Structural racism and myocardial infarction in the United States
Structural racism and myocardial infarction in the United States
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DOI：
10.1016/j.socscimed.2013.07.021
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发表时间：
2014-02-01
影响因子：
5.4
通讯作者：
Keyes, Katherine M.
中科院分区：
文献类型：
--
作者：
Lukachko, Alicia;Hatzenbuehler, Mark L.;Keyes, Katherine M.
越来越多的研究文献表明，种族主义是损害美国黑人健康的一个重要风险因素。种族主义可以采取多种形式，从人际互动到制度/结构条件和做法。然而，现有的研究往往侧重于使用自我报告措施来研究个人形式的种族歧视。人们很少关注结构性种族主义是否会损害美国黑人的健康。目前的研究通过使用结构性种族主义的新措施并明确检验结构性种族主义是美国黑人心肌梗塞的危险因素这一假设，弥补了现有研究中的空白。国家层面的结构性种族主义指标包括四个领域：（1）政治参与； （二）就业及工作状况； （三）受教育程度； （四）司法处理。提出这些领域的州级种族差异代表了黑人被系统性地排除在社会资源和流动性之外。去年心肌梗死的数据来自全国酒精及相关疾病流行病学调查（非西班牙裔黑人：N = 8245；非西班牙裔白人：N = 24,507），这是一项针对 18 岁及以上美国平民、非机构化人群的全国代表性调查。模型根据个人层面的混杂因素（年龄、性别、教育、家庭收入、医疗保险）以及州层面的贫困差异进行了调整。结果表明，生活在结构性种族主义程度较高的州的黑人通常比生活在结构性种族主义程度较低的州的黑人更有可能报告过去一年的心肌梗塞。相反，与生活在低结构性种族主义州的白人相比，生活在高结构性种族主义州的白人患心肌梗塞的几率为零或更低。这些结果提出了一种令人兴奋的可能性，即结构性种族主义不仅可能损害污名化的目标，而且还可能使那些掌握污名化和歧视权力的人受益。 (C) 2013 Elsevier Ltd. 保留所有权利。
There is a growing research literature suggesting that racism is an important risk factor undermining the health of Blacks in the United States. Racism can take many forms, ranging from interpersonal interactions to institutional/structural conditions and practices. Existing research, however, tends to focus on individual forms of racial discrimination using self-report measures. Far less attention has been paid to whether structural racism may disadvantage the health of Blacks in the United States. The current study addresses gaps in the existing research by using novel measures of structural racism and by explicitly testing the hypothesis that structural racism is a risk factor for myocardial infarction among Blacks in the United States. State-level indicators of structural racism included four domains: (1) political participation; (2) employment and job status; (3) educational attainment; and (4) judicial treatment. State-level racial disparities across these domains were proposed to represent the systematic exclusion of Blacks from resources and mobility in society. Data on past-year myocardial infarction were obtained from the National Epidemiologic Survey on Alcohol and Related Conditions (non-Hispanic Black: N = 8245; non-Hispanic White: N = 24,507), a nationally representative survey of the U.S. civilian, non-institutionalized population aged 18 and older. Models were adjusted for individual-level confounders (age, sex, education, household income, medical insurance) as well as for state-level disparities in poverty. Results indicated that Blacks living in states with high levels of structural racism were generally more likely to report past-year myocardial infarction than Blacks living in low-structural racism states. Conversely, Whites living in high structural racism states experienced null or lower odds of myocardial infarction compared to Whites living in low-structural racism states. These results raise the provocative possibility that structural racism may not only harm the targets of stigma but also benefit those who wield the power to enact stigma and discrimination. (C) 2013 Elsevier Ltd. All rights reserved.