Racial Differences In Exposure Research Articles

25 Evaluating serum copper and kidney function in a cohort of bariatric surgery patients

OBJECTIVES/GOALS: High serum copper (Cu) levels have previously been described in bariatric patients. The kidneys are a target organ for Cu toxic insult but the role of Cu on kidney function (eGFR) is uncertain. This study examines the association between Cu and eGFR in a bariatric population in Southeast Louisiana. METHODS/STUDY POPULATION: Seven hundred fifty patients will be recruited from the Bariatric Center of the University Medical Center in New Orleans. Inclusion criteria include: age ≥ 18 years, clinic visit between June 1, 2018 – May 31st 2024, and having a serum Cu test result. Covariables such as inflammatory markers and hormonal contraception use will be assessed as potential confounders. Blood pressure will be assessed as a potential effect modifier. Data will be obtained from electronic medical records. Two cohorts will be assembled, a pre-surgery cross-sectional cohort and another followed post-surgery. Separate models will be developed stratified by race-ethnicity. RESULTS/ANTICIPATED RESULTS: In a pilot study of bariatric patients 26% had elevated (>155 mcg/dl) serum Cu and pronounced racial differences were noted. Characteristics consisted of a mean BMI of approximately 50 kg/m2; 91% were female and 69% were Black. Black patients had approximately double the prevalence (OR 1.98; 95% CI: 1.15, 3.4) compared to white patients. Due to the dual nature of the kidneys’ involvement in metabolism via excretion and being the target organ for toxic insult, racial differences in exposure, coupled with the disproportionate rates of chronic kidney disease in Black adults, may be an explanation for the association between elevated Cu levels and eGFR in Black adults in this study. DISCUSSION/SIGNIFICANCE: Results from this study will provide insight into the prevalence of Cu and its association with kidney function in a bariatric population. Chronic kidney disease or other forms of renal impairment may result in the need for more conservative guidelines for dietary copper in bariatric medicine.

IHeard STL: Development and first year findings from a local surveillance and rapid response system for addressing COVID-19 and other health misinformation.

The U.S. Surgeon General and others have emphasized a critical need to address COVID-19 misinformation to protect public health. In St. Louis, MO, we created iHeard STL, a community-level misinformation surveillance and response system. This paper reports methods and findings from its first year of operation. We assembled a panel of over 200 community members who answered brief, weekly mobile phone surveys to share information they heard in the last seven days. Based on their responses, we prioritized misinformation threats. Weekly surveillance data, misinformation priorities, and accurate responses to each misinformation threat were shared on a public dashboard and sent to community organizations in weekly alerts. We used logistic regression to estimate odds ratios (ORs) for associations between panel member characteristics and misinformation exposure and belief. In the first year, 214 panel members were enrolled. Weekly survey response rates were high (mean = 88.3% ± 6%). Exposure to a sample of COVID-19 misinformation items did not differ significantly by panel member age category or gender; however, African American panel members had significantly higher reported odds of exposure and belief/uncertain belief in some misinformation items (ORs from 3.4 to 17.1) compared to white panel members. Our first-year experience suggests that this systematic, community-based approach to assessing and addressing misinformation is feasible, sustainable, and a promising strategy for responding to the threat of health misinformation. In addition, further studies are needed to understand whether structural factors such as medical mistrust underly the observed racial differences in exposure and belief.

Salty Subjects: Unpacking Racial Differences in Salt-Sensitive Hypertension.

To review underlying mechanisms and environmental factors that may influence racial disparities in the development of salt-sensitive blood pressure. Our group and others have observed racial differences in diet and hydration, which may influence salt sensitivity. Dietary salt elicits negative alterations to the gut microbiota and immune system, which may increase hypertension risk, but little is known regarding potential racial differences in these physiological responses. Antioxidant supplementation and exercise offset vascular dysfunction following dietary salt, including in Black adults. Furthermore, recent work proposes the role of racial differences in exposure to social determinants of health, and differences in health behaviors that may influence risk of salt sensitivity. Physiological and environmental factors contribute to the mechanisms that manifest in racial differences in salt-sensitive blood pressure. Using this information, additional work is needed to develop strategies that can attenuate racial disparities in salt-sensitive blood pressure.

Moving Out and Apart: Race, Poverty, and the Suburbanization of Public School Segregation

Purpose: As US suburbs experience profound demographic shifts, scholars have expressed concern of rising segregation among suburban public schools. We extend this work by examining exposure to poverty by race and racial differences in exposure to economic disadvantage in the wake of the Great Recession across a typology of suburban neighborhoods in the Chicago metropolitan area. Research Methods/Approach: We merge enrollment data from schools with census data on the demographic and economic attributes of residents and examine racial differences in exposure to school poverty. Findings: We find intrasuburban variation, with all racial groups seeing a stark increase in economic school segregation between 2007 and 2018, with Whites experiencing the largest growth in inner suburbs, and Black and Hispanics increasingly disadvantaged in outer suburbs. Implications: Our findings underscore complex forms of suburban disadvantage in rapidly diversifying suburbs.

EXPLORING RACIAL DISPARITIES IN AD/ADRD RISK: EVERYDAY DISCRIMINATION AS A SOCIAL STRESSOR

Abstract Using evidence from the Health and Retirement Study (HRS), we explore racial disparities in Alzheimer’s Disease and Related Dementia (AD/ADRD) risk. From a stress process perspective, there is substantial evidence in the literature that everyday discrimination is a chronic strain for Black individuals that acts as a social determinant of illness. However, few studies have examined specific relationships between this social stressor, race and AD/ADRD risk. Using generalized linear regression and Cox proportional hazard models, we explored racial differences in exposure and vulnerability to everyday discrimination. Results suggest that Black individuals experience more frequent exposure to everyday discrimination than their counterparts, and this chronic strain predicts AD/ADRD risk. However, contrary to the stress process model, White respondents were more vulnerable to the effect of everyday discrimination on AD/ADRD risk. Racial bias from medical professionals during the diagnostic process as well as mortality selection bias may explain these unexpected findings, especially given that racial minorities who experience high rates of everyday discrimination may not live long enough to reach the average age of diagnosis. These results provide further evidence that discrimination is a key factor in explaining racial disparities in late-life disorders, while also taking into consideration that many racial minorities with high rates of this type of stress may not survive to late-life.

Racial Disparities in Mortality During the 1918 Influenza Pandemic in United States Cities.

Against a backdrop of extreme racial health inequality, the 1918 influenza pandemic resulted in a striking reduction of non-White to White influenza and pneumonia mortality disparities in United States cities. We provide the most complete account to date of these reduced racial disparities, showing that they were unexpectedly uniform across cities. Linking data from multiple sources, we then examine potential explanations for this finding, including city-level sociodemographic factors such as segregation, implementation of nonpharmaceutical interventions, racial differences in exposure to the milder spring 1918 "herald wave," and racial differences in early-life influenza exposures, resulting in differential immunological vulnerability to the 1918 flu. While we find little evidence for the first three explanations, we offer suggestive evidence that racial variation in childhood exposure to the 1889-1892 influenza pandemic may have shrunk racial disparities in 1918. We also highlight the possibility that differential behavioral responses to the herald wave may have protected non-White urban populations. By providing a comprehensive description and examination of racial inequality in mortality during the 1918 pandemic, we offer a framework for understanding disparities in infectious disease mortality that considers interactions between the natural histories of particular microbial agents and the social histories of those they infect.

The Role of Kinship in Racial Differences in Exposure to Unemployment.

Most studies on unemployment have assessed its individual-level costs. However, beyond its effects on individuals, unemployment incurs costs for their immediate families and extended kin. Close kin provide the majority of social support for unemployed adults. Applying demographic and statistical techniques to official statistics and using COVID-19 survey data on kinship and labor force experience, we assess the unemployment level and exposure to unemployment in the United States from a kinship perspective. The results indicate dramatic racial disparities in the number of unemployed kin and the number of kin affected by an unemployed person. Specifically, during the pandemic-induced recession, Black Americans had 1.7 unemployed people in their extended family compared with 1.2 among Whites. Further, every job loss in a Black extended family affected approximately 23 related members of the family through kinship ties, compared with approximately 20 among Whites. The racial gap in the number of unemployed kin is evident in all age-groups and escalates with age. This study's findings highlight the need to understand unemployment and its demographic implications, which are stratified by race.

Does the Chronic Stress of Everyday Discrimination or Race Itself Better Predict AD Onset Risk?

Using evidence from the Health and Retirement Study, we explore racial disparities in Alzheimer's Disease (AD) onset risk. From a stress process perspective, there is substantial evidence in the literature that everyday discrimination is a chronic strain for Black individuals that acts as a social determinant of illness. However, few studies have examined specific relationships between this social stressor, race, and AD onset risk. Using Cox Proportional Hazard Models, we examined racial differences in exposure and vulnerability to everyday discrimination. Findings suggest that everyday discrimination predicts AD onset risk, and Black individuals experience more frequent exposure to everyday discrimination as a chronic strain. However, contrary to the stress process model, Black respondents were not more vulnerable to the effect of everyday discrimination on AD onset risk. Racial bias from medical professionals during the diagnostic process and mortality selection bias may explain this effect. Overall, the results of this study provide further evidence that discrimination is a key factor in predicting AD while also considering that many racial minorities with high rates of this type of social stress may not receive an unbiased diagnosis and/or survive to late life to develop AD.

Racial Segregation and School Poverty in the United States, 1999–2016

Research over the past decade suggests that racial segregation appears to have the largest implications for students’ achievement when linked to racial differences in exposure to school poverty. This paper provides a summary and update to prior literature describing patterns and trends of racial differences in school poverty rates from the 1998–1999 through 2015–2016 school years. We describe black-white and Hispanic-white differences in school poverty rates within U.S. school districts, metropolitan areas, states, and the nation over this nearly 20-year period. We find that while exposure to poverty in schools has risen dramatically, racial differences in exposure to school poverty have been relatively stable during this time. These average trends, however, belie meaningful variability among places. Places serving large proportions of minority students have larger but declining average racial differences in exposure to school poverty. Large school districts also have larger average racial differences in exposure and have been experiencing increases in this measure over time.

Misdemeanor Disenfranchisement? The Demobilizing Effects of Brief Jail Spells on Potential Voters

This paper presents new causal estimates of incarceration’s effect on voting, using administrative data on criminal sentencing and voter turnout. I use the random case assignment process of a major county court system as a source of exogenous variation in the sentencing of misdemeanor cases. Focusing on misdemeanor defendants allows for generalization to a large population, as such cases are very common. Among first-time misdemeanor defendants, I find evidence that receiving a short jail sentence decreases voting in the next election by several percentage points. Results differ starkly by race. White defendants show no demobilization, while Black defendants show substantial turnout decreases due to jail time. Evidence from pre-arrest voter histories suggest that this difference could be due to racial differences in exposure to arrest. These results paint a picture of large-scale, racially-disparate voter demobilization in the wake of incarceration.

Death of family members as an overlooked source of racial disadvantage in the United States

Long-standing racial differences in US life expectancy suggest that black Americans would be exposed to significantly more family member deaths than white Americans from childhood through adulthood, which, given the health risks posed by grief and bereavement, would add to the disadvantages that they face. We analyze nationally representative US data from the National Longitudinal Study of Youth (n = 7,617) and the Health and Retirement Study (n = 34,757) to estimate racial differences in exposure to the death of family members at different ages, beginning in childhood. Results indicate that blacks are significantly more likely than whites to have experienced the death of a mother, a father, and a sibling from childhood through midlife. From young adulthood through later life, blacks are also more likely than whites to have experienced the death of a child and of a spouse. These results reveal an underappreciated layer of racial inequality in the United States, one that could contribute to the intergenerational transmission of health disadvantage. By calling attention to this heightened vulnerability of black Americans, our findings underscore the need to address the potential impact of more frequent and earlier exposure to family member deaths in the process of cumulative disadvantage.

Understanding Racial Differences in Exposure to Violent Areas: Integrating Survey, Smartphone, and Administrative Data Resources.

Emerging evidence indicates that exposure to violent areas may influence youth wellbeing. We employ smartphone GPS data on youth activity spaces to examine the extent of, and potential explanations for, racial disparities in these exposures. Multilevel models of data from the Adolescent Health and Development in Context study indicate that exposures to violent areas vary significantly across days of the week and between youth who reside in the same neighborhood. African American youth are exposed to areas with substantially higher levels of violence. Residing in a disadvantaged neighborhood is significantly associated with exposure to violent areas and explains a non-trivial proportion of the racial difference in this outcome. However, neighborhood factors are incomplete explanations of the racial disparity. Characteristics of the activity locations at which youth spend time explain the residual racial disparity in exposure to violent areas. These findings highlight the importance of youth activity spaces, above and beyond their neighborhood environments.

Abstract IA02: Genetic, environmental, and biological contributions to racial disparities in lung cancer incidence

Abstract Lung cancer is the leading cause of cancer-related deaths in the United States (1). In addition, there are significant disparities in lung cancer across populations. Compared with European Americans, African Americans are disproportionally affected by lung cancer, both in terms of incidence and survival (2,3). Lung adenocarcinoma among African Americans is 1.30 (1.10 - 1.90) times higher compared with European Americans; squamous cell carcinoma 1.80 (95% C.I. 1.1 - 2.3) times higher (4). There are also differences in lung cancer outcomes between European Americans and African Americans (2,5), some of which may be due to differences in cell biology between these two populations. However, studies have generally shown that differences in access to care may explain most of the variance in survival times (5-7). In addition, the gains in survival over the past 20 years among lung cancer patients have been similar in both European Americans and African Americans. Thus, the causal factors – genetic, environmental or otherwise – that lead to a greater incidence of lung cancer in African Americans are largely unknown. Smoking is the strongest risk factor for lung cancer development. However, several studies suggest that smoking prevalence and behaviors do not fully explain the disparity in lung cancer incidence. For example, African Americans have a lower smoking prevalence than European Americans and only 5.8% of African Americans are heavy smokers, compared with 19.2% of European Americans (8). In fact, when one compares smoking rates across ethnic groups matched for equal levels of smoking, African Americans still experience a higher burden of lung cancer incidence (8) - although this is attenuated with higher numbers of cigarettes smoked per day. This has led some to suggest that African Americans are more susceptible to the carcinogenic effects of tobacco at lower doses. However, this has not been empirically tested. It is possible that there are differences in nicotine and tobacco carcinogen metabolism between European Americans and European Americans that could account for the differences in cancer incidence between. On average, 72% of nicotine is converted to cotinine, the primary proximate metabolite of nicotine (9). Racial and ethnic differences in urinary (10,11) and blood cotinine (11-13) concentration per cigarette smoked have been well established. In addition, studies have found that levels of NNK metabolites (11,14) and thiocyanate (11) are higher in African Americans compared with European Americans. However, no clear genes or pathways have yet been identified that explain the disparity. And, given the strong relationship between smoking and lung cancer, it is hard to completely discount smoking as a cause of incidence disparities (8). Other risk factors to explain higher lung cancer incidence among African Americans include genetics, SES, smoking, BMI, and/or alcohol consumption. Recent studies show that the same loci associated with risk of lung cancer in European American smokers, i.e., chr15q25, are also associated with lung cancer in African Americans (15-18). Disparities in lung cancer incidence could be driven by the environment. For example, a recent study found that African Americans were more likely to reside in areas with the highest levels of air toxin exposure (19). Studies of breast and prostate cancer (20,21) have shown that whatever the cause of cancer health disparities, the consequences of these disparities manifest themselves as differences in the molecular and cell biology of the cancer. In lung cancer, we have explored the biological differences between lung cancer in European Americans and African Americans. These studies show that while some of the perturbed pathways in lung cancer remain the same for European Americans and African Americans, there are specific differences distinct to African Americans. Continued research efforts in the field are needed to determine the contribution of smoking, and indeed other factors, to lung cancer disparities. This work needs to be complemented with research that dissects the consequences of these disparities and the translation of these discoveries into improved patient care.

Exposure to Pre- and Perinatal Risk Factors Partially Explains Mean Differences in Self-Regulation between Races.

ObjectivesTo examine whether differential exposure to pre- and perinatal risk factors explained differences in levels of self-regulation between children of different races (White, Black, Hispanic, Asian, and Other).MethodsMultiple regression models based on data from the Early Childhood Longitudinal Study, Birth Cohort (n ≈ 9,850) were used to analyze the impact of pre- and perinatal risk factors on the development of self-regulation at age 2 years.ResultsRacial differences in levels of self-regulation were observed. Racial differences were also observed for 9 of the 12 pre-/perinatal risk factors. Multiple regression analyses revealed that a portion of the racial differences in self-regulation was explained by differential exposure to several of the pre-/perinatal risk factors. Specifically, maternal age at childbirth, gestational timing, and the family’s socioeconomic status were significantly related to the child’s level of self-regulation. These factors accounted for a statistically significant portion of the racial differences observed in self-regulation.ConclusionsThe findings indicate racial differences in self-regulation may be, at least partially, explained by racial differences in exposure to pre- and perinatal risk factors.

By all measures: an examination of the relationship between segregation and health risk from air pollution

A great deal of evidence suggests that African-Americans in more racially segregated communities are at a higher risk for a variety of health problems. Scholars have argued that these health inequalities might be explained by racial differences in exposure to air toxins. However, there are a number of ways to measure segregation, each representing different pathways of exposure. There has yet to be a systematic evaluation of how exposure to air toxins varies by these different measures, making it difficult to begin to theorize about the causal story linking segregation, pollution and health. This paper addresses this gap by examining how the health risk from industrial toxins varies by the 19 most commonly used segregation measures. Results show that, with the exception of two segregation measures, living in metro areas with relatively higher segregation levels, is associated with significantly greater health risk from industrial air toxins for all racial groups. Moreover, African-Americans in more segregated metro areas typically experience an added risk of exposure compared to non-Hispanic whites.

Acute infection contributes to racial disparities in stroke mortality

It is unknown whether racial differences in exposure to acute precipitants of stroke, specifically infection, contribute to racial disparities in stroke mortality. Among participants in the nationally representative Health and Retirement Study with linked Medicare data (1991-2007), we conducted a case-crossover study employing within-person comparisons to study racial/ethnic differences in the risks of death and hospitalization from ischemic stroke following acute infection. There were 964 adults hospitalized for ischemic stroke. Acute infection increased the 30-day risks of ischemic stroke death (5.82-fold) and ischemic stroke hospitalization (1.87-fold). Acute infection was a more potent trigger of acute ischemic stroke death in non-Hispanic blacks (odds ratio [OR] 39.21; 95% confidence interval [CI] 9.26-166.00) than in non-Hispanic whites (OR 4.50; 95% CI 3.14-6.44) or Hispanics (OR 5.18; 95% CI 1.34-19.95) (race-by-stroke interaction, p = 0.005). When adjusted for atrial fibrillation, infection remained more strongly associated with stroke mortality in blacks (OR 34.85) than in whites (OR 3.58) and Hispanics (OR 3.53). Acute infection increased the short-term risk of incident stroke similarly across racial/ethnic groups. Infection occurred often before stroke death in non-Hispanic blacks, with 70% experiencing an infection in the 30 days before stroke death compared to a background frequency of 15%. Acute infection disproportionately increases the risk of stroke death for non-Hispanic blacks, independently of atrial fibrillation. Stroke incidence did not explain this finding. Acute infection appears to be one factor that contributes to the black-white disparity in stroke mortality.

Racial Differences in Exposure and Reactivity to Daily Family Stressors

Using data from the National Study of Daily Experiences (NSDE), this study examined racial differences in exposure and reactivity to daily stressors involving family members. Respondents included African American and European American adults aged 34 to 84 (N = 1,931) who participated in 8 days of daily interviews where they reported on daily stressors, affect, and physical health symptoms. Results revealed racial similarities in family stressor exposure. Both races were also emotionally reactive to family arguments and family network events (i.e., events that happen to a family member), whereas African Americans were more physically reactive to family arguments. For African Americans, reactivity to family arguments endured; the increased negative affect and physical symptoms associated with family arguments lasted into the next day. Findings provide evidence for racial similarities and differences, suggesting that family relationships are universally stressful, whereas the negative effects of family stressors are more enduring among African Americans.

Spatial and temporal dimensions of neighborhood effects on high school graduation

Research into the effects of neighborhood characteristics on children’s behavior has burgeoned in recent years, but these studies have generally adopted a limited conceptualization of the spatial and temporal dimensions of neighborhood effects. We use longitudinal data from the Panel Study of Income Dynamics and techniques of spatial data analysis to examine how both the socioeconomic characteristics of extralocal neighborhoods—neighborhoods surrounding the immediate neighborhood of residence—and the duration of exposure to disadvantaged neighborhoods throughout the childhood life course influence the likelihood of graduating from high school. Among blacks and whites, socioeconomic advantage in the immediate neighborhood increases the likelihood of completing high school, but among whites higher levels of socioeconomic advantage in extralocal neighborhoods decrease high school graduation rates. Extralocal neighborhood advantage suppresses the influence of advantage in the immediate neighborhood so that controlling for extralocal conditions provides stronger support for the neighborhood effects hypothesis than has previously been observed. Exposure to advantaged neighborhoods over the childhood life course exerts a stronger effect than point-in-time measures on high school graduation, and racial differences in exposure to advantaged neighbors over the childhood life course help to suppress a net black advantage in the likelihood of completing high school.

Racial Differences in Self-Reported Exposure to Information about Hospice Care

Previous research suggests that lack of knowledge of hospice is a barrier to the use of hospice care by African Americans. However, there is little data examining racial differences in exposure to hospice information. Examine racial differences in self-reported exposure to hospice information and determine how this exposure impacts beliefs about hospice care. We surveyed 200 community-dwelling older adults (65 or older). We used Spearman's correlations to examine the relationship between responses to individual items on the Hospice Beliefs and Attitudes Scale (HBAS) and self-reported exposure to hospice information (never heard of hospice, heard a little, or heard a lot). We used multivariate analyses to examine predictors of exposure to hospice information and beliefs about hospice care (total score on HBAS). Compared to whites (n = 95), African Americans (n = 105) reported significantly less exposure to hospice information (p = 0.0004). Nineteen percent of African Americans and 4% of whites had never heard of hospice; 47.6% of African Americans and 71.6% of whites had heard a lot about hospice. In multivariate analysis controlling for demographics and health status, African Americans had a two times higher odds of reporting that they had never heard of hospice or heard only a little about hospice versus heard a lot about hospice (odds ratio [OR] = 2.24 [1.17, 4.27]. Greater exposure to hospice information was associated with more favorable beliefs about hospice care (outcome: total score on HBAS; parameter estimate 1.34, standard error 0.44, p = 002). African Americans reported less exposure to information about hospice than whites. Greater exposure to hospice information was associated with more favorable beliefs about some aspects of hospice care. Because knowledge is power, educational programs targeting older African Americans are needed to dispel myths about hospice and to provide minorities with the tools to make informed choices about end-of-life care.

Teaching and Learning Guide for: Racial Residential Segregation in Urban America

Teaching and Learning Guide for: Racial Residential Segregation in Urban America