Black Mortality Research Articles

Associations Between Infant Formula Exposure, Housing Instability and Postneonatal Mortality Among Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

To quantify infant mortality rates (IMR) using expanded racial categories, and to examine associations between infant formula exposure, housing instability and postneonatal mortality among Minnesota WIC Participants. Births in Minnesota from 2014 through 2019 (n = 404,102) and associated infant death records (n = 2034) were used to calculate neonatal and postneonatal rates using expanded racial categories. Those births that participated in the WIC program (n = 170,011) and their linked death records (n = 853) were analyzed using logistic regression to examine associations between formula exposure, housing instability, and postneonatal death. Postneonatal IMR was more than twice as prevalent among Black (African American) as East African immigrant infants (IMR = 3.9 vs 1.5). After adjustment for confounding (term status and nativity of mother (U.S. vs foreign born), infants exposed to formula by 28days were four times as likely to die in the postneonatal period as those without formula exposure (aOR = 4.0; 95% CI 3.2-4.9). WIC participants who experienced housing instability at birth were 1.7 times as likely to lose an infant in the postneonatal period (28 to 364days of age) as those in stable housing (aOR = 1.7; 95% CI 1.2, 2.4). Disaggregating Black mortality rates revealed inequities in infant mortality among Black families of varied backgrounds. Formula exposure and housing instability are modifiable risk factors associated with postneonatal mortality. Appropriate interventions to reduce barriers to breastfeeding and provide housing stability for vulnerable families could reduce disparities in postneonatal mortality.

Abstract IA030: Ensuring diversity in clinical trials

Abstract It is well known that minorities, particularly Blacks, are underrepresented in cancer prevention, early detection, and treatment trials. However the mortality rates for Blacks are significantly higher than other race/ethnic groups. Research suggests that community involvement is integral to solving public health problems, including involvement in clinical trials-a gold standard. Significant racial/ethnic disparities exist in the accrual of participants for clinical trials. Location and cultural aspects of clinical trials influence recruitment and accrual to clinical trials. Being able to identify and resolve social determinants of health is essential for clinical trial participation. It is increasingly necessary to be aware of defining characteristics, such as location and culture of the populations from which research participants are enrolled. Utilizing embedded community academic sites to adapt clinical trial research in order to increase minority participation in nontherapeutic cancer clinical trials is warranted. Considerable attention has focused on the need to increase underserved racial and ethnic populations in clinical research, especially in light of the cancer health disparities that disproportionately plague these groups. Clinical trial design and implementation are time-consuming and require a multistep process that is complicated by other factors, including eligibility criteria for clinical trials for underserved racial and ethnic populations, recruitment processes, and patients’ misconceptions or lack of information about clinical trials. Georgetown-Lombardi National Capital Area Minority/Underserved NCORP (NCI Community Oncology Research Program) coupled with the Ralph Lauren Center for Cancer Prevention will reveal strategies and approaches instrumental to our success. These efforts resulted in the development of a strong community capacity–building and clinical research cancer recruitment strategy, and improved engagement of the community in clinical research, thus ensuring diversity in clinical trials. Citation Format: Lucile Adams-Campbell. Ensuring diversity in clinical trials [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA030.

Racial Disparities in Liver Disease Mortality Trends Among Black and White Populations in the United States, 1999-2020: An Analysis of CDC WONDER Database.

Liver disease is a significant public health problem in the United States, with notable racial disparities in mortality. This study examines liver disease mortality trends among Black and White populations during 1999-2020. We used CDC WONDER database to ascertain liver disease age-standardized mortality rates in Black and White Americans. Annual percent change was calculated. Age-standardized absolute rate difference and rate ratios were computed by subtracting and dividing the White population's rate from that of the Black population. Liver diseases accounted for 171,627 Black and 1,314,903 White deaths during 1999-2020. Age-standardized mortality rates for Blacks decreased from 22.5 to 20.1 per 100,000 person-years (annual percentage change -0.4%, -0.6% to -0.2%), whereas an increase was observed for Whites, from 17.9 to 25.3 per 100,000 person-years (annual percentage change 1.4%, 1.4% to 1.7%). The rate ratio decreased from 1.26 (1.22-1.29) in 1999 to 0.79 (0.78-0.81) in 2020. This pattern was evident in all census regions, more pronounced among the younger (age 25-64 years) than older (age 65+ years) population and observed across different urbanization levels. The pattern may be attributable to increasing alcohol-related liver disease and metabolic dysfunction-associated steatotic liver disease-related deaths in Whites and tapering in viral hepatitis and primary liver cancer-related deaths in Blacks. Despite notable improvement, racial disparities persist in primary liver cancer and viral hepatitis among the Black population. The rise in alcohol-related liver disease and metabolic dysfunction-associated steatotic liver disease-related deaths among Whites, and enduring liver cancer and viral hepatitis disparities in the Black population, underscores the urgent need for tailored public health interventions.

Abstract 127: Trends of Racial Disparities and the In-Hospital Outcomes of Patients With Pulmonary Artery Catheterization for Cardiogenic Shock

Introduction: The use of pulmonary artery catheterization (PAC) in patients with cardiogenic shock (CS) has been associated with improved outcomes in non-randomized studies. However, the racial difference in PAC utilization and outcomes in CS have not been assessed. Methods: We identified all patients with CS who had PAC from the national inpatient sample of the Health Care Utilization Project database between 2016 - 2020. Patients were classified according to ethnic groups as white, black, Hispanic, and Asians Outcomes of interest included in-hospital mortality and use mechanical circulatory support (MCS) by ethnic group. Result: From 76,815 patients who underwent PAC during CS admission 64.18% of were Whites, 24.78% Blacks, 8.19% Hispanics, and 2.85% Asians. Black patients were younger, had higher prevalence of obesity, CHF, nicotine use and oxygen dependence. Compared to whites, blacks had lower mortality (aOR: 0.79; CI: 0.69 - 099, p=0.043), respiratory failure (aOR: 0.67; CI: 0.59 - 0.81, p<0.001), mechanical support device utilization (aOR: 0.73, CI; 0.67 - 0.81, p<0.001), and pacemaker utilization (aOR: 0.37; CI: 0.18 - 0.78, p=0.008). Hispanics had a longer length of stay (21 days vs 17.7 days). Blacks had higher rates of PAC use than other racial minorities between and mortality rates in blacks were noted to decline significantly in patients that had PAC during hospitalizations for CS (aOR: 0.49, CI; 0.46 - 0.52, p<0.001). Conclusion: The utilization of PAC in patients with CS is associated with better outcomes, including mortality and this was noted as well in the individual racial subgroups. Despite these findings, racial disparities persist. These disparities could be alleviated by equitable distribution of healthcare resources.

Association of area-level structural racism with racial disparities in cancer mortality.

172 Background: Structural racism (SR) refers to interactive systems of discrimination that perpetuate advantage for one racial group over others. Single-variable SR measures, such as residential segregation and historical red-lining, are associated with cancer disparities but do not represent all aspects of SR. We aimed to develop a composite measure of SR for cancer research and examine the association of county-level SR with disparities in cancer mortality. Methods: Adapting methods from obesity and public safety research, we developed a SR composite score (SRCS) by calculating the ratio of Black to White performance on eight county-level variables across five domains (housing, education, employment, income and healthcare) using race-stratified census data from 2006-2020. Using North Carolina as a test set, we rank-ordered counties on a min-max scale 1-100 for each domain and averaged scores across domains to create the SRCS, where higher SRCS suggests greater SR. Outcomes were county age-standardized mortality rates (per 100k) for all cancers combined, breast, prostate, colorectal and lung cancers, extracted from CDC Wonder for non-Hispanic Blacks and Whites (2000-2020). We used generalized estimating equations to regress mortality rates on SRCS, race, and their interaction. Results: County-level SRCS was positively associated with county-level racial disparities in all-cancer mortality; for each 10-unit increase in SRCS, Black-White difference in rates increased by 15.3/100k (p<0.001). For individual cancers, a 10 unit rise in county SRCS was associated with a 1.93/100k increase in the colorectal cancer mortality gap (p=0.003) and a 6.18/100k increase in the lung cancer mortality gap (p<0.001). SRCS was not associated with mortality disparities for breast and prostate cancers, although these disparities were large. For all-cancer mortality and all tumor types except breast cancer, mortality rates of Whites significantly decreased as SRCS increased, while mortality rates for Blacks remained roughly stable with rising SRCS. Adjustment for county-level measures of social deprivation, unemployment, primary care provider ratio, and severe housing problems did not attenuate the relationship of SRCS with mortality. Conclusions: A composite measure of SR is associated with racial disparities in overall cancer mortality and mortality of specific solid tumors. Continued research is needed to further understand the role of area-level social determinants, ecologic fallacy, and differences in the relationship of SRCS to mortality across cancers. Nevertheless, increased SR is associated with lower county-level cancer mortality among Whites, suggesting that SR may perpetuate cancer mortality disparities via relative advantage to White residents rather than direct disadvantage to Black residents.

Atrial fibrillation/atrial flutter related mortality trends in the US population 2010-2020: Regional, racial, sex variations.

There is an evolving need to evaluate atrial fibrillation/atrial flutter (AF/AFL) mortality trends across races, sexes, geographic regions and urbanization statuses to better understand management inequalities. This observational study utilized the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. Mortality rates due to AF/AFL as underlying and contributing causes of death between 2010 and 2020 were investigated. Mortality trends due to AF/AFL as contributing causes of death for different races, sexes, census regions and urbanization statuses were analyzed using annual percentage change (APC), and Joinpoint regression analysis. Mortality from AF/AFL as the underlying cause was increasing across the US until 2016 (APC 4.8%), followed by a plateau 2016-2020 (APC 0.0 %). Conversely, the mortality rate due to AF/AFL as a contributing cause increases 2010-2020 (APC 3.3%). The mortality rate in both sexes significantly increased in almost all groups, with the largest increase seen in Non-Hispanic Black males. Rural areas had a higher mortality rate (36.9 and 22.9 per 100,000 for males and females in 2020, respectively) and higher slope of increase than urban areas in total US population. Non-Hispanic White people had greater mortality than Non-Hispanic Black people; however, Non-Hispanic Black mortality rates are increasing at a faster rate in urban areas. AF/AFL as the underlying cause of death has plateaued from 2016 across the US 2010-2020; whilst AF/AFL as contributing cause of death is increasing. Significant discrepancies in mortality rates are identified between races and urbanization status.

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.

Oral Cavity and Oropharyngeal Cancer Disparities in Alabama and the United States: A Review

IntroductionIn the United States, an estimated 53,000 people developed new cases of oral cavity and pharyngeal cancers (OPC) in 2019, and an estimated 10,860 deaths were associated with OPC. While oral cavity and pharyngeal cancers affect people of all ages, races, ethnicities, and genders, many recent epidemiological studies of OPC have identified significant disparities in OPC incidence and mortality rates among differing populations. There are 2 main etiologic factors that lead to the development of OPC. The first is by modifiable risk behaviors, and the second is infection by the human papillomavirus (HPV). Studies have shown that HPV not only causes cervical and anal cancers, but also causes a subset of head and neck squamous cell carcinomas (HNSCC). MethodsOPC prevalence, mortality, incidence based on gender, race, and anatomical location published by the Surveillance, Epidemiology, and End Results Program (SEER) and the Alabama Statewide Cancer Registry from 1980 to 2016 were examined. ResultsOral cancer is more common in men than women, among those with a history of tobacco or heavy alcohol use, and individuals infected with HPV. Current trends show that OC and OP cancer incidence are decreasing in African-American males, and that overall incidence rates are highest in White males. Furthermore, incidence rates in Blacks have been decreasing from 1980 from a rate of 16.82 per 100,000 to 8.64 per 100,000 in 2016. In contrast, incidence rates have been relatively unchanged for the White population in the same time period, a decrease from 12.98 to 12.64 per 100,000.According to SEER data of OC and OP cancers, mortality rates in 1980, per 100,000, are 6.97 in Blacks and 3.87 in Whites. However, over the course of the past few decades, data show a dramatic improvement in the mortality rates in Blacks from 6.97 to 2.63 per 100,000 in 2016, and slight improvement in mortality rate in Whites from 3.87 to 2.60 per 100,000 in 2016. One study published in 2009 suggested that better survival outcomes in White OP cancer patients were associated with better-prognosis HPV-positive tumors, which are rarer in the Black population.Interestingly, while overall mortality rates are similar for the White and Black populations with OC and OP cancers in 2016, there is still a significant disparity when looking at the 5-year survival rates. In the period of 1978-1980, the 5-year survival percentage for the White population with OPC is 55.4% vs. 34.9% in the Black population with OPC. In the period of 2009-2015, the 5-year survival rate for the White population with OPC is 70.3% vs. 50.9% in the Black population with OPC. In Alabama, incidence rates for OC and OP cancers have remained stable from 2005 to 2014 with rates from 13.1 to 12.9 per 100,000. Compared to overall incidence rates in the United States from 2010-2015, incidence rates in Alabama were higher for Black males, White males, and females. Mortality rates were also worse for the same patient populations in Alabama as compared to the United States. The higher incidence rates in Alabama may be associated with higher levels of tobacco use in the state as compared to the rest of the country.

The Factors That Contribute to the High Death Rate of Black People in America

During the Covid-19 pandemic, the black mortality rate in the United States of America appears to be higher than that of any other population group. It is interesting as to what factors cause black people to be more susceptible and vulnerable to the coronavirus. Black population is the main focus of this paper. The topic we want to investigate is the outstandingly high mortality rate for the black in the U.S. Throughout the research, we discussed the current situation of black people, demographic and socioeconomical, and conduct mathematical analysis (mainly multivariate OLS method) to try to find out the connection between three different variables: 1. black mortality rate, 2. black infection rate and 3. chronic underlying disease rate. Eventually, we conclude that chronic underlying health conditions rate and infection rate are positively correlated with the death rate of the black population across the United States. One way to interpret this finding is that worse body conditions are less capable of withstanding the attack of Covid-19 and side effects of provisional treatment before vaccine is invented. However, lower respiratory diseases surprisingly turn out to be negatively correlated with the death caused by Covid-19. One plausible interpretation for this surprising result is that people who have gotten such lower respiratory diseases have better precautionary awareness. They may also be more familiar with the healthcare amenities concerned such as masks and ventilators because lower respiratory diseases and Covid-19 fall in the same category.

Changes in COVID-19-Associated Deaths During a Year Among Blacks and Hispanics Compared to Whites in the State of Connecticut.

Background With recent COVID-19 vaccination rates relatively high in the USA, the USA still maintains the most documented cases globally,[1] even though COVID-19 cases, hospitalization, and mortality have been declining. However, the health burden has been largely felt in communities involving racial and ethnic minorities. Thus, in order to provide a clearer picture of what is happening in Black, Indigenous, and people of color communities, we examined the racial/ethnic differences of monthly COVID-19 deaths in Connecticut.MethodsThis is an epidemiological study analyzing mortality data from March 1, 2020, to February 28, 2021, obtained from the Connecticut State Department of Public Health. The data include cause of death (COVID-19 death identified by ICD-10 code U071), race/ethnicity (non-Hispanic White (White), non-Hispanic Black (Black), and Hispanic), sex, and age. Both crude and age-adjusted rates were reported by racial/ethnic groups. To compare age-adjusted rates between racial groups, with estimated age-adjusted death counts as outcomes, between-racial group rate ratios, 95% confidence intervals, and p values significant at < 0.05 were derived from the Poisson regression model.ResultsFrom March 2020 to May 2020 (wave 1) of COVID-19 cases, the COVID-19-related mortality rates were the highest for all three race groups (Whites, Blacks, and Hispanics) with statistical group differences (p < 0.05). Blacks had the highest rates of deaths followed by Hispanics and then Whites. Further, more Whites died in a nursing home when compared to Blacks and Hispanics. From June 2010 to October 2020 (wave 2), COVID-19 mortality declined significantly for all three race groups with no statistical differences between groups. COVID-19 deaths in nursing homes declined for all three racial/ethnic groups. From November 2020 to February 2021 (wave 3), COVID-19 mortality rates were significantly higher compared to wave 2 but lower than wave 1 for all three race groups. The mortality rates for Blacks and Hispanics were higher than Whites. Hispanics had the highest rates of deaths, followed by Blacks, and then Whites (p < 0.05). Whites showed the lowest mortality rates among all three racial/ethnic groups.ConclusionsIn summary, COVID-19 health disparities among Black and Hispanic populations were evident in this study. Blacks and Hispanics had significantly higher mortality rates when compared to Whites. Blacks had the highest mortality rates during wave 1, and in wave 3, Hispanics has the highest mortality rates. Our data are important because they show monthly COVID-19 deaths data by race. Data reported this way gives a better and more accurate understanding of what is really happening in Black, Indigenous, and people of color populations.

The Intersections of Pandemic, Public Policy and Social Inequality in the United States

The COVID-19 pandemic has placed the United States of America (U.S.) under enormous strain, leaving it with higher deaths during the first wave of the outbreak (per 100,000 of population) compared to all other advanced economies. In addition to the elderly, Minorities across all age groups in the U.S. are amongst those hardest hit by the virus. The disparate impact has been attributed to various enduring problems related to the social determinants of health adversely affecting Minorities. The present study explores the relationship between the pandemic, public policy, and race/ethnicity-based vulnerability, as the three have fused to disproportionately impact Minorities. We ask, does greater stringency of state measures aimed at controlling the spread of the virus lead to improved mortality rates for Blacks, Hispanics, and Whites equally? And, if not, to what extent does the role of pre-existing and COVID-specific vulnerability play in determining outcomes observed between groups? To answer these questions, we rely on a mix of correlational and regression analyses. Our findings point to the highly divergent impact of public policy and vulnerability on COVID-19 mortality. This suggests that state-led policy to address both the short-term and long-term consequences of the pandemic needs to account for the particular nature of vulnerability affecting Minorities in the U.S.

Mortality differences in pulmonary fibrosis among the most populated states in the United States

BackgroundRecent studies suggest that the mortality rate of pulmonary fibrosis (PF) in the U.S. is decreasing. However, the mortality trends and demographic differences of PF among the states have not been evaluated. ObjectiveTo evaluate PF-related mortality rates and trends in the nine most populated states in the U.S. MethodsPopulation-based study using the Multiple Cause of Death Database available through the Centers for Disease Control and Prevention website. PF-related deaths were identified using ICD codes. ResultsFrom 2004 to 2018, average annual mortality rates ranged from being the lowest in New York (110.8 per 1,000,000) to the highest in North Carolina (195.3 per 1,000,000). The mortality rates showed a decline in the majority of the states and were stable in the other states. The most significant declines were in California and Michigan. The average mortality rates in males were higher than females in all the states (rate ratio ranged from 1.56 in Texas to 1.81 in New York) and the decline in the mortality rates was more pronounced compared to males in most states. The mortality rates in Blacks were lower compared to Whites in all the states (rate ratio ranged from 0.47 in New York to 0.69 in Ohio) and the decline in the mortality rates over the period was more significant than in Whites. ConclusionsThere is substantial variation in mortality rates and mortality trends between states and different demographics. Further studies are needed to evaluate the environmental factors, diagnostic accuracy, and coding practices contributing to these differences.

Influenza and Pneumonia Mortality Across the 30 Biggest U.S. Cities: Assessment of Overall Trends and Racial Inequities.

Influenza and pneumonia account for substantial morbidity in the United States and show a demonstrated racial inequity. Detailed race-specific analysis at the city level can be used to guide targeted prevention efforts within the most at-risk communities. The purpose of this study is to analyze city-level data of influenza/pneumonia mortality rates and racial disparities across the 30 biggest U.S. cities over time. We assess racial inequities in influenza/pneumonia mortality in the 30 biggest cities and compare city-level trends overtime through age-adjusted overall and race-specific mortality rates calculated from public death records for the years 2008–2017. The national influenza/pneumonia mortality rate significantly decreased as did 45% of the cities included in the study. Nationally, the Black mortality rate was 16% higher than White mortality rate, and a significant disparity was seen within about one-third of the biggest cities. Over half (56%) of the cities showed reductions in both Black and White mortality; however, there was no overall trend in racial equity with some cities reducing the inequities between the Blacks and Whites and others increasing the inequities. Elevated mortality rates in communities of color can be traced to structural racism, social factors, and access to treatment and prevention services. We recommend an approach utilizing community outreach administered through localized public health organizations and supported by data at the city level.

Using machine learning to estimate the effect of racial segregation on COVID-19 mortality in the United States

This study examines the role that racial residential segregation has played in shaping the spread of COVID-19 in the United States as of September 30, 2020. The analysis focuses on the effects of racial residential segregation on mortality and infection rates for the overall population and on racial and ethnic mortality gaps. To account for potential confounding, I assemble a dataset that includes 50 county-level factors that are potentially related to residential segregation and COVID-19 infection and mortality rates. These factors are grouped into eight categories: demographics, density and potential for public interaction, social capital, health risk factors, capacity of the health care system, air pollution, employment in essential businesses, and political views. I use double-lasso regression, a machine learning method for model selection and inference, to select the most important controls in a statistically principled manner. Counties that are 1 SD above the racial segregation mean have experienced mortality and infection rates that are 8% and 5% higher than the mean. These differences represent an average of four additional deaths and 105 additional infections for each 100,000 residents in the county. The analysis of mortality gaps shows that, in counties that are 1 SD above the Black-White segregation mean, the Black mortality rate is 8% higher than the White mortality rate. Sensitivity analyses show that an unmeasured confounder that would overturn these findings is outside the range of plausible covariates.

Diabetes mortality across the 30 biggest U.S. cities: Assessing overall trends and racial inequities

AimsNational data suggest that diabetes mortality disproportionately affects Blacks compared to whites. We aimed to (1) calculate diabetes mortality rates (where diabetes was an underlying cause of death) among the general population of the U.S. and the largest 30 cities; (2) calculate Black/white mortality rate ratios and rate differences; and (3) compare changes in mortality rates and inequities across two 5-year periods (2008–2012 (T1) and 2013–2017 (T2)). MethodsWe used vital statistics mortality data and American Community Survey population estimates. ResultsThe U.S. diabetes mortality rate at T1 was 20.91 per 100,000, and significantly increased to 21.05 at T2. El Paso had the highest diabetes mortality rate at both time points (T1 = 33.06; T2 = 35.98), while San Francisco had the lowest rate (T1 = 11.41; T2 = 13.18). The U.S. Black mortality rate was 2.21 times higher than the white rate at T2 (95%CI [2.19–2.23]). Eleven cities had significantly higher rate ratios than the U.S. at T2. The Black:white rate ratio in Washington, D.C. was approximately three times higher than the national rate ratio. ConclusionsThis city-level data is important to inform more targeted local policy interventions and programming to promote health equity, particularly within cities with the greatest inequities.

Learning From the Past and Working in the Present to Create an Antiracist Future for Academic Medicine.

Learning From the Past and Working in the Present to Create an Antiracist Future for Academic Medicine.

COVID-19 and the Widening Gap in Health Inequity.

The coronavirus disease 2019 (COVID-19) pandemic has brought to light significant health inequities that have existed in our society for decades. Blacks, Hispanics, Native Americans, and immigrants are the populations most likely to experience disparities related to burden of disease, health care, and health outcomes. Increasingly, national and state statistics on COVID-19 report disproportionately higher mortality rates in blacks. There has never been a more pressing time for us to enact progressive and far-reaching changes in social, economic, and political policies that will shape programs aimed at improving the health of all people living in the United States.

Flint Goodridge Hospital and Black Health Care in Twentieth-Century New Orleans

Flint Goodridge Hospital and Black Health Care in Twentieth-Century New Orleans

Racial residential segregation, socioeconomic disparities, and the White-Black survival gap.

ObjectiveTo evaluate the association between racial residential segregation, a prominent manifestation of systemic racism, and the White-Black survival gap in a contemporary cohort of adults, and to assess the extent to which socioeconomic inequality explains this association.DesignThis was a cross sectional study of White and Black men and women aged 35–75 living in 102 large US Core Based Statistical Areas. The main outcome was the White-Black survival gap. We used 2009–2013 CDC mortality data for Black and White men and women to calculate age-, sex- and race adjusted White and Black mortality rates. We measured segregation using the Dissimilarity index, obtained from the Manhattan Institute. We used the 2009–2013 American Community Survey to define indicators of socioeconomic inequality. We estimated the CBSA-level White–Black gap in probability of survival using sequential linear regression models accounting for the CBSA dissimilarity index and race-specific socioeconomic indicators.ResultsBlack men and women had a 14% and 9% lower probability of survival from age 35 to 75 than their white counterparts. Residential segregation was strongly associated with the survival gap, and this relationship was partly, but not fully, explained by socioeconomic inequality. At the lowest observed level of segregation, and with the Black socioeconomic status (SES) assumed to be at the White SES level scenario, the survival gap is essentially eliminated.ConclusionWhite-Black differences in survival remain wide notwithstanding public health efforts to improve life expectancy and initiatives to reduce health disparities. Eliminating racial residential segregation and bringing Black socioeconomic status (SES) to White SES levels would eliminate the White-Black survival gap.

Concordance in the relative mortality rates for prostate cancer and gastric cancer in African Americans.

270 Background: The racial disparity in outcomes for prostate cancer, gastric cancer, and multiple myeloma is demonstrated by these malignancies having the highest age-adjusted mortality rate ratio for black Americans versus white Americans. A variety of factors have been identified as contributing to this disparity, leading to our hypothesis that there would not be concordance, in respect to the mean, when the county-level age-adjusted black: white mortality rate ratio for a malignancy was compared to the other two malignancies. Methods: Publically available information from cancerrates.gov was used to obtain county-level data in regards to race-specific age-adjusted mortality rates for prostate cancer, gastric cancer, and multiple myeloma. Counties with potentially unstable age-adjusted mortality rates were excluded. A malignancy’s age-adjusted mortality rate for blacks was divided by the complementary rate for whites to determine the black: white mortality rate ratio. Across a county, malignancies were compared for concordance in mortality rate ratios relative to the mean ratio for that malignancy. After a preliminary inspection noted that all New Jersey counties had a markedly lower black: white mortality ratio for gastric cancer than other counties in the data set, the New Jersey counties were excluded from analysis and odds ratios for concordance were calculated. Results: All counties (n = 68) had a black: white age-adjusted mortality ratio of &gt; 1 for each malignancy. In the analyzed counties (n = 52), there was a statistically significant concordance in black: white mortality rate ratios for prostate cancer and gastric cancer (OR = 3.26, p = 0.046). The black: white mortality rate ratios for neither prostate cancer (OR = 1.17, p = 0.78) nor gastric cancer (OR = 1.17, p = 0.78) demonstrated a statistically significant concordance with multiple myeloma. Conclusions: The concordance in the black: white mortality rate ratios for prostate cancer and gastric cancer in this dataset indicate that these two malignancies may share common clinical, environmental, or genetic factors in African-Americans. Future research is needed into what common factors may contribute to disparities in these two malignancies.