Impact Of Racial Residential Segregation Research Articles

Impact of Residential Segregation on Healthcare Utilization and Perceived Quality of Care Among Informal Caregivers in the United States.

This study aimed to investigate the impact of racial residential segregation on healthcare utilization and perceived quality of care among informal caregivers in the US. It further assessed potential variations in the estimated impact across caregivers' race and socioeconomic status. We used data from the Health Information National Trends Survey Data Linkage Project (fielded in 2020) for a sample of 583 self-identified informal caregivers in the US. Fitting a series of regression models with the maximum likelihood estimation, we computed the beta coefficients (β) of interest and their associated Wald 95% confidence limits (CI). Caregivers who resided in areas with higher segregation, compared to those living in lower segregated areas, were less likely to visit a healthcare professional [β = - 2.08; Wald 95%CI - 2.093, - 2.067] (moderate); [β = - 2.53; Wald 95%CI - 2.549, - 2.523] (high)]. Further, caregivers residing in moderate [β = - 0.766; Wald 95%CI - 0.770, - 0.761] and high [β = - 0.936; Wald 95%CI - 0.941, - 0.932] segregation regions were less likely to perceive a better quality of care compared to those located in low segregation areas. Moreover, as segregation level increased, Black caregivers were less likely to see a health professional, less frequently used healthcare services, and had poorer perceived healthcare quality when compared to Whites. Our findings indicate that higher residential segregation is associated with lower healthcare utilization, such as visiting a healthcare professional, and poorer perceived healthcare quality among informal caregivers. Given the essential role of informal caregivers in the current healthcare system, it is vital to investigate and address challenges associated with access to and quality of essential healthcare services to improve caregivers' health and well-being, specifically for caregivers of minority backgrounds.

Association of Racial Residential Segregation With Long-Term Outcomes and Readmissions After Out-of-Hospital Cardiac Arrest Among Medicare Beneficiaries.

Background The national impact of racial residential segregation on out-of-hospital cardiac arrest outcomes after initial resuscitation remains poorly understood. We sought to characterize the association between measures of racial and economic residential segregation at the ZIP code level and long-term survival and readmissions after out-of-hospital cardiac arrest among Medicare beneficiaries. Methods and Results In this retrospective cohort study, using Medicare claims data, our primary predictor was the index of concentration at the extremes, a measure of racial and economic segregation. The primary outcomes were death up to 3 years and readmissions. We estimated hazard ratios (HRs) across all 3 types of index of concentration at the extremes measures for each outcome while adjusting for beneficiary demographics, treating hospital characteristics, and index hospital procedures. In fully adjusted models for long-term survival, we found a decreased hazard of death and risk of readmission for beneficiaries residing in the more segregated White communities and higher-income ZIP codes compared with the more segregated Black communities and lower-income ZIP codes across all 3 indices of concentration at the extremes measures (race: HR, 0.87 [95% CI, 0.81-0.93]; income: HR, 0.75 [95% CI, 0.69-0.78]; and race+income: HR, 0.77 [95% CI, 0.72-0.82]). Conclusions We found a decreased hazard of death and risk for readmission for those residing in the more segregated White communities and higher-income ZIP codes compared with the more segregated Black communities and lower-income ZIP codes when using validated measures of racial and economic segregation. Although causal pathways and mechanisms remain unclear, disparities in outcomes after out-of-hospital cardiac arrest are associated with the structural components of race and wealth and persist up to 3 years after discharge.

Association between Racial Residential Segregation and COVID-19 Mortality.

This study investigates the impact of racial residential segregation on COVID-19 mortality during the first year of the US epidemic. Data comes from the Center for Disease Control and Prevention (CDC), and the Robert Wood Johnson Foundation's and the University of Wisconsin's joint county health rankings project. The observation includes a record of 8,670,781 individuals in 1488 counties. We regressed COVID-19 deaths, using hierarchical logistic regression models, on individual and county-level predictors. We found that as racial residential segregation increased, mortality rates increased. Controlling for segregation, Blacks and Asians had a greater risk of mortality, while Hispanics and other racial groups had a lower risk of mortality, compared to Whites. The impact of racial residential segregation on COVID-19 mortality did not vary by racial group.

Racial residential segregation and COVID-19 vaccine uptake: an analysis of Georgia USA county-level data

BackgroundFoundational literature demonstrates that racial residential segregation results in poorer health outcomes for Black people than white people due to a variety of social determinants of health. COVID-19 vaccine uptake is important for better health outcomes, regardless of race. The COVID-19 pandemic has elevated concerns about racial health disparities but with little discussion of racial residential segregation as a predictor of disparate health outcomes. This paper investigates the relationship between racial residential segregation and COVID-19 vaccine uptake using county level data from the State of Georgia (USA).MethodsUsing publicly available data, regression analysis is conducted for 138 of the 159 counties in Georgia USA, using a dissimilarity index that describes county level differences in racial residential segregation. The primary independent variable is Black-white differences in vaccine uptake at the county level. The analytic methods focus on a spatial analysis to support information for county level health departments as the basis for health policy and resource allocation.ResultsConstructing a variable of the difference in vaccination rates between Black and white residents we find that Black-white differences in COVID-19 vaccination are most notable in the 69 most segregated of the 159 counties in Georgia. A ten-point lower segregation index is associated with an improvement in the Black-white vaccination gap of 1.5 percentage points (95% CI -0.31, -0.00). Income inequality and access to health care resources, such as access to a primary care physician, also predict Black-white differences in vaccination rates at the county level. Suggested mapping approaches of publicly available data at a state county level, provides a resource for local policy makers to address future challenges for epidemic and pandemic situations.ConclusionCounty level and geospatial data analysis can inform policy makers addressing the impact of racial residential segregation on local health outcomes, even for pandemic and epidemic issues.

Effects of racial residential segregation on oral squamous cell carcinoma prognosis and survival

ObjectivesThe objective of this study is to evaluate the impact of racial residential segregation on disease prognosis and overall survival in Black patients diagnosed with oral squamous cell carcinoma (OSCC), relative to White patients. Materials and methodsThis retrospective cohort study identified individuals diagnosed with OSCC between 2005 and 2015 using the Surveillance, Epidemiology and End Results Database. Patients were included with cancers diagnosed in the following locations: lip, tongue, gum, floor of mouth, palate, and other/unspecified. Tumors located at the base of tongue, tonsils, and oropharynx were excluded. The primary predictor variable was the degree of residential segregation. The primary outcome was overall survival. A Kaplan Meier survival analysis and univariate/multivariate analyses were performed to account for potential confounders of survival. ResultsA total of 35,769 patients met inclusion criteria. At the time of initial diagnosis, Black patients presented with OSCC of higher grades and more advanced stages (p < 0.001). A greater number of Black subjects were dead by the time of last follow-up compared to White subjects (p < 0.001). Across the entire spectrum of residential segregation, cumulative survival was worse among Black patients compared to Whites (p < 0.001). Multivariate analysis identified highly segregated counties, advanced age, higher grade/advanced stage at time of diagnosis, lack of surgery, and no chemotherapy treatment as poor prognostic factors for survival among Black individuals. ConclusionRacial residential segregation results in poorer long-term cancer survival among Black patients. Understanding the links between residential segregation and inequities in cancer outcomes will allow policymakers to better implement targeted, population-based interventions in treating various cancers.

The impact of racial residential segregation on prostate cancer diagnosis and treatment.

To examine the effects of racial residential segregation and structural racism on the diagnosis, treatment, and outcomes of patients with prostate cancer. This retrospective cohort study examined men diagnosed with prostate cancer between 2005 and 2015. We collected data from Black and White men, aged ≥30years, living within the 100 most populous counties participating in the Surveillance, Epidemiology, and End Results programme, a nationally representative dataset. The racial Index of Dissimilarity, a validated measure of segregation, was the primary exposure of interest. Outcomes of interest included advanced stage at diagnosis (Stage IV), surgery for localised disease (Stage I-II), and 10-year overall and cancer-specific survival. Multivariable Poisson regression analyses with robust error variance estimated the relative risk (RR) of advanced stage at diagnosis and surgery for localised disease at differing levels of segregation. Survival analysis was performed using competing hazards analysis. Multivariable models estimating stage at diagnosis showed that the disparities between Black and White men disappeared at low levels of segregation. Disparities in receiving surgery for localised disease persisted across all levels of segregation. In racially stratified analyses, segregation had no effect on stage at diagnosis or surgical resection for Black patients. White patients saw a 56% (RR 0.42, P<0.001) reduced risk of presenting at advanced stage and 20% increased likelihood (RR 1.20, P<0.001) of surgery for localised disease. Black patients in the lowest segregation areas had the lowest overall mortality, but the highest cancer-specific mortality. Our study provides evidence that residential segregation has a significant impact on Black-White disparities in prostate cancer, likely through improved outcomes for White patients and worse outcomes for Black patients in more segregated areas. These findings suggest that mitigating segregation and the downstream effects of socioeconomic factors could alleviate these disparities.

Trust in the Bayou City: Do Racial Segregation and Discrimination Matter for Generalized Trust?

The key role that generalized trust plays in social capital formation is well documented, but its determinants are not well understood. Many studies suggest that racially and ethnically diverse areas have lower generalized trust than more homogeneous areas, but evidence regarding the impact of the spatial arrangement of racial and ethnic groups is not conclusive. Further, while scholars theorize that discrimination may play a role in racial trust gaps, no study has empirically supported this linkage. We examine the impact of racial residential segregation and perceived discrimination on generalized trust in two highly diverse Texas counties using data from the 2014 Kinder Houston Area Survey. Results indicate that perceived racial discrimination negatively impacts trust and may mediate the black-white trust gap, whereas racial segregation is positively associated with trust. Additionally, having an interracial friendship, one form of bridging ties, moderates the segregation-trust relationship such that, up to a certain level of segregation, having an interracial friendship increases one’s likelihood of trusting others. Together, these results provide insight into processes that generate or sustain the general trust that makes social capital formation possible and point to the continuing importance of race in shaping experiences and outcomes in modern American society.

Impact of racial residential segregation (RRS) on stage at diagnosis and survival after diffuse large B-cell lymphoma (DLBCL).

6557 Background: Racial disparities in disease presentation and survival have been reported for DLCBL, which may arise from biological or socioeconomic status (SES) differences that influence treat...

The Old Jim Crow: Racial Residential Segregation and Neighborhood Imprisonment

This article examines the impact of racial residential segregation on imprisonment rates at the neighborhood level. Key to the strength of this enterprise is block‐group level data on imprisonment, crime, and other demographic factors for about 5,000 neighborhoods in North Carolina. These data also include information on county racial residential segregation from the Population Studies Center at the University of Michigan. Hierarchical linear models that control for neighborhood characteristics, such as racial diversity, crime, poverty, unemployment, median income, homeownership, and other factors, show that neighborhoods in more segregated counties have higher imprisonment rates than neighborhoods in less segregated counties. On average, neighborhoods in counties with segregation levels at the minimum of 41.4 are expected to have imprisonment rates of 0.186 percent, while neighborhoods in counties with segregation levels at the maximum of 95.6 are expected to have imprisonment rates more than twice as high, or about 0.494 percent.

Racial residential segregation impacts on low birth weight using improved neighborhood boundary definitions

Research on local racial residential segregation and health generally utilize census tract boundaries as a proxy from within which to estimate individual exposures. Census tracts however, may not accurately reflect the neighborhood environments in which people live and interact. Census tract geography may also capture non-exchangeable populations in socially stratified cities, impacting statistical assumptions of independence. To address these concerns, this study assessed the impact of racial residential segregation (i.e., racial isolation and racial clusters) on low birth weight (i.e., intrauterine growth retardation (IUGR) and preterm birth) in the Detroit Metropolitan Area using optimized neighborhood boundary definitions. Automated zone-matching (AZM) methodology was applied to redefine neighborhood (zones). Maternal and infant health information was obtained from Michigan’s vital statistics birth registry (n=137,965) for the years 2004–2006. Multilevel models were estimated to assess the effect of high racial isolation and high racial clusters on IUGR and preterm birth, controlling for maternal race, single marital status, smoking and area-level poverty. The results from this study showed that high racial isolation had a significant effect on IUGR, while the odds of preterm birth were higher in racially clustered zones. African American mothers were at increased odds of having IUGR or preterm infants than other mothers; however, these disparities reduced in highly segregated zones. The predicted incidence of IUGR across racially isolated zones and census tracts differed indicating a modifiable area unit problem (MAUP). MAUP effects were not observed in models predicting preterm incidence in high racial clusters or IUGR or preterm incidence in high poverty areas, demonstrating the stability-reliability of these estimates. Future research should continue to optimize neighborhood boundary definitions, while assessing the sensitivity of segregation measures to changes in scale, to improve our understanding of segregation impacts on racial disparities in low birth weight.

Racial Segregation and Black Urban Homicide

Social deprivation and social isolation perspectives provide grounds for expecting residential segregation to increase violent crime among oppressed minorities. The AA. examine the impact of racial residential segregation on rates of African-American homicide victimization for large U.S. central cities. The analyses demonstrate that black-white segregation leads to higher rates of black killing altough the relationship exists only for stranger and acquaintance homicides. This suggests that social isolation, rather than social deprivation, is the mechanism by which segregation leads to higher levels of homicide among African Americans.