Carceral-community epidemiology, structural racism, and COVID-19 disparities.
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ABSTRACT:
SUBMITTER: Reinhart E
PROVIDER: S-EPMC8166074 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:COVID-19 is challenging many societal institutions, including our criminal justice systems. Some have proposed or enacted (e.g., the State of New Jersey) reductions in the jail and/or prison populations. We present a mathematical model to explore the epidemiologic impact of such interventions in jails and contrast them with the consequences of maintaining unaltered practices. We consider infection risk and likely in-custody deaths, and estimate how within-jail dynamics lead to spill-over risks, not only affecting incarcerated people but increasing exposure, infection, and death rates for both corrections officers and the broader community beyond the justice system. We show that, given a typical jail-community dynamic, operating in a business-as-usual way results in substantial, rapid, and ongoing loss of life. Our results are consistent with the hypothesis that large-scale reductions in arrest and speeding of releases are likely to save the lives of incarcerated people, jail staff, and the wider community.
| S-EPMC9148636 | biostudies-literature
Project description:ImportanceUnderstanding how structural racism is associated with adolescent mental health is critical to advance health equity.ObjectiveTo assess associations between neighborhood privilege, measured by the Index of Concentration at the Extremes (ICE) and adolescent depressive symptoms, suicidality, and related racial and ethnic disparities.Design, setting, and participantsThis was a retrospective cohort study using electronic health records of adolescents aged 12 to 16 years who attended well-teen visits between 2017 and 2021. Kaiser Permanente Northern California is an integrated health care delivery system serving 4.6 million members. The cohort included 34 252 individuals born singleton at an affiliated facility from January 1, 2005, to December 31, 2009, and who had completed at least 1 mental health screener during a well-teen visit by November 23, 2021.ExposuresAmerican Community Survey 2016 to 2021 5-year estimates were used to calculate ICE scores for adolescents' residential census tract at ages 10 to 11. Three ICE measures were used as proxies of structural racism: racial privilege (ICE-race and ethnicity; hereinafter ICE-race), economic privilege (ICE-income), and combined economic and racial privilege (ICE-income plus race and ethnicity; herinafter ICE-income plus race). ICE scores were categorized into quintiles based on California statewide distributions.Main outcomes and measuresDepressive symptoms and suicidality were assessed through self-report screeners during well-teen visits. Depressive symptoms were considered to be present if patients had a score on the Patient Health Questionnaire-2 of 3 or higher (the tool uses a Likert scale to determine the frequency [0 = not at all; 3 = nearly every day] that they had depressed mood and lack of pleasure in usual activities in the past 2 weeks; responses were summed and dichotomized).ResultsAnalyses included 34 252 adolescents (12-16 years of age; mean [SD] age, 13.7 [0.8] years; 17 557 [51.3%] male, 7284 [21.3%] Asian or Pacific Islander, 2587 [7.6%] Black], 9061 [26.5%] Hispanic, 75 [0.2%] American Indian or Indigenous, 12 176 [35.5%] White, and 3069 [9%] other or unknown). Risks of depressive symptoms and suicidality generally increased with each level of declining neighborhood privilege. Adjusted risk ratios comparing adolescents from neighborhoods with the least to most racial and economic privilege were 1.37 (95% CI, 1.20-1.55) for depressive symptoms and 1.59 (95% CI, 1.23-2.05) for suicidality. Racial disparities between Black and White youth and Hispanic and White youth decreased after adjusting for each ICE measure, and became nonsignificant in models adjusting for ICE-race and ICE-income plus race.Conclusions and relevanceIn this cohort study, lower neighborhood privilege was associated with greater risks of adolescent depressive symptoms and suicidality. Furthermore, adjusting for neighborhood privilege reduced mental health disparities affecting Black and Hispanic adolescents. These findings suggest that efforts to promote equity in adolescent mental health should extend beyond the clinical setting and consider the inequitable neighborhood contexts that are shaped by structural racism.
| S-EPMC10439477 | biostudies-literature
Project description:Substantial health disparities exist across race/ethnicity in the USA, with Black Americans often most affected. The current COVID-19 pandemic is no different. While there have been ample studies describing racial disparities in COVID-19 outcomes, relatively few have established an empirical link between these disparities and structural racism. Such empirical analyses are critically important to help defuse "victim-blaming" narratives about why minority communities have been badly hit by COVID-19. In this paper, we explore the empirical link between structural racism and disparities in county-level COVID-19 outcomes by county racial composition. Using negative binomial regression models, we examine how five measures of county-level residential segregation and racial disparities in socioeconomic outcomes as well as incarceration rates are associated with county-level COVID-19 outcomes. We find significant associations between higher levels of measured structural racism and higher rates of COVID-19 cases and deaths, even after adjusting for county-level population sociodemographic characteristics, measures of population health, access to healthcare, population density, and duration of the COVID-19 outbreak. One percentage point more Black residents predicted a 1.1% increase in county case rate. This association decreased to 0.4% when structural racism indicators were included in our model. Similarly, one percentage point more Black residents predicted a 1.8% increase in county death rates, which became non-significant after adjustment for structural racism. Our findings lend empirical support to the hypothesis that structural racism is an important driver of racial disparities in COVID-19 outcomes, and reinforce existing calls for action to address structural racism as a fundamental cause of health disparities.
| S-EPMC7815192 | biostudies-literature
Project description:In this study, we introduce the 'racial opportunity gap' as a place-based measure of structural racism for use in population health research. We first detail constructing the opportunity gap using race-sex specific estimates of intergenerational economic mobility outcomes for a recent cohort. We then illustrate its utility in examining spatial variation in the racial mortality gap. First we demonstrate a correlation between the racial opportunity gap and the racial mortality gap across U.S. counties; where the gap in the adult earnings of black and white children born to families at the same income level is greater so, too, is the gap in mortality. Second, we show in a multivariable framework that the racial opportunity gap is associated with the racial mortality gap net of differences in the socioeconomic composition of the two groups. In so doing, we aim to provide population health researchers with a new empirical tool and analytic framework for examining the role of structural racism in generating racial health disparities.
| S-EPMC7076092 | biostudies-literature
Project description:IntroductionStructural racism is strongly related to racial health disparities. However, surprisingly few studies have developed empirical tools to measure structural racism. In addition, the few measures that have been employed have only considered structural racism at the neighborhood level. To expand upon previous studies, this paper uses a novel measure to measure structural racism at the county level for the non-Hispanic Black population.MethodsWe used confirmatory factor analysis to create a model to measure the latent construct of structural racism for 1181 US counties. The model included five indicators across five dimensions: racial segregation, incarceration, educational attainment, employment, and economic status/wealth. Structural equation modeling and factor analysis were used to generate factor scores that weighted the indicators in order to produce the best model fit. The resulting factor scores represented the level of structural racism in each county. We demonstrated the utility of this measure by demonstrating its strong correlation with Black-White disparities in firearm homicide rates.ResultsOur calculations revealed striking geographic differences across counties in the magnitude of structural racism, with the highest values generally being observed in the Midwest and Northeast. Structural racism was significantly associated with higher Black firearm homicide rates, lower White homicide rates, and a higher Black-White racial disparity in firearm homicide.ConclusionsThese new measures can be utilized by researchers to relate structural racism to racial health disparities at the county level.
| S-EPMC9744051 | biostudies-literature
Project description:Non-Hispanic Black (NHB) and Hispanic patients with acute myeloid leukemia (AML) have higher mortality rates than non-Hispanic White (NHW) patients despite more favorable genetics and younger age. A discrete survival analysis was performed on 822 adult patients with AML from 6 urban cancer centers and revealed inferior survival among NHB (hazard ratio [HR] = 1.59; 95% confidence interval [CI]: 1.15, 2.22) and Hispanic (HR = 1.25; 95% CI: 0.88, 1.79) patients compared with NHW patients. A multilevel analysis of disparities was then conducted to investigate the contribution of neighborhood measures of structural racism on racial/ethnic differences in survival. Census tract disadvantage and affluence scores were individually calculated. Mediation analysis of hazard of leukemia death between groups was examined across 6 composite variables: structural racism (census tract disadvantage, affluence, and segregation), tumor biology (European Leukemia Network risk and secondary leukemia), health care access (insurance and clinical trial enrollment), comorbidities, treatment patterns (induction intensity and transplant utilization), and intensive care unit (ICU) admission during induction chemotherapy. Strikingly, census tract measures accounted for nearly all of the NHB-NHW and Hispanic-NHW disparity in leukemia death. Treatment patterns, including induction intensity and allogeneic transplant, and treatment complications, as assessed by ICU admission during induction chemotherapy, were additional mediators of survival disparities in AML. This is the first study to formally test mediators for observed disparities in AML survival and highlights the need to investigate the mechanisms by which structural racism interacts with known prognostic and treatment factors to influence leukemia outcomes.
| S-EPMC9710198 | biostudies-literature
Project description:Abstract The relationship between pandemic, or chronic infectious diseases, and the carceral, meaning set‐apart spaces of enforced confinement for “wrong‐doers,” has a long, tangled history. It features in Foucault's inquiries into disciplinary power and its associated spatial formations, not least in the shape of the modern prison. Drawing lightly from Foucault's claims about disciplinary and biopolitical power, as well as on his anti‐prison activism, this paper explores three possibilities for penal transformation arising during the early months of COVID‐19 in UK prisons (circa March to August 2020). Consulting primary source material, these possibilities are respectively identified as “retrenching,” “reworking” or “reducing” the carceral. A chief finding is that under the press of pandemic “emergency,” the tilt of emphasis has been towards a retrenched or reworked “carceral state,” disappointing any promise of abolition, let alone more humble reduction in carceral conditions. The “biological sub‐citizens” of prisons are hence being left especially vulnerable to the press of pandemic, in part precisely because of how carceral spatialities are being intensified. Short Abstract The relationship between pandemic, or chronic infectious diseases, and the carceral, meaning set‐apart spaces of enforced confinement for “wrong‐doers,” has a long, tangled history. It features in Foucault’s inquiries into disciplinary power and its associated spatial formations, not least in the shape of the modern prison. Drawing lightly from Foucault’s claims about disciplinary and biopolitical power, as well as on his anti‐prison activism, this paper explores three possibilities for penal transformation arising during the early months of COVID‐19 in UK prisons.
| S-EPMC9347962 | biostudies-literature
Project description:Building on nascent literature examining the health-related effects of vicarious structural racism, we examined indirect exposure to the Flint Water Crisis (FWC) as a predictor of birth outcomes in Michigan communities outside of Flint, where residents were not directly exposed to lead-contaminated water. Using linear regression models, we analyzed records for all singleton live births in Michigan from 2013 to 2016, excluding Flint, to determine whether birth weight (BW), gestational age (GA), and size-for-gestational-age (SzGA) decreased among babies born to Black people, but not among babies born to White people, following the highly publicized January 2016 emergency declaration in Flint. In adjusted regression models, BW and SzGA were lower for babies born to both Black and White people in the 37 weeks following the emergency declaration compared to the same 37-week periods in the previous 3 years. There were no racial differences in the association of exposure to the emergency declaration with BW or SzGA. Among infants born to Black people, GA was 0.05 weeks lower in the 37-week period following the emergency declaration versus the same 37-week periods in the previous 3 years (95% CI: -0.09, -0.01; p = 0.0177), while there was no change in GA for infants born to White people following the emergency declaration (95% CI: -0.01, 0.03; p = 0.6962). The FWC, which was widely attributed to structural racism, appears to have had a greater impact, overall, on outcomes for babies born to Black people. However, given the frequency of highly publicized examples of anti-Black racism over the study period, it is difficult to disentangle the effects of the FWC from the effects of other racialized stressors.
| S-EPMC9486078 | biostudies-literature
Project description:ObjectiveTo examine differences in community mobility reduction and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outcomes across counties with differing levels of socioeconomic disadvantage.MethodsThe sample included counties in the United States with at least one SARS-CoV-2 case between April 1 and May 15, 2020. Outcomes were growth in SARS-CoV-2 cases, SARS-CoV-2-related deaths, and mobility reduction across three settings: retail/recreation, grocery/pharmacy, and workplace. The main explanatory variable was the social deprivation index (SDI), a composite socioeconomic disadvantage measure.ResultsAdjusted differences in outcomes between low-, medium-, and high-SDI counties (defined by tertile) were calculated using linear regression with state-fixed effects. Workplace mobility reduction was 1.75 (95% CI, -2.36 to -1.14; P<.001) and 3.48 percentage points (95% CI, -4.21 to -2.75; P<.001) lower for medium- and high-SDI counties relative to low-SDI counties, respectively. Mobility reductions in the other settings were also significantly lower for higher-SDI counties. In analyses adjusted for SARS-CoV-2 prevalence on April 1, medium- and high-SDI counties had 1.39 (95% CI, 0.85 to 1.93; P<.001) and 2.56 (95% CI, 1.77 to 3.34; P<.001) more SARS-CoV-2 cases/1000 population on May 15 compared with low-SDI counties, respectively. Deaths per capita were also significantly higher for higher-SDI counties.ConclusionCounties with higher social deprivation scores experienced greater growth in SARS-CoV-2 cases and deaths, but reduced mobility at lower rates. These findings are consistent with evidence demonstrating that economically disadvantaged communities have been disproportionately impacted by the coronavirus disease 2019 pandemic. Efforts to socially distance may be more burdensome for these communities, potentially exacerbating disparities in SARS-CoV-2-related outcomes.
| S-EPMC7580696 | biostudies-literature
Project description:ObjectiveThis study contributes to the literature by empirically testing the extent to which place-based structural racism is a driver of state-level racial inequalities in COVID-19 mortality using theoretically-informed, innovative approaches.MethodsCDC data are used to measure cumulative COVID-19 death rates between January 2020 and August 2022. The outcome measure is a state-level Black-White (B/W) ratio of age-adjusted death rates. We use state-level 2019 administrative data on previously validated indicators of structural racism spanning educational, economic, political, criminal-legal and housing to identify a novel, multi-sectoral latent measure of structural racism (CFI = 0.982, TLI = 0.968, and RMSEA = 0.044). We map B/W inequalities in COVID-19 mortality as well as the latent measure of structural racism in order to understand their geographic distribution across U.S. states. Finally, we use regression analyses to estimate the extent to which structural racism contributes to Black-White inequalities in COVID-19 mortality, net of potential confounders.ResultsResults reveal substantial state-level variation in the B/W ratio of COVID-19 death rates and structural racism. Notably, regression estimates indicate that the relationship between the structural racism and B/W inequality in COVID-19 mortality is positive and statistically significant (p < 0.001), both in the bivariate model (adjusted R2 = 0.37) and net of the covariates (adjusted R2 = 0.54). For example, whereas states with a structural racism value 2 standard deviation below the mean have a B/W ratio of approximately 1.12, states with a structural racism value 2 standard deviation above the mean have a ratio of just above 2.0.DiscussionFindings suggest that efficacious health equity solutions will require bold policies that dismantle structural racism across numerous societal domains.
| S-EPMC9723349 | biostudies-literature