Abstract P208: The Differential Impact Of Residential Segregation On Gestational Hypertension Development Among Minority Women

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Mary D Schiff ◽  
Anthony Fabio ◽  
Tiffany Gary-Webb ◽  
Dara Mendez
Keyword(s):  
Black Women ◽  
Residential Segregation ◽  
Census Tract ◽  
Gestational Hypertension ◽  
Cardiometabolic Health ◽  
Economic Segregation ◽  
Birth Record ◽  
Child Bearing ◽  
Record Data ◽  
Us Census

Introduction: Higher levels of residential segregation have been associated with poorer cardiometabolic health profiles among women. Still, it remains unclear whether segregation may differentially impact the development of gestational hypertension (gHTN) among an ethnically-diverse cohort of pregnant women. We used birth record data from 2003-2009 and data from the 2000 US Census to determine whether racial and economic segregation are associated with gHTN among a diverse cohort of child-bearing women in the greater Philadelphia area. Methods: We quantified racial and economic segregation using sociodemographic data from the US Census and the local Getis-Ord (Gi*) spatial statistic. The Gi* produces a spatially-weighted z-score for each census tract reflecting the degree of clustering of racially-similar neighborhoods in an area relative to the surrounding Philadelphia region. We categorized each type of segregation as low (Gi*<0), moderate (Gi*0-1.96), or high (Gi*>1.96), and assigned these to each woman by her census tract of residence. Gestational hypertension was defined in the birth record data as the development of pregnancy-induced hypertension or preeclampsia. We used hierarchical generalized linear mixed effect models to obtain risk ratios and differences (per 1000 women) for the relationships between each form of residential segregation and gHTN. All models were stratified by maternal race/ethnicity, and sequentially adjusted for maternal sociodemographics, health behaviors, medical histories, and neighborhood-level characteristics. Results: Our sample consisted of 220,897 Non-Hispanic (NH) Black (26%), NH White (64%), and Hispanic (10%) women, of whom 4% developed gHTN. However, a much greater proportion of NH Black women both developed gHTN and lived in high segregation neighborhoods compared to NH Whites and Hispanics. After adjustment, NH Black women in moderate and high economic segregation areas had 16% higher risk (RR=1.16, 95% CI: 1.03-1.31) and 23% higher risk (RR=1.23, 95% CI: 1.08-1.39) of gHTN, respectively, compared to NH Black women living in low segregation areas. NH Black women in highly racially segregated neighborhoods saw an additional 9 cases of gHTN (per 1000 women) compared to NH Black women living in more racially integrated neighborhoods (RD=8.47, 95% CI: 3.14-13.80). Among NH White and Hispanic women, economic segregation was not associated with gHTN, and only marginally significant findings were observed for racial segregation. Conclusions: In our diverse sample of child-bearing women from the greater Philadelphia area, higher levels of racial and economic segregation were associated with greater risk of gHTN among NH Black women. Future work should seek to delineate the specific pathways by which neighborhoods differentially impact individual level cardiovascular health based upon race.

scholarly journals Cancer Incidence and Multilevel Measures of Residential Economic and Racial Segregation for Cancer Registries

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Nancy Krieger ◽  
Justin M Feldman ◽  
Rockli Kim ◽  
Pamela D Waterman
Keyword(s):  
Lung Cancer ◽  
Residential Segregation ◽  
Census Tract ◽  
Total Population ◽  
Racial Segregation ◽  
Economic Segregation ◽  
Census Tract Level ◽  
Race Ethnicity ◽  
Incident Cases ◽  
The City

Abstract Background The handful of studies (<30) on cancer and residential segregation have focused on racial segregation, primarily at the city/town level. We tested a priori hypotheses about choice of measure and level by extending use of the Index of Concentration at the Extremes (ICE) to quantify both economic and racial residential segregation, singly and combined, and conducted analyses for the total population and stratified by race/ethnicity. Methods Outcomes comprised Massachusetts incidence rates (2010–2014) for invasive breast, cervical, and lung cancer, analyzed in relation to census tract and city/town ICE measures for income, race/ethnicity, race/ethnicity + income, and the federal poverty line. Multilevel Poisson regression modeled observed counts of incident cases. Results Both choice of metric and level mattered. As illustrated by cervical cancer, in models including both the census tract and city/town levels, the rate ratio for the worst to best quintile for the total population was greatest at the census tract level for the ICE for racialized economic segregation (3.0, 95% confidence interval [CI] = 2.1 to 4.3) and least for the poverty measure (1.9, 95% CI = 1.4 to 2.6), with null associations at the city/town level. In analogous models with both levels for lung cancer, however, for the non-Hispanic black and Hispanic populations, the rate ratios for, respectively, the ICE and poverty measures, were larger (and excluded 1) at the city/town compared with the census tract level. Conclusions Our study suggests that the ICE for racialized economic segregation, at multiple levels, can be used to improve monitoring and analysis of cancer inequities.

scholarly journals Racial Residential Segregation and Hypertensive Disorder of Pregnancy Among Women in Chicago: Analysis of Electronic Health Record Data

2018 ◽  
Vol 31 (11) ◽  
pp. 1221-1227 ◽  
Author(s):  
Stephanie L Mayne ◽  
Disha Yellayi ◽  
Lindsay R Pool ◽  
William A Grobman ◽  
Kiarri N Kershaw
Keyword(s):  
Black Women ◽  
Residential Segregation ◽  
Census Tract ◽  
Hypertensive Disorder ◽  
Electronic Health Record Data ◽  
Racial Residential Segregation ◽  
Maternal Characteristics ◽  
Neighborhood Poverty ◽  
Hypertensive Disorder Of Pregnancy ◽  
Electronic Health

Abstract BACKGROUND Racial residential segregation is associated with higher rates of chronic hypertension, as well as greater risk of preterm birth and low birthweight. However, few studies have examined associations between segregation and hypertensive disorder of pregnancy (HDP). METHODS Electronic health records from 4,748 singleton births among non-Hispanic black women at Prentice Women’s Hospital in Chicago, IL (2009–2013) were geocoded to the census tract level. Residential segregation was measured using the Gi* statistic, a z-score measuring the extent to which each individual’s neighborhood composition deviates from the composition of the larger surrounding area. Segregation was categorized as low (z &lt; 0), medium (z = 0–1.96) or high (z &gt; 1.96). We estimated cross-sectional associations of segregation with HDP using multilevel logistic regression models with census tract random intercepts. Models adjusted for neighborhood poverty and maternal characteristics. We also examined effect modification by neighborhood poverty. RESULTS Overall, 27.2% of women lived in high segregation, high-poverty neighborhoods. Racial residential segregation was not associated as a main effect with HDP in models adjusting for neighborhood poverty and maternal characteristics. However, at higher levels of neighborhood poverty (&gt;20%), women living in high- and medium-segregated neighborhoods had greater odds of HDP relative to those in low-segregation neighborhoods (P interaction: 0.002). CONCLUSIONS In this sample of non-Hispanic black women in Chicago, racial residential segregation was associated with greater prevalence of HDP among those living in higher poverty neighborhoods. Understanding sources of heterogeneity in the relationship between segregation and health will help refine targeted intervention efforts to reduce disparities.

scholarly journals Income Inequality and Economic Segregation in Los Angeles from 1980 to 2010

2021 ◽  
pp. 371-387
Author(s):  
John R. Hipp ◽  
Jae Hong Kim
Keyword(s):  
Los Angeles ◽  
Income Inequality ◽  
Residential Segregation ◽  
Gini Coefficient ◽  
Metropolitan Regions ◽  
Economic Segregation ◽  
The Gini Coefficient ◽  
Time Period ◽  
The Us ◽  
Us Census

AbstractRising income inequality is a critical problem in both the global North and South. In the United States, the Gini coefficient measuring nationwide income inequality rose from 0.403 in 1980 to 0.480 in 2014 (US Census), and residential segregation by income has increasingly occurred in many metropolitan regions and is particularly reflected in the spatial separation of the wealthiest households. This chapter focuses on the change in the level of income inequality in the Los Angeles region since 1980 and how it is related to changes in residential segregation between economic groups over that same time period. We use data from the US Census collected in 1980, 1990, 2000, and 2010. We measure residential segregation between economic groups based on occupational structure, and measure ‘neighbourhoods’ using Census tracts: these are units defined by the US Census and typically average about 4,000 residents. The overall level of inequality in the region is measured at each decade point using the Gini coefficient for household income. Maps demonstrate where different socioeconomic status groups have tended to locate and how economic segregation has changed in Los Angeles over this time period. We also assess the extent to which changes in inequality are related to changes in economic segregation over the last four and a half decades.

Abstract MP66: Social Determinants And Co-morbid Conditions In Women Of Child-bearing Age With Hypertension From 2001-2018

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Lara C Kovell ◽  
Claire Meyerovitz ◽  
Didem Ayturk ◽  
Stephen P Juraschek ◽  
Tiffany A Moore Simas ◽  
...  
Keyword(s):  
Black Women ◽  
Social Determinants ◽  
White Women ◽  
Hispanic Women ◽  
Private Insurance ◽  
Anthropometric Measures ◽  
Mortality And Morbidity ◽  
Child Bearing ◽  
Race Ethnicity ◽  
Morbid Conditions

Introduction: Hypertension (HTN) is the most important modifiable risk factor of serious maternal mortality and morbidity. Social determinants, including economic stability and access to healthcare, influence HTN outcomes and are critical to understanding and addressing racial and ethnic differences in HTN control. Objective: To assess social determinants and co-morbidities in US women of child-bearing age with HTN by race/ethnicity Methods: We studied women (age 20-50) with HTN in the National Health and Nutrition Examination Surveys 2001-2018. Social determinants and co-morbid conditions were examined in groups categorized by race/ethnicity - Non-Hispanic White (White), Non-Hispanic Black (Black), and Hispanic. Demographics, anthropometric measures, and co-morbid conditions were compared with White women as reference. Results: In all women with HTN, the mean (SE) age was 36.0 (0.3) years and 63% were on BP medication. Compared to white women, Black and Hispanic women had lower food security, poverty income ratio, smoking use, and private insurance (all p<0.0001, Table ). Black women had higher BP medication use, BMI, and BP compared to White women (all p<0.0001). Hispanic women had higher rates of diabetes (p=0.009) and no place to go for healthcare (p=0.005) compared to White women. Food insecurity was present in 34% of Hispanic women. Conclusions: Despite effective diagnostics and therapy, health inequity is common in women of child-bearing age with HTN, with differences by race/ethnicity in social determinants and co-morbid conditions. Each racial/ethnic group with HTN brings social determinants and comorbid conditions important for providers to recognize.

scholarly journals Racial/Ethnic Disparities in Mammogram Frequency Among Women With Intellectual Disability

2019 ◽  
Vol 57 (3) ◽  
pp. 177-187 ◽  
Author(s):  
Evelyn Arana ◽  
Amy Carroll-Scott ◽  
Philip M. Massey ◽  
Nora L. Lee ◽  
Ann C. Klassen ◽  
...  
Keyword(s):  
Intellectual Disability ◽  
Black Women ◽  
Medical Record ◽  
Ethnic Groups ◽  
White Women ◽  
Ethnic Disparities ◽  
Medical Record Data ◽  
Record Data ◽  
Race Ethnicity ◽  
Racial Ethnic

Abstract Little information exists on the associations between intellectual disability (ID) and race/ethnicity on mammogram frequency. This study collected survey and medical record data to examine this relationship. Results indicated that Hispanic and Black women with ID were more likely than White women with ID to have mammograms every 2 years. Participants who live in a state-funded residence, were aged 50+, and had a mild or moderate level of ID impairment were more likely to undergo mammography compared to participants living with family or alone, were &lt;50, and had severe ID impairment. Further research is needed to understand the mechanisms explaining disparities in mammograms between these racial/ethnic groups.

scholarly journals Neighborhood Socioeconomic Status in Relation to All-cause, Cancer, and Cardiovascular Mortality in the Black Women’s Health Study

2016 ◽  
Vol 26 (2) ◽  
pp. 157 ◽  
Author(s):  
Traci N. Bethea ◽  
Julie R. Palmer ◽  
Lynn Rosenberg ◽  
Yvette C. Cozier
Keyword(s):  
Socioeconomic Status ◽  
Black Women ◽  
Cardiovascular Mortality ◽  
Health Study ◽  
Block Group ◽  
Census Block ◽  
Census Block Group ◽  
Neighborhood Socioeconomic Status ◽  
Us Census ◽  
Neighborhood Ses

<p><strong>Background</strong>: Neighborhood socioeconomic status (SES) is associated with adverse health outcomes, but longitudinal data among Black Americans, who tend to live in more deprived neighborhoods, is lacking. <br />Objectives: We prospectively assessed the relation of neighborhood SES to mortality in the Black Women’s Health Study.</p><p><strong>Design</strong>: A prospective cohort of 59,000 Black women was followed from 1995-2011. Participant addresses were geocoded and US Census block group was identified. Neighborhood SES was measured by a score based on US Census block group data for six indicators of income, education and<br />wealth.</p><p><strong>Main outcome measures:</strong> Deaths were identified through the National Death Index. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% CIs with control for covariates.</p><p><strong>Results</strong>: Based on 2,598 deaths during 1995-2011, lower neighborhood SES was associated with increased all-cause and cancer mortality irrespective of individual education: among those with 16 or more years of education, HRs for lowest relative to highest neighborhood SES quartile were 1.42 (95% CI 1.18-1.71) for all-cause and 1.54 (95% CI 1.14-2.07) for cancer mortality. Neighborhood SES was associated with cardiovascular mortality among lesseducated women.</p><p><strong>Conclusions</strong>: Lower neighborhood SES is associated with greater risk of mortality among Black women. The presence of the association even among women with high levels of education suggests that individual<br />SES may not overcome the unfavorable influence of neighborhood deprivation. <em>Ethn Dis</em>. 2016;26(2):157-164; doi:10.18865/<br />ed.26.2.157</p>

Turkish-Style Segregation

2017 ◽  
Vol 45 (3) ◽  
pp. 235-270 ◽  
Author(s):  
Ela Ataç
Keyword(s):  
Residential Segregation ◽  
Urban Areas ◽  
Economic Status ◽  
Anglo Saxon ◽  
The West ◽  
Common Pattern ◽  
Economic Segregation ◽  
Socio Economic Status ◽  
Different Characteristics ◽  
Shed Light

Research into social and spatial segregation in urban areas has a very long tradition in the Anglo-Saxon geography. Even after the 2000s only a few researchers have turned to the non-Western countries to understand and explain segregation in different geographies. As a country in-between the East and the West, in Turkey, where segregation reveals itself in many forms there are very few studies dealing directly with the question of segregation. The article thus deems it crucial to shed light on a rarely-known geography in terms of residential and socio-economic segregation practices focusing on a larger Anatolian geography. Key findings show that as far as residential segregation is concerned among socio-economic status groups, Turkish cities have a characteristic pattern where the highest and the lowest status groups never share a common border in urban areas. But, it is also seen that socio-economic groups behind this common pattern exhibit completely different characteristics.

Racial Disparity in Postpartum Readmission due to Hypertension among Women with Pregnancy-Associated Hypertension

2020 ◽  
Author(s):  
Rebecca Chornock ◽  
Sara N. Iqbal ◽  
Tetsuya Kawakita
Keyword(s):  
Risk Factors ◽  
Black Women ◽  
Maternal Age ◽  
White Women ◽  
Task Force ◽  
Gestational Hypertension ◽  
Mode Of Delivery ◽  
Chronic Hypertension ◽  
Antihypertensive Medications ◽  
Initial Discharge

Abstract Objective Postpartum hypertension is a leading cause of readmission in the postpartum period. We aimed to examine the prevalence of racial/ethnic differences in postpartum readmission due to hypertension in women with antepartum pregnancy-associated hypertension. Study Design This was a multi-institutional retrospective cohort study of all women with antepartum pregnancy-associated hypertension diagnosed prior to initial discharge from January 2009 to December 2016. Antepartum pregnancy-associated hypertension, such as gestational hypertension, preeclampsia (with or without severe features), hemolysis, elevated liver enzyme, low platelet (HELLP) syndrome, and eclampsia was diagnosed based on American College of Obstetricians and Gynecologists Task Force definitions. Women with chronic hypertension and superimposed preeclampsia were excluded. Our primary outcome was postpartum readmission defined as a readmission due to severe hypertension within 6 weeks of postpartum. Risk factors including maternal age, gestational age at admission, insurance, race/ethnicity (self-reported), type of antepartum pregnancy-associated hypertension, marital status, body mass index (kg/m2), diabetes (gestational or pregestational), use of antihypertensive medications, mode of delivery, and postpartum day 1 systolic blood pressure levels were examined. Multivariable logistic regression models were performed to calculate adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs). Results Of 4,317 women with pregnancy-associated hypertension before initial discharge, 66 (1.5%) had postpartum readmission due to hypertension. Risk factors associated with postpartum readmission due to hypertension included older maternal age (aOR = 1.44; 95% CI: 1.20–1.73 for every 5 year increase) and non-Hispanic black race (aOR = 2.12; 95% CI: 1.16–3.87). Conclusion In women with pregnancy-associated hypertension before initial discharge, non-Hispanic black women were at increased odds of postpartum readmission due to hypertension compared with non-Hispanic white women.

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