Large Racial Disparities Research Articles

Inequality in the “Cradle of Liberty”: Race/Ethnicity and Wealth in Greater Boston

New data collected for the Boston Metropolitan Statistical Area provide detailed information on financial assets that allow analysis to extend beyond the traditional black–white divide. Targeting US-born blacks, Caribbean blacks, Puerto Ricans, Dominicans, and other Hispanics, findings from the National Asset Scorecard for Communities of Color survey underscore the large racial and ethnic disparities in financial wealth, even after controlling for demographic and socioeconomic status. Further, some notable differences between Boston’s communities of color highlight the importance of detailed analyses for research on the racial wealth gap. In particular, among non-white communities Dominicans report comparatively low asset and high debt amounts, while Caribbean blacks report relatively higher levels of wealth. Altogether, these findings point to the need for wealth building opportunities in communities of color and further investigation of the causes and consequences of financial disparities between groups of color disaggregated by specific ancestral origin.

Induced Abortion, Mortality, and the Conduct of Science

There is no credible scientific opposition to the fact that a genetically distinct human life begins at conception and that an induced abortion is a death. Yet, abortion is not reported as a cause of death in the U.S. vital statistics system. Mortality patterns have profound implications for public policy. As a cause of death, we found abortion to be highly consequential, with large racial and ethnic disparities. Abortion represented 16.4% of non-Hispanic White deaths, but 61.1% and 64.0% of non-Hispanic Black and Hispanic deaths respectively. For Years of Potential Life Lost (YPLL), the ubiquitous measure of premature death, abortion accumulated 63.1% of non-Hispanic White YPLL and 86.5% and 87.4% of non-Hispanic Black and Hispanic YPLL respectively. Further, as measured by the availability of valid data and resources allocated for research, there is evidence that the science community is not appropriately engaged on this crucial public health problem.

Racial disparities in reaching the renal transplant waitlist: is geography as important as race?

In the United States, African Americans and whites differ in access to the deceased donor renal transplant waitlist. The extent to which racial disparities in waitlisting differ between United Network for Organ Sharing (UNOS) regions is understudied. The US Renal Data System (USRDS) was linked with US census data to examine time from dialysis initiation to waitlisting for whites (n = 188,410) and African Americans (n = 144,335) using Cox proportional hazards across 11 UNOS regions, adjusting for potentially confounding individual, neighborhood, and state characteristics. Likelihood of waitlisting varies significantly by UNOS region, overall and by race. Additionally, African Americans face significantly lower likelihood of waitlisting compared to whites in all but two regions (1 and 6). Overall, 39% of African Americans with ESRD reside in Regions 3 and 4--regions with a large racial disparity and where African Americans comprise a large proportion of the ESRD population. In these regions, the African American-white disparity is an important contributor to their overall regional disparity. Race remains an important factor in time to transplant waitlist in the United States. Race contributes to overall regional disparities; however, the importance of race varies by UNOS region.

Two Strikes

There are large racial disparities in school discipline in the United States, which, for Black students, not only contribute to school failure but also can lay a path toward incarceration. Although the disparities have been well documented, the psychological mechanisms underlying them are unclear. In two experiments, we tested the hypothesis that such disparities are, in part, driven by racial stereotypes that can lead teachers to escalate their negative responses to Black students over the course of multiple interpersonal (e.g., teacher-to-student) encounters. More generally, we argue that race not only can influence how perceivers interpret a specific behavior, but also can enhance perceivers’ detection of behavioral patterns across time. Finally, we discuss the theoretical and practical benefits of employing this novel approach to stereotyping across a range of real-world settings.

Lung cancer incidence trends by gender, race and histology in the United States, 1973-2010.

BackgroundLung cancer (LC) incidence in the United States (US) continues to decrease but with significant differences by histology, gender and race. Whereas squamous, large and small cell carcinoma rates have been decreasing since the mid-80s, adenocarcinoma rates remain stable in males and continue to increase in females, with large racial disparities. We analyzed LC incidence trends by histology in the US with an emphasis on gender and racial differences.MethodsLC incidence rates from 1973–2010 were obtained from the SEER cancer registry. Age-adjusted incidence trends of five major histological types by gender and race were evaluated using joinpoint regression. Trends of LC histology and stage distributions from 2005–2010 were analyzed.ResultsUS LC incidence varies by histology. Squamous, large and small cell carcinoma rates continue to decrease for all gender/race combinations, whereas adenocarcinoma rates remain relatively constant in males and increasing in females. An apparent recent increase in the incidence of squamous cell carcinoma and adenocarcinoma since 2005 can be explained by a concomitant decrease in the number of cases classified as other non-small cell carcinoma. Black males continue to be disproportionally affected by squamous LCs, and blacks continue to be diagnosed with more advanced cancers than whites.ConclusionsLC incidence by histology continues to change over time. Additional variations are expected as screening becomes disseminated. It is important to continue to monitor LC rates to evaluate the impact of screening on current trends, assess the continuing benefits of tobacco control, and focus efforts on reducing racial disparities.

Distance decay and persistent health care disparities in South Africa.

BackgroundAccess to health care is a particular concern given the important role of poor access in perpetuating poverty and inequality. South Africa’s apartheid history leaves large racial disparities in access despite post-apartheid health policy to increase the number of health facilities, even in remote rural areas. However, even when health services are provided free of charge, monetary and time costs of travel to a local clinic may pose a significant barrier for vulnerable segments of the population, leading to overall poorer health.MethodsUsing newly available health care utilization data from the first nationally representative panel survey in South Africa, together with administrative geographic data from the Department of Health, we use graphical and multivariate regression analysis to investigate the role of distance to the nearest facility on the likelihood of having a health consultation or an attended birth.ResultsNinety percent of South Africans live within 7 km of the nearest public clinic, and two-thirds live less than 2 km away. However, 14% of Black African adults live more than 5 km from the nearest facility, compared to only 4% of Whites, and they are 16 percentage points less likely to report a recent health consultation (p < 0.01) and 47 percentage points less likely to use private facilities (p < 0.01). Respondents in the poorest income quintiles live 0.5 to 0.75 km further from the nearest health facility (p < 0.01). Racial differentials in the likelihood of having a health consultation or an attended birth persist even after controlling for confounders.ConclusionsOur results have two policy implications: minimizing the distance that poor South Africans must travel to obtain health care and improving the quality of care provided in poorer areas will reduce inequality. Much has been done to redress disparities in South Africa since the end of apartheid but progress is still needed to achieve equity in health care access.

African American organ donor registration: a mixed methods design using the theory of planned behavior.

A large racial disparity exists in organ donation. To identify factors associated with becoming a registered organ donor among African Americans in Alabama. Concurrent mixed methods design guided by the Theory of Planned Behavior to analyze African Americans' decisions to become a registered organ donor by using both qualitative (focus groups) and quantitative (survey) methods. The sample consisted of 22 registered organ donors and 65 non registered participants from 6 focus groups completed in urban (n = 3) and rural (n = 3) areas. Participants emphasized the importance of the autonomy to make one's own organ donation decision and have this decision honored posthumously. One novel barrier to becoming a registered organ donor was the perception that organs from African Americans were often unusable because of the high prevalence of chronic medical conditions such as diabetes and hypertension. Another novel theme discussed as an advantage to becoming a donor was the subsequent motivation to take responsibility for one's health. Family and friends were the most common groups of persons identified as approving and disapproving of the decision to become a donor. The most common facilitator to becoming a donor was information, whereas fear and the lack of information were the most common barriers. In contrast, religious beliefs, mistrust, and social justice themes were infrequently referenced as barriers to becoming a donor. Findings from this study may be useful for prioritizing organ donation community-based educational interventions in campaigns to increase donor registration.

Exome chip evaluation of genetic variants for association with uterine fibroids

Uterine fibroid(UFs) affect up to 77% of women by menopause with large racial disparities and account for $9.4 billion in yearly healthcare costs. Although UFs are heritable, genetic risk is poorly understood. The first genome-wide association study(GWAS) of UFs was performed in 2011 in a Japanese population, however, to-date few large-scale genetic studies have been performed in US populations.(1) The objective of this study is to conduct a whole exome association study of UF risk in European Americans(EA) and African Americans(AA). This is case-control genetic association study of UFs defined using pelvic imaging data obtained from an electronic medical record biorepository (BioVU DNA Repository). Logistic regression adjusted for ancestry and age was used in 728 EA and AA DNA samples (EA: 246 cases, 243 controls; AA: 121 cases, 118 controls) to evaluate SNPs for association, stratified by race. Meta-analyses of results with fixed effect models were performed to obtain combined evidence for associations across racial groups. Our strongest association within EAs was within t-complex 11, testis-specific like 1 (TCP11L1, rs1064005, OR 1.79, 95% CI 1.36-2.32, p 3.94x10-5) and within multiple SNPs within the HLA region (smallest p 9.28x10-5). It is of note that the exome chip has enhanced coverage of the HLA region compared to GWAS arrays. Among AAs strong associations were observed within glipican 4 (GC4, OR = 0.46, 95% CI 0.31-0.68, p = 8.73x10-5). Meta-analysis across EA and AA further strengthened the associations observed at TCP11L1 (smallest meta-p 4.09x-7, with effect sizes consistent across races). Prior gene expression studies of TCP11L have shown increased expression in tumor tissues compared to normal tissues across several different cancers and variants within HLA genes have been associated with UF risk in prior studies. These pilot data suggest common variants in exonic regions increase risk for UF in both EA and AA populations. However, further validation of our study findings is needed to confirm our results. We are currently genotyping >4,000 samples for GWAS and exome arrays to further evaluate the relationship between gene variants and UF risk.

Reducing cancer disparities through community engagement in policy development: the role of cancer councils.

Cancer is the second leading cause of death in the U.S and a source of large racial and ethnic disparities in population health. Policy development is a powerful but sometimes overlooked public health tool for reducing cancer burden and disparities. Along with other partners in the public health system, community-based organizations such as local cancer councils can play valuable roles in developing policies that are responsive to community needs and in mobilizing resources to support policy adoption and implementation. This paper examines the current and potential roles played by local cancer councils to reduce cancer burden and disparities. Responsive public health systems require vehicles for communities to engage in policy development. Cancer councils provide promising models of engagement. Untapped opportunities exist for enhancing policy development through cancer councils, such as expanding targets of engagement to include private-sector stakeholders and expanding methods of engagement utilizing the Affordable Care Act's Prevention and Public Health Fund.

Cost-Effectiveness of a Program to Eliminate Disparities in Pneumococcal Vaccination Rates in Elderly Minority Populations: An Exploratory Analysis

ObjectiveInvasive pneumococcal disease is a major cause of preventable morbidity and mortality in the United States, particularly among the elderly (>65 years). There are large racial disparities in pneumococcal vaccination rates in this population. Here, we estimate the cost-effectiveness of a hypothetical national vaccination intervention program designed to eliminate racial disparities in pneumococcal vaccination in the elderly. MethodsIn an exploratory analysis, a Markov decision-analysis model was developed, taking a societal perspective and assuming a 1-year cycle length, 10-year vaccination program duration, and lifetime time horizon. In the base-case analysis, it was conservatively assumed that vaccination program promotion costs were $10 per targeted minority elder per year, regardless of prior vaccination status and resulted in the elderly African American and Hispanic pneumococcal vaccination rate matching the elderly Caucasian vaccination rate (65%) in year 10 of the program. ResultsThe incremental cost-effectiveness of the vaccination program relative to no program was $45,161 per quality-adjusted life-year gained in the base-case analysis. In probabilistic sensitivity analyses, the likelihood of the vaccination program being cost-effective at willingness-to-pay thresholds of $50,000 and $100,000 per quality-adjusted life-year gained was 64% and 100%, respectively. ConclusionsIn a conservative analysis biased against the vaccination program, a national vaccination intervention program to ameliorate racial disparities in pneumococcal vaccination would be cost-effective.

Racial disparities in colorectal cancer incidence by type 2 diabetes mellitus status

Type 2 diabetes mellitus (T2DM) prevalence has increased dramatically in the United States since the early 1970s. Though T2DM is known to be associated with colorectal cancer (CRC), information on racial differences in the relationship between T2DM and CRC is limited. Using a retrospective cohort design, we compared the association between T2DM and CRC, including subsites of the colon, in African Americans (AAs) and European Americans (EAs) in South Carolina, a region with large racial disparities in rates of both diseases. A total of 91,836 individuals who were ≥30 years old on 1 January 1990 and had ≥12 months of South Carolina Medicaid eligibility between 1 January 1990 and 31 December 1995 were included in the analyses. Cancer data from 1996 to 2007 included information on anatomic subsite. Subjects who had T2DM (n = 6,006) were >50 % more likely to be diagnosed with colon cancer compared to those without T2DM (n = 85,681). The association between T2DM and colon cancer was higher in AAs [odds ratio (OR) = 1.72 (95 % confidence interval: 1.21, 2.46); n = 47,984] than among EAs (OR = 1.24; 0.73, 2.11; n = 43,703). Overall, individuals with T2DM were over twice as likely to be diagnosed with in situ or local colon cancer (OR = 2.12; 1.40, 3.22; n = 191) compared to those without T2DM, with a higher likelihood among AAs (OR = 2.49; 1.52, 4.09; n = 113). Results from a Medicaid population in a high-risk region of the United States showed an increased likelihood of CRC with T2DM and suggest a racial disparity that disfavors AAs and provides further impetus for efforts aimed at diabetes prevention in this group.

The Intersection and Accumulation of Racial and Gender Inequality: Black Women's Wealth Trajectories

Prior research has found evidence of large racial and gender disparities in wealth, with blacks possessing less wealth than whites and women having less wealth than men. An intersectionality approach suggests that the overlapping impacts of racial and gender domination are likely to combine in a multiplicative fashion that places black women in a uniquely precarious economic position. However, little is known about the wealth holdings of black women and even less is known about whether their wealth increases, decreases or remains stable as they approach retirement age, a stage of life when savings are especially important. This study utilizes seven waves of panel data from the Health and Retirement Study (HRS) and growth curve models to estimate the wealth trajectories of black women between the ages of 51 and 73. Results reveal that black women have especially low levels of net worth and net financial assets during middle and late life, suggesting high risk of economic insecurity in later life. Consistent with political economy and intersectionality perspectives, their persistently low wealth trajectories are likely the result of state policies, discrimination, residential segregation and health disparities. Ameliorative policy prescriptions are discussed.

Mass imprisonment and racial disparities in childhood behavioral problems

Research Summary This essay provides estimates of the influence of mass imprisonment on racial disparities in childhood well-being. To do so, we integrate results from three existing studies in a novel way. The first two studies use two contemporary, broadly representative data sets to estimate the effects of paternal incarceration on a range of child behavioral and mental health problems. The third study estimates changes in Black–White disparities in the risk of paternal imprisonment across the 1978 and 1990 American birth cohorts. Our research demonstrates the following: 1) The average effect of paternal incarceration on children is harmful, not helpful, and consistently in the direction of more mental health and behavioral problems. 2) The rapid increase in the use of imprisonment coupled with significant racial disparities in the likelihood of paternal (and maternal) imprisonment are linked to large racial disparities in childhood mental health and behavioral problems. 3) We find that mass imprisonment might have increased Black–White inequities in externalizing behaviors by 14–26% and in internalizing behaviors by 25–45%. Policy Implications Our results add to a growing research literature indicating that the costs associated with mass imprisonment extend far beyond well-documented impacts on current inmates. The legacy of mass incarceration will be continued and worsening racial disparities in childhood mental health and well-being, educational attainment, and occupational attainment. Moreover, the negative effects of mass imprisonment for childhood well-being are likely to remain, even if incarceration rates returned to pre-1970s levels. Our results show that paternal incarceration exacerbates child behavioral and mental health problems and that large, growing racial disparities in the risk of imprisonment have contributed to significant racial differences in child well-being. The policy implications of our work are as follows: 1) Estimates of the costs associated with the current scale of imprisonment are likely to be severely underestimated because they do not account for the significant indirect effects of mass incarceration for children, for families, and for other social institutions such as the educational system and social service providers. 2) Policies that reduce incarceration rates for nonviolent offenders with no history of domestic violence will most dramatically reduce the effects of mass incarceration on childhood racial inequality. More research is needed to detail other important factors (e.g., crime type, criminal history, or gender of parent) that condition the effect of paternal incarceration on children. 3) Paternal incarceration effects target the most disadvantaged and vulnerable of children and are likely to result in long-term behavioral health problems. We propose a strengthening of the social safety net—especially as it applies to the poorest children—and programs that address the complicated needs of children of incarcerated parents.

Racial Gaps in Child Health Insurance Coverage in Four South American Countries: The Role of Wealth, Human Capital, and Other Household Characteristics

OBJECTIVE. To evaluate the extent of racial gaps in child health insurance coverage in South America and study the contribution of wealth, human capital, and other household characteristics to accounting for racial disparities in insurance coverage. DATA SOURCES/STUDY SETTING. Primary data collected between 2005 and 2006 in 30 pediatric practices in Argentina, Brazil, Ecuador, and Chile. DESIGN. Country-specific regression models are used to assess differences in insurance coverage by race. A decomposition model is used to quantify the extent to which wealth, human capital, and other household characteristics account for racial disparities in insurance coverage. DATA COLLECTION/EXTRACTION METHODS. In-person interviews were conducted with the mothers of 2,365 children. PRINCIPAL FINDINGS. The majority of children have no insurance coverage except in Chile. Large racial disparities in insurance coverage are observed. Household wealth is the single most important household-level factor accounting for racial disparities in coverage and is significantly and positively associated with coverage, followed by maternal education and employment/occupational status. Geographic differences account for the largest part of racial disparities in insurance coverage in Argentina and Ecuador. CONCLUSIONS. Increasing the coverage of children in less affluent families is important for reducing racial gaps in health insurance coverage in the study countries.

The Locus of Racial Disadvantage in the Labor Market

Using a pooled sample constructed from recent installments of the Displaced Workers Survey, this study examines the racial disparities in postdisplacement outcomes while controlling for the predisplacement experience and earnings of individual workers. It finds no racial difference in the reemployment wage, but there is a large racial disparity in the chances of reemployment among workers with equivalent characteristics and experience. This lower reemployment rate of displaced black workers may be due to individual differences in search behavior, but it is also consistent with contemporary accounts of hiring discrimination.

Are Blacks and Hispanics Disproportionately Incarcerated Relative to Their Arrests? Racial and Ethnic Disproportionality Between Arrest and Incarceration.

Do large racial and ethnic disparities in prison populations reflect systematic racial and policy discrimination in the criminal justice system, or do they reflect disproportionate involvement of blacks and Hispanics in "serious" or street crime? Our investigation of this question keys off the approach initiated by Alfred Blumstein is his pioneering studies on the topic. While yielding important findings, there are, however, substantial gaps in the empirical literature on the racial disproportionality issue. We attempt to fill those gaps by (1) using both data on prison admission as well as in-stock prison populations, (2) presenting more recent racially and ethnically disaggregated arrest and incarceration data from Pennsylvania for 2003-2007, and (3) including Hispanic offenders in our racial and ethnic disproportionality comparisons. Our results indicate, first, that the representation of blacks, whites, and Hispanics among offenders admitted to state prison and in the prison population corresponds closely to their representation in arrest statistics. Second, using arrests as a marker of violent offending, the overrepresentation of blacks among offenders admitted to state prisons occurs because they commit a disproportionate number of frequently imprisoned (i.e., violent) crimes. Third, for those offenses where there is a within-race difference between arrest and incarceration representation, Hispanics experience the greatest disadvantage. Fourth, failing to account for Hispanics in white and black estimates tends to inflate white proportions and deflate black proportions of arrests, admissions, and prison population estimates, masking the "true" black and white racial disproportionality. We conclude that while there is a need for continued concern with possible racial discrimination in justice system processing, this concern should not distract attention from what arguably is the more important matter-ameliorating the social environmental conditions that foster disproportionate minority (especially black) involvement in violent crime.

Mortality of Bullous Skin Disorders From 1979 Through 2002 in the United States

To identify and analyze trends in bullous disease mortality from 1979 through 2002 in the United States. Retrospective population-based analysis. Mortality records from the Centers for Disease Control and Prevention mortality database. Mortality records from 1979 through 2002 for persons who died of bullous disease. Age-adjusted mortality rates and trends for 4 bullous disease subgroups: toxic epidermal necrolysis, pemphigoid, pemphigus, and epidermolysis bullosa. The overall age-adjusted (to the 2000 US standard population) annual mortality rate from bullous diseases of the skin was 0.103 death per 100 000. The average mortality from bullous disorders was 0.098 per 100 000 in 1979 through 1982 and remained stable at 0.099 per 100 000 during the final 4 years of the study, 1999 through 2002. Pemphigoid had a significant increase in mortality from 1979 through 2002, while pemphigus demonstrated a significant decrease in mortality. The mortality rate for toxic epidermal necrolysis was much higher among blacks (0.192 death per 100 000) than whites (0.025 per 100 000) (P < .001), with a mortality rate ratio of 7.57 (95% confidence interval, 6.97-8.21). Overall mortality from bullous diseases remained stable from 1979 through 2002, although an increasing mortality from pemphigoid and a decreasing mortality from pemphigus occurred during this period. A very large racial disparity in mortality from toxic epidermal necrolysis was observed.

Racial/Ethnic Differences in Quality of Care for North Carolina Medicaid Recipients

National health care quality measures suggest that racial and ethnic minority populations receive inferior quality of care compared to whites across many health services. As the largest insurer of low-income and minority populations in the United States, Medicaid has an important opportunity to identify and address health care disparities. Using 2006 Healthcare Effectiveness Data and Information Set (HEDIS) measures developed by the National Committee for Quality Assurance (NCQA), we examined quality of care for cancer screening, diabetes, and asthma among all eligible non-dual North Carolina Medicaid recipients by race and ethnicity. In comparison to non-Latino whites, non-Latino African Americans had higher rates of screening for breast cancer (40.7% vs. 36.7%), cervical cancer (60.5% vs. 54.6%), and colorectal cancer (25.5% vs. 20.6%) and lower rates of LDL testing among people with diabetes (61.8% vs. 65.7%) and appropriate asthma medication use (88.7% vs. 97.0%). A1C testing and retinal eye exam rates among people with diabetes were similar. Smaller racial/ethnic minority groups had favorable quality indicators across most measures. Comparability of findings to national population-based quality measures and other health plan HEDIS measures is limited by lack of case-mix adjustment. For the health services examined, we did not find evidence of large racial and ethnic disparities in quality of care within the North Carolina Medicaid program. There is substantial room for improvement, however, in cancer screening and preventive care for Medicaid recipients as a whole.

The 2007 National Asthma Education and Prevention Program Asthma Guidelines: Accelerating Their Implementation and Facilitating Their Impact on Children With Asthma

Nearly 2 decades have elapsed since the National Center for Health Statistics raised concerns regarding the trends in increasing asthma prevalence. Additional research highlighted the large racial disparities and geographic variations in asthma morbidity and mortality rates. Although there was little national consensus on the care of children with asthma at the time, there were improvements in the understanding of the mechanisms and treatment of asthma. It was in this context that the National Heart, Lung, and Blood Institute launched the National Asthma Education and Prevention Program, which convened its first panel of experts to create the national consensus clinical practice guidelines on the treatment of asthma. More than 15 years have passed since the publication of those first guidelines and, in August 2007, the National Heart, Lung, and Blood Institute released its newest updates, which are the product of the National Asthma Education and Prevention Program third expert panel. The release of the updated guidelines serves as an occasion to examine important issues regarding the dissemination and clinical implementation of National Asthma Education and Prevention Program guidelines. The goals of this report are to examine the adoption of earlier versions of the National Asthma Education and Prevention Program guidelines and to suggest opportunities for rapid adoption of the newly released guidelines.

A multilevel decomposition approach to estimate the role of program location and neighborhood disadvantage in racial disparities in alcohol treatment completion

Large racial disparities in completion rates from substance abuse treatment programs in urban settings remain largely unexplained, although evidence is accumulating that neighborhood conditions may influence individual substance abuse patterns and consequences. Understanding racial disparities in alcohol treatment completion, in particular, is crucial to resolving health disparities because racial/ethnic minorities bear a disproportionate burden of alcohol-related health consequences. Patient records for all non-homeless African American ( N = 1677 ), Hispanic ( N = 1635 ), and white ( N = 1216 ) alcohol outpatients, ages 18 or older, discharged during 1998–2000 from publicly funded treatment programs in Los Angeles County, the second largest system of publicly funded substance abuse treatment in the United States, were combined with census data. We tested the hypothesis that racial differences in treatment completion are related to differences in neighborhood context, particularly neighborhood-level disadvantage. Estimates from multilevel statistical models indicate that treatment neighborhood disadvantage is independently associated with treatment completion after controlling for patient characteristics and facility- and zip code-level random effects. Results of a Oaxaca decomposition of the regression estimates indicate that racial differences in treatment neighborhood disadvantage account for 32.3% of African American–white differences in treatment completion. Hispanic–white differences in completion, and the effect of home neighborhood disadvantage on completion, were non-significant. We conclude that the location of publicly funded alcohol treatment programs is related to racial disparities in treatment completion, but additional research is necessary to understand the mechanism behind this association.