Racial Residential Segregation Research Articles

Uber to get groceries: Are ride-hail services accessing Chicago’s food deserts?

ABSTRACT Segregation has many negative consequences for marginalized populations, including increased poverty, low-quality housing, and decreased access to quality education, employment, and food stores. This study illuminates how food and transportation infrastructures exacerbate these inequalities and whether ride-hail services like Uber and Lyft help affected populations access food stores. As a descriptive understanding of the intersection between food, transportation, and racial and ethnic residential segregation in Chicago, Illinois, this study analyzes two questions: (1) how often are ride-hail trips crossing food desert census tract boundaries and (2) are ride-hail trips that access food deserts also accessing neighborhoods that contain supermarkets? Using spatial analyses of data from the city of Chicago, the American Community Survey, food store locations, and the USDA food access atlas, this study finds that ride-hail services are accessing food desert neighborhoods at a very low rate, and very few rides access food desert and supermarket-containing neighborhoods in the same trip.

54 Identifying Geographic Clusters of H. pylori Associated Metastatic Early-Onset Gastric Cancer: A case-control study in Los Angeles

OBJECTIVES/GOALS: More young adults (age <50 years) are diagnosed with metastatic gastric cancer (mGC) every year. We will evaluate the association between environmental risk factors (including historical racial residential segregation) clinical, pathologic, molecular features and H.pylori associated early-onset mGC (mE-GC). METHODS/STUDY POPULATION: This retrospective matched case-control study of patients (1:2 by diagnosis year) with mGC (early-onset [E-GC; <50 years]; vs older-onset [O-GC; >50 years]) from 2000-2022 from the Los Angeles Cancer Surveillance Program (LA-CSP) will be enriched by a chart-abstracted cohort from USC Norris Comprehensive Cancer (NCCC). This annotated database captures sociodemographic, medical, and pathologic features of patients treated for mGC at NCCC. It will link to LA-CSP data exploring neighborhood features (obesity rate, poverty, insurance, access to care, ethnic enclave, historical segregation, etc.) of cases and controls to identify, characterize, and compare geographic “hotspot” neighborhoods of mE-GC. We hypothesize younger Hispanic and Asian patients are at higher risk of H.pylori associated mGC. RESULTS/ANTICIPATED RESULTS: From 2000-2022, 339 patients (mE-GC n = 113; mO-GC n=226) were treated at NCCC. We will have characterized clinical and pathological features of mE-GC vs mO-GC. We determined the proportion of H. pylori associated mE-GC vs mO-GC. We will have established the geographical distribution of patients with mE-GC vs mO-GC to identify high-risk neighborhoods. We will link neighborhood risk factors such as food scarcity, poverty, health care access, ethnic enclaves, to the distinct clinical and pathological features of mE-GC, including H. pylori status. Descriptive statistics, chi-square, t-tests, and multivariable regression will be used to compare mE-GC to mO-GC. After controlling for underlying demographics and tumor features, we anticipate clusters of mE-GC and mO-GC in areas of historical racial segregation. DISCUSSION/SIGNIFICANCE: Linking neighborhood and individual risk factors for mE-GC will inform early detection and prevention efforts for vulnerable individuals in high-risk neighborhoods. Building community partnerships within these neighborhoods is essential for developing interventions targeting H. pylori treatment to reduce health disparities in mE-GC.

Hospital racial composition and outcomes after transcatheter and surgical aortic valve replacement.

Key points Racial/ethnic cardiovascular disparities have been demonstrated in optimal cardiovascular health. Racial residential segregation may be a cause of disparities in health. Early outcomes after aortic valve replacement are worse in hospitals treating a larger proportion of non‐White patients.

Neighborhood-level factors associated with COVID-19 vaccination rates: a case study in Chicago

IntroductionChicago’s deeply-rooted racial and socioeconomic residential segregation is a pattern mirrored in other major cities, making it a prototype for studying the uptake of public health interventions across the US. Residential segregation is related to availability of primary care, sense of community, and trust in the healthcare system, components which are essential in the response to crises like Covid-19 in which vaccine rollout was primarily community-based. We aimed to evaluate the association between rates of access to primary care and community-belonging with Covid-19 vaccination within Chicago’s neighborhoods.MethodsData from Chicago Department of Public Health (12/2020-6/2022) on Covid-19 vaccination rates, race/ethnicity (% Black and % Hispanic/Latinx residents), age (% >65), gender (% female), socioeconomic status (% below the federal poverty line), access to needed care rate, and rate of self-reported sense of community-belonging on the neighborhood level were analyzed. Linear mixed models (LMMs) were used to study the impact of variables on vaccination; each neighborhood was added as a random effect to account for with-community association.ResultsThe average Covid-19 vaccination rates across Chicago’s neighborhoods was 79%, ranging from 37 to 100%, with median 81%. We found that Covid-19 vaccination rates were positively correlated with access to needed care (p < 0.001) and community-belonging (p < 0.001). Community areas that had lower vaccination rates had greater percentage of Black residents (p < 0.0001) and greater poverty rates (p < 0.0001). After adjusting for poverty, race, gender and age in the models, the association between vaccination rates and access to care or community-belonging were no longer significant, but % Black residents and poverty remained significant.ConclusionsThough access to needed primary care and community-belonging are correlated with vaccination rates, this association was not significant when controlling for demographic factors. The association between poverty, race and vaccination status remained significant, indicating that socioeconomic and racial disparities across Chicago drive Covid-19 vaccine recommendation adherence regardless of care access. Understanding how poverty, and its intersectional relation to race and primary care access, affects vaccination should be a priority for public health efforts broadly.

Where Does the Black–White Life Expectancy Gap Come From? The Deadly Consequences of Residential Segregation

AbstractThe disparity in life expectancy between white and black Americans exceeds five years for men and three years for women. While prior research has investigated the roles of healthcare, health behaviors, biological risk, socioeconomic status, and life course effects on black mortality, the literature on the geographic origins of the gap is more limited. This study examines how the black–white life expectancy gap varies across counties and how much of the national gap is attributable to within‐county racial inequality versus differences between counties. The estimates suggest that over 90 percent of the national gap can be attributed to within‐county factors. Using a quasi‐experimental research design, I find that black–white residential segregation increases the gap by approximately 16 years for men and five years for women. The segregation effect loads heavily on causes of death associated with access to and quality of healthcare; safety and violence; and public health measures. Residential segregation does not appear to operate through health behaviors or individual‐level factors but instead acts primarily through institutional mechanisms. Efforts to address racial disparities in mortality should focus on reducing racial residential segregation or reducing inequalities in the mechanisms through which residential segregation acts: public services, employment opportunities, and community resources.

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

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

Association Between Changes in Racial Residential and School Segregation and Trends in Racial Health Disparities, 2000-2020: A Life Course Perspective.

Most studies of the relationship between racial segregation and racial health disparities have focused on residential segregation. School-based racial segregation is an additional form of segregation that may be associated with racial disparities in health. This study examines the relationship between both residential segregation and school segregation and racial health disparities among non-Hispanic Black compared to non-Hispanic White persons at the county level in the United States. It also examines the relationship between changes in residential and school segregation and subsequent trajectories in a variety of racial health disparities across the life course. Using the CDC WONDER Multiple Case of Death database, we derived an annual estimate of race-specific death rates and rate ratios for each county during the period 2000-2020. We then examined the relationship between baseline levels of residential and school segregation in 1991 as well as changes between 1991-2000 and the trajectories of the observed racial health disparities between 2000 and 2020. We used latent trajectory analysis to identify counties with similar patterns of residential and school segregation over time and to identify counties with similar trajectories in each racial health disparity. Outcomes included life expectancy, early mortality (prior to age 65), infant mortality, firearm homicide, total homicide, and teenage pregnancy rates. During the period 1991-2020, racial residential segregation remained essentially unchanged among the 1051 counties in our sample; however, racial school segregation increased during this period. Increases in school segregation from 1991 to 2000 were associated with higher racial disparities in each of the health outcomes during the period 2000-2020 and with less progress in reducing these disparities. This paper provides new evidence that school segregation is an independent predictor of racial health disparities and that reducing school segregation-even in the face of high residential segregation-could have a long-term impact on reducing racial health disparities. Furthermore, it suggests that the health consequences of residential segregation have not been eliminated from our society but are now being exacerbated by a new factor: school-based segregation. Throughout this paper, changes in school-based segregation not only show up as a consistent significant predictor of greater racial disparities throughout the life course, but at times, an even stronger predictor of health inequity than residential segregation.

Risk and Protective Factors for Firearm Assault Injuries Among Black Men: A Scoping Review of Research.

Black men are disproportionately affected by firearm assaults in the United States, and these disparities are rooted in structural and social inequities. The objective of this scoping review of research was to identify risk and protective factors for firearm assault injuries among Black men at all levels of the social-ecological framework. The search was conducted in 2021. The initial search generated 1,122 articles. Studies were eligible if they (a) included an analysis of modifiable risk or protective factors for firearm assaults among Black men; (b) reported an estimate of correlation, association, or effect between risk or protective factors and firearm assault injuries, firearm violence, and/or firearm homicides; and (c) were published peer-reviewed articles. In all, 19 articles were identified for review. Risk factors identified at each ecological level include the following: (1) Individual: firearm possession/weapon use and criminal legal system interaction; (2) Relationships: gang membership and exposure to other people who have experienced a firearm assault; (3) Community: indicators for socioeconomic status and racial residential segregation; and (4) Societal: historical racist policy. Individual-level substance use had mixed results. Few (26%) studies examined protective factors at any ecological level, but community-level factors like neighborhood tree cover were identified. Future research needs to examine risk and protective factors at the societal level and multiple ecological levels simultaneously leading to more effective multi-level interventions that will guide policy formation. A greater diversity of study designs, research methods, and theoretical frameworks is needed to better understand factors associated with firearm assault among Black men.

EXPLORING THE EXPERIENCES OF PERCEIVED NEIGHBORHOOD SAFETY OF BLACK ADULTS: RESULTS FROM THE THINK PHRESH STUDY

Abstract Racial residential segregation is a complex socio-economic phenomenon that affects many communities across the U.S. Such residential segregation is a result of historic policies in the United States including redlining and inequitable urban redevelopment. Black adults who live in segregated areas face challenges and experience psychosocial stressors, including poverty, crime, and feeling unsafe in one’s neighborhood which are risk factors for many negative health and cognitive outcomes. To date, few studies have explored perspectives on experiences of racial residential segregation, and specifically, neighborhood safety trajectories that may relate to healthy aging. This qualitative study used data from a sample of participants in adulthood and older adulthood (aged 35-89, Mage= 64 years) from two predominantly black, low-income neighborhoods that have had different histories with regard to disinvestment and systemic racist policies. We used 60 in-depth interviews to explore perceptions around neighborhood safety trajectories and their perceived impact on aging outcomes. The results highlight several dimensions of perceived changes in neighborhood safety over time and how these are perceived to relate to aging outcomes, e.g., psychological stress. The findings also show a few differences between the two neighborhoods concerning policing strategies, individual behaviors, and resource availability, all of which may contribute to perceptions of safety. Implications of this work highlight the importance of developing culturally relevant interventions that target upstream social determinants of healthy aging and health disparities.

Current Approaches to Measuring Local Racial and Ethnic Residential Segregation in Population Health Studies

Current Approaches to Measuring Local Racial and Ethnic Residential Segregation in Population Health Studies

Abstract B094: Geographic accessibility to obstetricians and gynecologists is associated with incidence of live birth among Black adolescent and young adult female cancer survivors in Texas

Abstract Objective: To assess incidence of live birth after cancer diagnosis among Black adolescent and young adult women (AYA) age 15-39 years at diagnosis, and evaluate whether incidence varies by exposure to racial residential segregation, neighborhood poverty, or geographic accessibility to obstetricians/gynecologists.     Methods: Black AYA women diagnosed with cancer between January 1, 1995 and December 31, 2015 were identified using population-based data from the Texas Cancer Registry. These data were linked with live birth certificates through December 31, 2016 to identify the first live birth after diagnosis. We measured three neighborhood characteristics using the 2010 U.S. Census: 1) Black racial residential segregation, using the Index at the Concentration of Extremes; 2) percent of the population living in poverty; and 3) geographic accessibility to obstetricians/gynecologists, calculated using National Provider Identifier data as the supply of healthcare and U.S. Census data as the demand for healthcare. We estimated cumulative incidence of live birth accounting for the competing risk of death, overall and by low vs. high (≥ 20%) poverty and sample-based quartiles of racial residential segregation and geographic accessibility.   Results: We identified 689 first live births to 7,921 Black AYA women after cancer diagnosis. Two-thirds of the sample were age 30 years or older at diagnosis: 27.3% were aged 30-34 and 45.6% were aged 35-39. The most common cancer types were breast (34.3%), gynecologic (16.4%), lymphoma (9.8%), thyroid (8.5%), and gastrointestinal (7.5%). Stage at diagnosis was as follows: local (39.6%), regional (27.8%), distant (19.3%), and missing (13.4%). Five- and ten- year cumulative incidence of live birth after cancer diagnosis was 6.3 (95% confidence interval [CI]: 5.8-6.9) and 9.1 (95% CI: 8.4-9.8), respectively. Incidence of live birth was not associated with racial residential segregation or neighborhood poverty. Cumulative incidence of live birth varied by geographic accessibility to obstetricians/gynecologists (p=.046); however, nonlinear patterns were observed starting around five years after diagnosis, such that those residing in quartiles 1 (lowest accessibility) and 3 had lower incidence of live birth compared to those in quartiles 2 and 4 (highest accessibility).    Discussion:  To our knowledge, this is the first study examining the association of neighborhood characteristics and incidence of live birth in a population-based sample of Black AYA women after cancer diagnosis. We did not observe associations for racial residential segregation or neighborhood poverty. This may indicate that characteristics such as current health status, types of treatment received, or treatment side effects are more relevant for live birth after diagnosis. Geographic accessibility to obstetricians/gynecologists was associated with live birth, but in a nonlinear fashion. Future analyses will assess spatial patterns and potential confounders, such as urban or rural residence, which may account for non-linearity in this association. Citation Format: Sandi L. Pruitt, Jennifer S. Wang, Kevin A. Henry, Lynn N. Ibekwe, Caitlin C. Murphy. Geographic accessibility to obstetricians and gynecologists is associated with incidence of live birth among Black adolescent and young adult female cancer survivors in Texas [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 B094.

Abstract B140: Towards cancer health justice: Considerations in designing a US cohort of 100,000 Black women

Abstract Background. Racism is a fundamental driver of health inequities, perpetuating systemic disadvantages that disproportionately impact marginalized communities. Structural racism affects multiple domains of an individual’s life, including housing, education, health, and employment. Recent studies have leveraged census data to examine the impact of racism—typically captured using area-level factors such as residential racial segregation and neighborhood socioeconomics—on health outcomes, including cancer. However, these studies often fail to capture the complex multidimensional mechanisms by which structural racism uniquely impacts minoritized groups and seldom consider facilitators of resilience, which may better inform interventions. Purpose. Large-scale contemporary cohort studies are needed to understand the drivers of social determinants of health and their potential impact on cancer. The American Cancer Society (ACS) has committed to establishing a US cohort of at least 100,000 Black women to understand multi-level drivers of cancer development and outcomes. Approach. ACS investigators have implemented a culturally sensitive approach that recognizes and validates the experiences of Black women, actively centering them in the design process. Relying on the principles of accountability, rigor, transparency, and impact to guide decision making, the research team has addressed novel challenges around eligibility, recruitment, and retention. ACS investigators considered the mechanisms and frequency of engagement to ensure meaningful participation. They designed survey tools to assess known drivers of cancer and non-cancer outcomes but reflect an understanding of the interconnected systems of oppression that uniquely impact marginalized communities. The research team has also taken steps to address expectations around the collection of biospecimens, recognizing the importance of establishing trust and respecting individual choice. Outcomes. The study population will be comprised of Black women between the ages of 25 and 55 years who reside in the District of Columbia or one of 20 US states. The ACS will partner with organizations primarily representing or serving the target population to identify interested participants. Study activities will be conducted through an online portal optimized for mobile use. Through the portal, interested individuals will complete an electronic eligibility survey, review the informed consent, and complete the 60-minute baseline survey. Follow-up questionnaires will be sent to participants twice per year for at least 30 years to track exposure and health outcomes and their lived experiences. Enrollment will take place in two pilot markets in Fall 2023 to test the feasibility of the recruitment, e-consent, and e-surveys with anticipated full-scale launch and biospecimen substudy in 2024. Conclusions. In designing a cohort of 100,000 Black women, ACS investigators aim to amplify the VOICES of Black women—honoring their lived experience and strengthening partnerships in the community for long-term health improvements.  Citation Format: Lauren E. McCullough, Lauren R. Teras, Anusila Deka, Elizabeth G. Kirkland, Jeshondria McCray, Holly Vins, Jeuneviette E. Bontemps-Jones, Alpa V. Patel. Towards cancer health justice: Considerations in designing a US cohort of 100,000 Black women [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 B140.

Association of maternal education, neighborhood deprivation, and racial segregation with gestational age at birth by maternal race/ethnicity and United States Census region in the ECHO cohorts.

In the United States, disparities in gestational age at birth by maternal race, ethnicity, and geography are theorized to be related, in part, to differences in individual- and neighborhood-level socioeconomic status (SES). Yet, few studies have examined their combined effects or whether associations vary by maternal race and ethnicity and United States Census region. We assembled data from 34 cohorts in the Environmental influences on Child Health Outcomes (ECHO) program representing 10,304 participants who delivered a liveborn, singleton infant from 2000 through 2019. We investigated the combined associations of maternal education level, neighborhood deprivation index (NDI), and Index of Concentration at the Extremes for racial residential segregation (ICERace) on gestational weeks at birth using linear regression and on gestational age at birth categories (preterm, early term, post-late term relative to full term) using multinomial logistic regression. After adjustment for NDI and ICERace, gestational weeks at birth was significantly lower among those with a high school diploma or less (-0.31 weeks, 95% CI: -0.44, -0.18), and some college (-0.30 weeks, 95% CI: -0.42, -0.18) relative to a master's degree or higher. Those with a high school diploma or less also had an increased odds of preterm (aOR 1.59, 95% CI: 1.20, 2.10) and early term birth (aOR 1.26, 95% CI: 1.05, 1.51). In adjusted models, NDI quartile and ICERace quartile were not associated with gestational weeks at birth. However, higher NDI quartile (most deprived) associated with an increased odds of early term and late term birth, and lower ICERace quartile (least racially privileged) associated with a decreased odds of late or post-term birth. When stratifying by region, gestational weeks at birth was lower among those with a high school education or less and some college only among those living in the Northeast or Midwest. When stratifying by race and ethnicity, gestational weeks at birth was lower among those with a high school education or less only for the non-Hispanic White category. In this study, maternal education was consistently associated with shorter duration of pregnancy and increased odds of preterm birth, including in models adjusted for NDI and ICERace.

Racial and Ethnic Residential Segregation and Monocyte DNA Methylation Age Acceleration

Neighborhood segregation and poverty may be important drivers of health inequities. Epigenomic factors, including DNA methylation clocks that may mark underlying biological aging, have been implicated in the link between social factors and health. To examine the associations of neighborhood segregation and poverty with 4 DNA methylation clocks trained to capture either chronological age or physiological dysregulation. This cohort study uses data from the Multi-Ethnic Study of Atherosclerosis (MESA), a longitudinal study that started in 2000 to 2002, with follow-up in 2002 to 2004, 2004 to 2005, 2005 to 2007, and 2010 to 2012. In 2000 to 2002, adults who identified as White or Black race or Hispanic or Chinese ethnicity in 6 US sites (Baltimore, Maryland; Chicago, Illinois; Forsyth County, North Carolina; Los Angeles County, California; Northern Manhattan, New York; and St. Paul, Minnesota) were sampled for recruitment. A random subsample of 4 sites (Maryland, North Carolina, New York, and Minnesota) were selected for inclusion in the MESA epigenomics ancillary study at examination 5 (2010-2012). Participants who identified as White or Black race or Hispanic ethnicity, were aged 45 to 84 years, and did not have clinical cardiovascular disease were included in this analysis. Data were analyzed from May 2021 to October 2023. Information on 2000 census tract poverty and Getis-Ord G statistic segregation of Hispanic residents, non-Hispanic Black residents, or non-Hispanic White residents were linked to participant addresses at examination 1 (2000-2002). At examination 5, DNA methylation was measured in purified monocytes. DNA methylation age acceleration was calculated using 4 clocks trained on either chronological age or physiological dysregulation. Linear regressions were used to test associations. A total of 1102 participants (mean [SD] age, 69.7 [9.4] years; 562 [51%] women) were included, with 348 Hispanic participants, 222 non-Hispanic Black participants, and 533 non-Hispanic White participants. For non-Hispanic Black participants, living in tracts with greater segregation of Black residents was associated with GrimAge DNA methylation age acceleration, a clock designed to capture physiological dysregulation. A 1-SD increase in segregation was associated with 0.42 (95% CI, 0.20-0.64) years age acceleration (P < .001); this association was not observed with other clocks. This association was particularly pronounced for participants living in high poverty tracts (interaction term, 0.24; 95% CI, 0.07-0.42; P = .006). In the overall sample, census tract poverty level was associated with GrimAge DNA methylation age acceleration (β = 0.45; 95% CI, 0.20-0.71; adjusted P = .005). These findings suggest that epigenomic mechanisms may play a role in the associations of segregated and poor neighborhoods with chronic conditions.

Abstract 15643: Social Determinants of Health, Epigenetic Aging, and Subclinical Cardiovascular Disease: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Introduction: Associations of social determinants of health (SDOH) with subclinical cardiovascular disease (CVD), such as left ventricular mass index (LVMI) and coronary artery calcification (CAC), are poorly described. Mechanisms of such associations may involve epigenetic changes like DNA methylation. We sought to examine associations between selected SDOH measures and subclinical CVD, and potential mediation by GrimAge acceleration (GrimAA), a measure of epigenetic aging. Methods: We included 2932 Black and White adults from the CARDIA year 20 (Y20) exam (mean age 45y, 48% Black, 57% female). Associations between SDOH measures at Y20 (or cumulative up to Y20) and Y25 ln(CAC score +1) or LVMI (in g/m 2.7 ) were examined using linear regression. Statistical mediation analysis was used to estimate the proportion of associations attributable to GrimAA among 880 participants in whom it was measured. Results: All selected SDOH measures at Y20 - residential racial segregation (G* Score); census tract poverty; food insecurity; difficulty paying for basics, medications, or healthcare; and maximum years of participant or parental education - were associated with LVMI at Y25 (Table). For example, each 1% higher census tract poverty was associated with an average 0.95 g/m 2.7 higher LVMI. Several SDOH measures were also associated with CAC score at Y25. Similar associations were observed between cumulative SDOH exposures from Y0-Y20 and Y25 subclinical CVD. GrimAA mediated &gt;30% of the statistical association between participant education and LVMI or CAC (Table), and &gt;20% of the associations of residential segregation and census tract poverty with LVMI. Conclusions: SDOH metrics were significantly and longitudinally associated with subclinical CVD in midlife. DNA methylation, as represented by GrimAge acceleration, appears to statistically mediate these associations, suggesting possible molecular mechanisms by which SDOH may accelerate CVD risk.

Abstract 125: The Association of Racial Residential Segregation and Survival to Discharge After Out-of-Hospital Cardiac Arrest in the United States

Introduction: Racial and economic segregation is associated with poor health outcomes, including out-of-hospital cardiac arrest (OHCA) survival. Prior work identified disparities in OHCA survival for Medicare beneficiaries associated with residential segregation. We sought to use registry data to evaluate this association of racial and economic segregation with OHCA survival to discharge. Methods: We conducted a retrospective analysis of the 2013-2021 Cardiac Arrest Registry toEnhance Survival OHCA dataset. Arrests with missing data, pediatric patients, or EMS-witnessed were excluded. Our primary predictor, the index of concentration at the extremes(ICE), is a validated measure of racial and economic segregation. We examined three ICE measures (race, income, and race + income) calculated from US Census data and binned into tract-level quintiles. The primary outcome was survival to discharge. We performed multi-levelPoisson regression, with hospital random effect, and adjusted for age, gender, race and ethnicity, witness status, location, and bystander CPR to predict relative risk of survival to discharge and good neurological outcome. Results: We identified 624,626 adult OHCA patients with median age 64 years (SD 17), 38%female, 22% Black/African American, 50% White, 6.8% Hispanic/Latino. Overall, 156,712 (25%)survived to hospital admission, 10% survived to hospital discharge and 6.3% had good neurological outcome. Patients residing in the most segregated White and higher income tracts(Q5) had a 7-10% higher likelihood of survival to discharge compared to the most segregatedBlack and lower income communities (Q1) across all three measures (race RR: 1.09, CI 1.05-1.12; income RR: 1.07, CI 1.04-1.10; race + income RR: 1.10, CI 1.06-1.13). Similarly, neurological recovery was higher in Q5 (race RR: 1.20, CI 1.15-1.25; income RR: 1.12, CI 1.08-1.16; race + income RR: 1.19, CI 1.15-1.23) compared to Q1. Conclusion: We identified outcome disparities across three ICE measures for residents of the most segregated and lowest income Black census tracts compared to those in most segregated higher income White census tracts. Future work should focus on interventions for these disparities to improve survival and address health inequities.

Association Between Changes in Racial Residential Segregation and Trends in Racial Disparities in Early Mortality in 220 Metropolitan Areas, 2001-2018.

Racial residential segregation has been shown to affect the absolute levels of racial disparities in a wide variety of health outcomes in the USA but it is not known whether changes in segregation also influence these racial health disparities. This study examines the relationship between changes in racial residential segregation over four decades (1980-2020) and trends in racial disparities in early mortality (under age 65) rates among non-Hispanic Black and non-Hispanic White persons across a wide range of health outcomes in 220 metropolitan statistical areas (MSAs) during the period 2001-2018. Using the CDC WONDER Underlying Cause of Death database, we derived annual estimates of race-specific death rates and rate ratios for each MSA. We used latent trajectory analysis to examine the relationship between the level of segregation and changes in segregation over time in an MSA and trends in death rate disparities in that MSA. The trajectory analysis resulted in a linear, three group model in which trajectory Groups 1 and 2 had decreasing trends in the ratios of Black to White death rates over time while in Group 3, the disparity remained almost constant over time. Increases in the level of segregation in an MSA from 1980 to 2000 were significantly associated with the likelihood that the MSA was in Group 3 and experienced no improvement in racial health disparities in mortality over time. This paper provides new evidence that changes in segregation are related to trends in racial health disparities in mortality rates over time.

Association between racial residential segregation and walkability in 745 U.S. cities

Despite higher chronic disease prevalence, minoritized populations live in highly walkable neighborhoods in US cities more frequently than non-minoritized populations. We investigated whether city-level racial residential segregation (RRS) was associated with city-level walkability, stratified by population density, possibly explaining this counterintuitive association. RRS for Black-White and Latino-White segregation in large US cities was calculated using the Index of Dissimilarity (ID), and walkability was measured using WalkScore. Median walkability increased across increasing quartiles of population density, as expected. Higher ID was associated with higher walkability; associations varied in strength across strata of population density. RRS undergirds the observed association between walkability and minoritized populations, especially in higher population density cities.

Geovisualization of Temporal Change in Urban Racial Geography: A Step towards Explaining Persistent Segregation

To better understand the persistence of residential racial segregation in U.S. cities, it is essential to develop testable, spatially explicit models of racial dynamics. However, the original census data are not formatted in a way that facilitates the testing of such models. In this study, we propose a novel geoprocessing pipeline that transforms census data into image-like geovisualization of urban segregation. The process consists of converting original data to a grid format, transforming subpopulation shares in each grid cell into a CMYK color, and multiyear clustering of CMYK values followed by classification and smoothing of images. When applied to data from multiple censuses, our methodology generates a time series of snapshots that depict the spatio-temporal dynamics of racial change. As a demonstration, we have utilized our methodology to generate racial images for a period spanning from 1990 to 2020 in seven major cities. Detailed results are shown for Chicago and Atlanta. By visually examining these time series, we have identified patterns that challenge the conventional Schelling model of racial change. Instead, our findings point towards a model that incorporates the interplay of preferential growth and diffusion as significant factors that shape the complex dynamics of racial composition in these urban areas.

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

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