preterm birth risk among non-Hispanic Black and non-Hispanic White pregnant women.MethodsMultivariate Adaptive Regression Splines (MARS) models were developed for preterm birth prediction for non-Hispanic Black, non-Hispanic White, and combined study samples derived from the CDC’s Pregnancy Risk Assessment Monitoring System data (2012–2017). For each sample population, MARS models were trained and tested using 5-fold cross-validation. For each population, the Area Under the ROC Curve (AUC) was used to evaluate model performance, and variable importance for preterm birth prediction was computed.ResultsAmong 81,892 non-Hispanic Black and 277,963 non-Hispanic White live births (weighted sample), the best-performing MARS models showed high accuracy (AUC: 0.754–0.765) and similar-or-better performance for race/ethnicity-specific models compared to the combined model. The number of prenatal care visits, premature rupture of membrane, and medical conditions were more important than other variables in predicting preterm birth across the populations. Chronic stressors (e.g., low maternal education and intimate partner violence) and their correlates predicted preterm birth only for non-Hispanic Black women.ConclusionsOur study findings reinforce that such mid or upstream determinants of health as chronic stressors should be targeted to reduce excess preterm birth risk among non-Hispanic Black women and ultimately narrow the persistent Black-White gap in preterm birth in the U.S.

Spatiotemporal Changes in the Slavery–Inequality Relationship: The Diffusion of the Legacy of Slavery

Despite the persistence of relationships between historical racist violence and contemporary Black–White inequality, research indicates, in broad strokes, that the slavery–inequality relationship in the United States has changed over time. Identifying the timing of such change across states can offer insights into the underlying processes that generate Black–White inequality. In this study, we use integrated nested Laplace approximation models to simultaneously account for spatial and temporal features of panel data for Southern counties during the period spanning 1900 to 2018, in combination with data on the concentration of enslaved people from the 1860 census. Results provide the first evidence on the timing of changes in the slavery–economic inequality relationship and how changes differ across states. We find a region-wide decline in the magnitude of the slavery–inequality relationship by 1930, with declines traversing the South in a northeasterly-to-southwesterly pattern over the study period. Different paces in declines in the relationship across states suggest the expansion of institutionalized racism first in places with the longest-standing overt systems of slavery. Results provide guidance for further identifying intervening mechanisms—most centrally, the maturity of racial hierarchies and the associated diffusion of racial oppression across institutions, and how they affect the legacy of slavery in the United States.

Racial/ethnic inequities in care for patients with advanced endometrial cancer: What’s structural racism and social determinants of health got to do with it?

1602 Background: Structural racism and social determinants of health (SDOH) have been linked to inequities in cancer care and outcomes. However, little is known about the contribution of such factors to care inequities among patients with endometrial cancer, where Black women experience a nearly two-fold increased risk of death relative to their White counterparts. We examined the role of structural racism and SDOH in explaining racial/ethnic inequities in care for patients with advanced endometrial cancer (aEC). Methods: This retrospective study used the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database, focusing on patients diagnosed with aEC from January 2013 to September 2023 (follow-up through December 2023). Outcomes included time-to-treatment initiation, use of immunotherapy or targeted therapy, biomarker testing, and clinical trial participation. We estimated a series of multivariable Cox proportional hazards models assessing racial/ethnic inequities in outcomes, sequentially adjusting for clinical factors (e.g., age, stage at diagnosis) followed by structural racism (residential segregation) and SDOH factors (e.g., insurance, practice setting, area-level vehicle ownership). Results: The cohort included 5,496 patients (2.2% Asian, 14.8% Black, 5.2% Latinx, 61.4% White, and 16.0% Other/Unknown). Although diagnosed with more aggressive disease (37% vs. 21% serous carcinoma), Black patients were less likely than White patients to initiate treatment during follow-up (hazard ratio [HR]=0.91 [95% CI: 0.83-0.99]), participate in a clinical trial (HR=0.56 [95% CI: 0.38-0.84]), and receive biomarker testing (HR=0.88 [95% CI: 0.81-0.97]). Compared with their White counterparts, Latinx patients were less likely to participate in a clinical trial (HR=0.41 [95% CI: 0.19-0.87]). Black-White (HR=0.80 [95% CI: 0.47-1.38]) and Latinx-White (HR=0.71 [95% CI: 0.31-1.60]) inequities in clinical trial participation were partly explained by structural racism and SDOH factors, while Black-White inequities in treatment and biomarker testing remained largely unchanged following structural and social determinants adjustment. We saw no racial/ethnic differences in use of immunotherapy or targeted therapy. Conclusions: We observed racial/ethnic inequities in treatment initiation, biomarker testing, and clinical trial participation among patients with aEC, with structural racism and SDOH substantially accounting for inequities in trial participation. Thus, findings from this study suggest that efforts aimed at improving diversity in endometrial cancer trials, and overall equity in endometrial cancer outcomes, should prioritize mitigating the structural and social barriers to clinical trial participation.

Necessary, burdensome, or threatening? Awareness of Black-White disparities in health care access and self-rated health for Black and White Americans.

Awareness of racial health care inequities is one prerequisite to eliminating them. Although extant research has described awareness of racial health care inequities in the United States, the health impacts of such awareness on communities that are most impacted by these inequities remains unknown. Therefore, we examined associations between awareness of Black-White racial health care inequities and self-rated health for Black and White adults in the United States. We used survey data from non-Hispanic Black and White participants (N = 6,449) who responded to the national American Health Values Survey (2015-2016) to test associations between awareness of Black-White inequities in health care and self-rated health. Accurate awareness of health care inequities was associated with 47% higher odds of poorer self-rated health for Black individuals. Inaccurate awareness was associated with 36% higher odds of poorer self-rated health for White individuals. Accurate awareness may be adaptive, yet place an additional burden on Black individuals. Inaccurate awareness may harm White individuals' health. Health care system changes and alleviation of racism-related stress may be preventive supports for the health of Black individuals. Accurate awareness should be a goal for White individuals, not only to prevent health risks, but to also facilitate structural change for racial equity. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Born on the wrong side of the tracks: Exploring the causal effects of segregation on infant health

Prior research has found that a high level of residential racial segregation, or the degree to which racial/ethnic groups are isolated from one another, is associated with worsened infant health outcomes, particularly among non-Hispanic (NH) Black infant populations. However, because exposure to segregation is non-random, it is unclear whether and to what extent segregation is causally linked to infant health. To overcome this empirical limitation, we leverage exogenous variation in the placement of railroad tracks in the 19th century to predict contemporary segregation, an approach first introduced by Ananat (2011). In alignment with prior literature, we find that residential segregation has statistically significant associations with negative birth outcomes among Black infant populations in the area. Using OLS methods underestimates the negative impacts of segregation on infant health. We fail to detect comparable effects on health outcomes among NH White infant populations. Further, we identify several key mechanisms by which residential segregation could influence health outcomes among Black infant populations, including lower access to prenatal care during the first trimester, higher levels of anti-Black prejudice, greater transportation barriers, and increased food insecurity. Given that poor birth outcomes have adverse effects on adults’ health and well-being, the findings suggest that in-utero exposure to residential segregation could have important implications for Black–White inequality over the life course.

Structural racism and health: Assessing the mediating role of community mental distress and health care access in the association between mass incarceration and adverse birth outcomes

Research has linked spatial concentrations of incarceration with racial disparities in adverse birth outcomes. However, little is known about the specific mechanisms of this association. This represents an important knowledge gap in terms of intervention. We theorize two pathways that may account for the association between county-level prison rates and adverse birth outcomes: (1) community-level mental distress and (2) reduced health care access. Examining these mechanisms, we conducted a cross-sectional study of county-level prison rates, community-level mental distress, health insurance, availability of primary care physicians (PCP) and mental health providers (MHP), and adverse birth outcomes (preterm birth, low birth weight, infant mortality). Our data set included 475 counties and represented 2,677,840 live U.S. births in 2016. Main analyses involved between 170 and 326 counties. All data came from publicly available sources, including the U.S. Census and the Centers for Disease Control and Prevention. Descriptive and regression results confirmed the link between prison rates and adverse birth outcomes and highlighted Black-White inequities in this association. Further, bootstrap mediation analyses indicated that the impact of spatially concentrated prison rates on preterm birth was mediated by PCP, MHP, community-level mental distress, and health insurance in both crude and adjusted models. Community-level mental distress and health insurance (but not PCP or MHP) similarly mediated low birthweight in both models. Mediators were less stable in the effect on infant mortality with only MHP mediating consistently across models. We conclude that mass incarceration, health care access, and community mental distress represent actionable and urgent targets for structural-, community-, and individual-level interventions targeting population inequities in birth outcomes.

Mediators of Black-White inequities in cardiovascular mortality among survivors of 18 cancers in the USA.

This study aims to quantify Black-White inequities in cardiovascular disease (CVD) mortality among US survivors of 18 adult-onset cancers and the extent to which these inequities are explained by differences in socio-economic and clinical factors. Survivors of cancers diagnosed at ages 20-64 years during 2007-16 were identified from 17 Surveillance, Epidemiology and End Results registries. Associations between race and CVD mortality were examined using proportional hazards models. Mediation analyses were performed to quantify the contributions of potential mediators, including socio-economic [health insurance, neighbourhood socio-economic status (nSES), rurality] and clinical (stage, surgery, chemotherapy, radiotherapy) factors. Among 904 995 survivors, 10 701 CVD deaths occurred (median follow-up, 43 months). Black survivors were more likely than White survivors to die from CVD for all 18 cancers with hazard ratios ranging from 1.30 (95% CI = 1.15-1.47) for lung cancer to 4.04 for brain cancer (95%CI = 2.79-5.83). The total percentage mediations (indirect effects) ranged from 24.8% for brain (95%CI=-5.2-59.6%) to 99.8% for lung (95%CI = 61.0-167%) cancers. Neighbourhood SES was identified as the strongest mediator for 14 cancers with percentage mediations varying from 25.0% for kidney cancer (95%CI = 14.1-36.3%) to 63.5% for lung cancer (95%CI = 36.5-108.7%). Insurance ranked second for 12 cancers with percentage mediations ranging from 12.3% for leukaemia (95%CI = 0.7-46.7%) to 31.3% for thyroid cancer (95%CI = 10.4-82.7%). Insurance and nSES explained substantial proportions of the excess CVD mortality among Black survivors. Mitigating the effects of unequal access to care and differing opportunities for healthy living among neighbourhoods could substantially reduce racial inequities in CVD mortality among cancer survivors.

Childhood Family Instability and Young-Adult Union Experiences: Black–White Differences in Outcomes and Effects

Today's young adults have diverse union experiences; some enter enduring marital or cohabiting unions at young ages, but many delay or dissolve their unions or remain single. Childhood family instability—defined as parents' transitions into or out of romantic coresidential unions—offers one explanation for why some people are more likely than others to enter and exit unions. We evaluate whether this family instability hypothesis—a union-specific version of the general hypothesis that instability affects people across multiple life domains—can explain Black and White young adults' union formation and dissolution. Using data from the Panel Study of Income Dynamics' Transition into Adulthood Supplement (birth cohorts 1989–1999), we find that the marginal effects of childhood family instability on cohabitation and marriage are weaker for Black than for White youth. Further, Black–White differences in childhood family instability's prevalence are small. Consequently, novel decompositions that account for racial differences in instability's prevalence and marginal effects reveal that childhood family instability contributes little to Black–White inequality in young adults' union outcomes. Our results challenge the generalizability of the family instability hypothesis across racialized groups in the union domain. Explanations for Black–White differences in young-adult marriage and cohabitation reside beyond childhood family dynamics.

The impact of attending historically Black colleges and universities on cognitive decline in Black adults: A longitudinal analysis in the KHANDLE and STAR cohorts.

Black students attending predominantly White institutions (PWIs) versus historically Black colleges and universities (HBCUs) report more harmful discrimination and develop worse mental health outcomes, potentially offsetting the established benefits of college for lowering dementia incidence. Black participants in two cohorts (the Kaiser Healthy Aging and Diverse Life Experiences [KHANDLE] and the Study of Healthy Aging in African Americans [STAR]) who had attended college (N=716) self-reported the college name (classified as HBCU vs. PWI) and completed three waves of executive function (EF) and verbal episodic memory (VEM) assessments. HBCU effects on cognitive level and decline were estimated using adjusted linear mixed-effects models. HBCU (vs. PWI) attendees averaged better EF (β=0.05 [-0.22, 0.32]) and VEM (β=0.21 [-0.06, 0.46]) at age 70 though neither association was statistically significant. HBCU attendance was associated with slightly faster VEM decline (β=-0.03 [-0.05, 0.00]). Harmonized analyses with larger studies are needed to estimate important effects of HBCU attendance. Higher education is robustly linked to lower dementia risk, yet Black-White inequities persist among college-educated adults. Black students attending predominantly White institutions (PWIs) versus historically Black colleges and universities (HBCUs) report more harmful discrimination and develop worse mental health outcomes, which may offset the established benefits of college for lowering dementia incidence. HBCU (vs. non-HBCU) attendees averaged better executive function and verbal episodic memory (VEM) at average age 70, though confidence intervals were wide and associations were not statistically significant, and averaged slightly faster decline in VEM. Harmonized analyses using larger nationally representative studies are likely needed to avoid underestimating the health effects of HBCU attendance.

Black and white differences in subjective survival expectations: An evaluation of competing mechanisms

While black-white inequality in longevity is well documented in the United States, little is known about how individuals from different race/ethnic groups form their own personal survival expectations. Prior research has found that despite having higher mortality, blacks on average report higher survival expectations relative to whites. Using data from the Health and Retirement Study, we examined racial differences in subjective survival expectations across birth cohorts and provide explanatory mechanisms.We find that blacks—men in particular—were overly optimistic about their survival, but this effect had waned with successive birth cohorts. Furthermore, whereas subjective survival expectations and actual survival were correlated among white men, among black men the most optimistic fared worst. Blacks and whites differed not only in their response patterns, but also in how they weighed the different factors (socioeconomic, psychosocial, health, parental longevity) associated with expected survival. Importantly, those who estimated their survival probability with certainty had positive psychosocial characteristics, irrespective of race, but only whites had better health.These findings underscore the importance of group differences in subjective survival expectations as another potential form of inequality. Racial differences in how long individual expect to live may account for differences in social and economic behavior and outcomes, irrespective of actual longevity differentials.

Neighborhood Proactive Policing and Racial Inequities in Preterm Birth in New Orleans, 2018‒2019.

Objectives. To measure neighborhood exposure to proactive policing as a manifestation of structural racism and its association with preterm birth. Methods. We linked all birth records in New Orleans, Louisiana (n = 9102), with annual census tract rates of proactive police stops using data from the New Orleans Police Department (2018-2019). We fit multilevel Poisson models predicting preterm birth across quintiles of stop rates, controlling for several individual- and tract-level covariates. Results. Nearly 20% of Black versus 8% of White birthing people lived in neighborhoods with the highest rates of proactive police stops. Fully adjusted models among Black birthing people suggest the prevalence of preterm birth in the neighborhoods with the highest proactive policing rates was 1.41 times that of neighborhoods with the lowest rates (95% confidence interval = 1.04, 1.93), but associations among White birthing people were not statistically significant. Conclusions. Taken together with previous research, high rates of proactive policing likely contribute to Black‒White inequities in reproductive health. Public Health Implications. Proactive policing is widely implemented to deter violence, but alternative strategies without police should be considered to prevent potential adverse health consequences. (Am J Public Health. 2023;113(S1):S21-S28. https://doi.org/10.2105/AJPH.2022.307079).

Empirical evidence on structural racism as a driver of racial inequities in COVID-19 mortality.

This study contributes to the literature by empirically testing the extent to which place-based structural racism is a driver of state-level racial inequalities in COVID-19 mortality using theoretically-informed, innovative approaches. CDC data are used to measure cumulative COVID-19 death rates between January 2020 and August 2022. The outcome measure is a state-level Black-White (B/W) ratio of age-adjusted death rates. We use state-level 2019 administrative data on previously validated indicators of structural racism spanning educational, economic, political, criminal-legal and housing to identify a novel, multi-sectoral latent measure of structural racism (CFI = 0.982, TLI = 0.968, and RMSEA = 0.044). We map B/W inequalities in COVID-19 mortality as well as the latent measure of structural racism in order to understand their geographic distribution across U.S. states. Finally, we use regression analyses to estimate the extent to which structural racism contributes to Black-White inequalities in COVID-19 mortality, net of potential confounders. Results reveal substantial state-level variation in the B/W ratio of COVID-19 death rates and structural racism. Notably, regression estimates indicate that the relationship between the structural racism and B/W inequality in COVID-19 mortality is positive and statistically significant (p < 0.001), both in the bivariate model (adjusted R2 = 0.37) and net of the covariates (adjusted R2 = 0.54). For example, whereas states with a structural racism value 2 standard deviation below the mean have a B/W ratio of approximately 1.12, states with a structural racism value 2 standard deviation above the mean have a ratio of just above 2.0. Findings suggest that efficacious health equity solutions will require bold policies that dismantle structural racism across numerous societal domains.

Contextual Origins of Black-White Educational Disparities in the 21st Century: Evaluating Long-Term Disadvantage Across Three Domains

AbstractHow much do black-white educational disparities reflect differences in family, school, and neighborhood contexts? We use 16 years of statewide student administrative data from Michigan to update this classic sociological question with attention to observed racial differences in the duration of exposure to contextual disadvantage. We show that a longitudinal measure of family economic disadvantage explains significantly more of the black-white gap in test scores, high school completion, and college entry than a cross-sectional measure commonly used in education research. Racial differences in school context—much more than differences in neighborhood context—explain a large portion of remaining black-white educational disparities. Controlling for black-white differences in exposure to disadvantage across all three contexts reduces 8th and 11th grade test score gaps by over 60% and completely reverses educational attainment gaps, revealing a black net advantage. Our results demonstrate the need to incorporate longitudinal measures in educational administrative data and suggest that schools play a substantial role, after family disadvantage, in the persistence of racial educational inequality. More broadly, our study amplifies the argument that undoing systemic racism will require a confrontation with the deep contextual roots of black-white inequality in the 21st century.

Education in the Jim Crow South and Black-White inequities in allostatic load among older adults

In the U.S., Black adults consistently have higher allostatic load – an indicator of physiological dysregulation – than White adults. Education is considered a likely mechanism given racial differences in attainment, but evidence is mixed. This may be due, in part, to data limitations that have made it difficult for scholars to account for the structurally rooted systemic racism that shaped the U.S. education system and led to large racial inequities in school term length and school attendance among older adults who grew up in the Jim Crow South. Our study addresses this limitation by linking historical data on Black and White segregated school systems in the U.S. South from 1919 to 1954 to the Health and Retirement Study (HRS) to determine if a new measure of educational attainment that accounts for structural racism that led to differences in the number of school days attended by Black and White students across years and states better explains Black-White inequities in allostatic load among older adults who attended school during Jim Crow. We restrict our sample to HRS respondents racialized as White or Black, who resided in the South when they were school-aged, completed primary/secondary school between 1919 and 1954, and provided a measure of allostatic load (n = 1932). We find that our new measure of schooling – duration in school – reduced the Black-White inequity in allostatic load more so than self-reported years of schooling whether we measured allostatic load continuously (34% vs 16%) or categorically (45% vs 20%). Our findings highlight the importance of identifying and using historically informed measures of schooling that account for structurally rooted systemic racism when trying to understand how education shapes the health of individuals racialized as Black in the United States.

Structural racism, family structure, and Black–White inequality: The differential impact of the legacy of slavery on poverty among single mother and married parent households

AbstractObjectiveTo assess whether an indicator of structural racism—the legacy of slavery—impacts racial inequality in poverty among individuals within the same family structure.BackgroundFamily structure is a dominant explanation for racial inequality in poverty. This overemphasis on an “individual‐level” variable results in relatively less attention to the role of structural factors. Yet, structural factors, like the legacy of slavery, may be key to understanding how race and family structure intersect in the context of poverty.MethodThe authors use data from the Luxembourg Income Study, the American Community Survey, and the Historical 1860 Census. Multilevel models link individual‐ and state‐level data and separate models focus on counties. The authors assess whether a proxy of the legacy of slavery (i.e., the historical concentration of enslaved people in 1860) relates to Black–White inequality in poverty among single mother households and among married with children households in the US South.ResultsThere is an impact of the legacy of slavery on Black–White inequality in poverty even within‐family type, but the legacy of slavery appears to be more consequential for married with children households than single mother households. Among married parent households, the racial gap in poverty is more pronounced where the legacy of slavery is stronger.ConclusionResults suggest the link between family structure and racial inequality in poverty is overstated and more indirect, operating—at least partially—through structural racism.ImplicationsThis study challenges the perception of marriage as an anti‐poverty mechanism. It also underscores the limitations of viewing family structure from an individual‐level perspective when explaining racial inequality. Local manifestations of structural racism are part of how family structure matters for inequality in poverty.

Black-White Inequality in Outcomes of In Vitro Fertilization: a Systematic Review and Meta-analysis.

This study aims to systematically review disparities in outcomes of in vitro fertilization between Black and White patients. We searched CINAHL, Cochrane Library, EMBASE, Global Health, PsycINFO, PubMed, and Web of Science for observational studies published before August 2021. Outcomes included implantation, clinical pregnancy, spontaneous abortion, and live birth following in vitro fertilization in Black versus White patients. We used random-effects models for meta-analysis and the Mantel-Haenszel method to calculate unadjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between race and in vitro fertilization outcomes, comparing Black relative to White patients. We used the generic inverse variance method to calculate adjusted ORs. Nine observational studies met eligibility criteria, including 696 Black and 7,458 White patients. All were retrospective studies of US cohorts. In unadjusted meta-analyses, Black patients had a greater likelihood of spontaneous abortion (OR 2.08, 95% CI 1.59-2.71) and lower likelihood of live birth (OR 0.67, 95% CI 0.47-0.95) compared with White patients but no difference in implantation (OR 0.95, 95% CI 0.32-2.77) or clinical pregnancy (OR 0.78, 95% CI 0.54-1.12). In adjusted meta-analyses, Black patients had lower odds of live birth (OR 0.57, 95% CI 0.43-0.75) and no difference in clinical pregnancy (OR 0.87, 95% CI 0.51-1.48). This meta-analysis suggests that in vitro fertilization services achieve similar pregnancy rates in Black and White patients. However, Black patients have more spontaneous abortions and fewer live births, suggesting there may be disparities in the quality of achieved pregnancies or other factors associated with pregnancy loss. Systematic review registration: PROSPERO (ID CRD42021256250).

Black-White Inequities in Kidney Disease Mortality Across the 30 Most Populous US Cities.

To examine city-level kidney disease mortality rates and Black:White racial inequities for the USA and its largest cities, and to determine if these measures changed over the past decade. We used National Vital Statistics System mortality data and American Community Survey population estimates to calculate age-standardized kidney disease mortality rates for the non-Hispanic Black (Black), non-Hispanic White (White), and total populations for the USA and the 30 most populous US cities. We examined two time points, 2008-2013 (T1) and 2014-2018 (T2), and assessed changes in rates and inequities over time. Racial inequities were measured with Black:White mortality rate ratios and rate differences. Kidney disease mortality rates varied from 2.5 (per 100,000) in San Diego to 24.6 in Houston at T2. The Black kidney disease mortality rate was higher than the White rate in the USA and all cities studied at both time points. In T2, the Black mortality rate ranged from 7.9 in New York to 45.4 in Charlotte, while the White mortality rate ranged from 2.0 in San Diego to 18.6 in Indianapolis. At T2, the Black:White rate ratio ranged from 1.79 (95% CI 1.62-1.99) in Philadelphia to 5.25 (95% CI 3.40-8.10) in Washington, DC, compared to the US rate ratio of 2.28 (95% CI 2.25-2.30). Between T1 and T2, only one city (Nashville) saw a significant decrease in the Black:White mortality gap. The largest US cities experience widely varying kidney disease mortality rates and widespread racial inequities. These local data on racial inequities in kidney disease mortality can be used by city leaders and health stakeholders to increase awareness, guide the allocation of limited resources, monitor trends over time, and support targeted population health strategies.