Data Reveals How Health Outcomes Link to Structural Racism

A recent study from researchers out of Mount Sinai is providing data to support what many have argued in the past few years, that structural racism is linked to poorer health outcomes.

The study, published at the end of last year in JAMA Network Open, linked both global indicators of structural racism (lower percentage of White individuals, lower economic and racial spatial advantage, and higher area deprivation) and discrete indicators (higher reported violent crime, evictions, poverty, unemployment, uninsurance, and child care density, plus lower election participation, income, and education) to poor health outcomes.

These findings confirm a growing hypothesis across the industry. As the concepts of health equity and social determinants of health have grown in prominence, healthcare experts have explored how structural racism ultimately leads to poorer health outcomes and, thus, health disparities.

The researchers, joined by experts at Duke, the University of North Carolina at Chapel Hill, North Carolina State University, and the Feinstein Institutes for Medical Research, zeroed in on Durham County to break down the prevalence of chronic kidney disease (CKD), diabetes, and hypertension, and how it aligns with various indicators of structural racism.

“It was important to look at these three conditions because they are interconnected and highly associated with heart disease, as well as quality and length of life,” Dinushika Mohottige, MD, MPH, assistant professor of Population Science and Policy, and Medicine (Nephrology) at the Icahn School of Medicine at Mount Sinai and the paper’s first author, said in a statement.

“Importantly, Black people share a disproportionate burden of these three illnesses,” added Mohottige, who is also a member of Icahn Mount Sinai’s Institute for Health Equity Research who specializes in kidney health equity and formerly practiced at Duke University.

Using the Durham Neighborhood Compass and the corresponding Durham Community Health Indicators Project website, the researchers linked the prevalence of the three chronic illnesses at the neighborhood level with the global and discrete indicators of structural racism.

“Data which measure health outcomes such as kidney disease and diabetes––and which also measure social determinants of health, including information on the built environment and reported neighborhood violence––help us understand how the conditions where people live affect their well-being,” L. Ebony Boulware, MD, MPH, the dean of Wake Forest University School of Medicine, who served as the paper’s senior author, said in a press release. “This is especially true for groups that, because of their race or ethnicity, historically experience worse health outcomes when compared to others.”

Foremost, the team found that neighborhoods with the lowest proportions of White residents had the highest occurrence of CKD, diabetes, and hypertension. This indicates that these chronic illnesses are concentrated among racial and ethnic minorities, suggesting racial health disparities in disease prevalence.

Next, the team observed a link between the three chronic illnesses and the remaining global measures of structural racism. For example, neighborhoods with greater area deprivation, higher poverty rates, and lower rates of college education also saw higher rates of CKD, diabetes, and hypertension.

Finally, the researchers observed an increase in disease prevalence with discrete measures of structural racism. For example, for every standard deviation increase in reported violent crime, there was 1.15 times the rate of CKD, 1.2 times the rate of diabetes, and 1.08 times the rate of hypertension.

These findings align with what many in the healthcare industry have hypothesized: structural racism can have negative health consequences. However, according to Mohottige, this study is a good step forward in providing evidence.

“This study fills an important evidence gap and helps us identify factors which might be targeted to address community health inequities,” Mohottige explained. “Very limited evidence exists to tie together these structural racism constructs with the aggregate health of individuals in a given neighborhood using electronic health data and rigorous assessments of chronic conditions.”