The intricacy of structural racism measurement: A pilot development of a latent-class multidimensional measure.
The intricacy of structural racism measurement: A pilot development of a latent-class multidimensional measure.
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DOI：
10.1016/j.eclinm.2021.101092
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发表时间：
2021-10
影响因子：
15.1
通讯作者：
Hardeman RR
中科院分区：
文献类型：
--
作者：
Chantarat T;Van Riper DC;Hardeman RR
结构性种族主义是一个复杂的不平等系统，共同导致有色人种社区，特别是黑人的健康状况不佳。然而，结构性种族主义的多层面性质并没有被人口健康学者用来研究健康不平等的现有措施所捕获。可以使用复杂的分析技术进行多维测量。结构性种族主义的多维度衡量标准是否比现有的单维度衡量标准提供了更多的洞察力，这一点尚不清楚。我们得出了黑人-白人居住隔离，教育，就业，收入和房屋所有权不平等的措施，评估了美国2，338个公共使用微数据区（CAMS），并使用潜在的阶级模型将其整合为结构性种族主义的多维措施。我们使用Kruskal-Wallis检验，按照结构性种族主义水平（高/低）和多维类别，比较了在54个纽约市（NYC）社区中观察到的COVID-19疫苗接种率中位数。本研究于二零二一年三月进行。我们的潜在阶级模型确定了美国的三个结构性种族主义阶级，所有这些都可以在纽约市找到。我们观察到结构性种族主义的五个维度之间错综复杂的相互作用，这些维度不能简单地归类为"高"（即，在结构性种族主义的所有方面都很高）、"中等"或"低"。与A类ADA（两次给药完成率中位值为6.9%）相比，观察到B类ADA（5.5%，p = 0.04）和C类ADA（5.2%，p = 0.01）的完成率显著较低。当根据结构性种族主义的每个维度评估疫苗接种率时，仅在具有高和低黑人-白人收入不平等的黑人-白人之间观察到显著差异（7.2% vs. 5.3%，p = 0.001）。我们的分析表明，衡量结构性种族主义作为一个多层面的健康决定因素，提供了额外的洞察机制的人口健康不平等相对于使用多个单维度的措施，而不捕捉其联合效果。该项目由明尼苏达大学罗伯特·J·琼斯城市研究和外联参与中心资助。明尼苏达州人口中心提供了额外的支持，该中心由尤妮斯·肯尼迪·施莱佛国家儿童健康和人类发展研究所（Grant P2C HD041023）资助。
Structural racism is a complex system of inequities working in tandem to cause poor health for communities of color, especially for Black people. However, the multidimensional nature of structural racism is not captured by existing measures used by population health scholars to study health inequities. Multidimensional measures can be made using complex analytical techniques. Whether or not the multidimensional measure of structural racism provides more insight than the existing unidimensional measures is unknown. We derived measures of Black-White residential segregation, inequities in education, employment, income, and homeownership, evaluated for 2,338 Public Use Microdata Areas (PUMAs) in the United States (US), and consolidated them into a multidimensional measure of structural racism using a latent class model. We compared the median COVID-19 vaccination rates observed across 54 New York City (NYC) PUMAs by levels (high/low) of structural racism and the multidimensional class using the Kruskal-Wallis test. This study was conducted in March 2021. Our latent class model identified three structural racism classes in the US, all of which can be found in NYC. We observed intricate interactions between the five dimensions of structural racism of interest that cannot be simply classified as “high” (i.e., high on all dimensions of structural racism), “medium,” or “low.” Compared to Class A PUMAs with the median rate of two-dose completion of 6·9%, significantly lower rates were observed for Class B PUMAs (5·5%, p = 0·04) and Class C PUMAs (5·2%, p = 0·01). When the vaccination rates were evaluated based on each dimension of structural racism, significant differences were observed between PUMAs with high and low Black-White income inequity only (7·2% vs. 5·3%, p = 0·001). Our analysis suggests that measuring structural racism as a multidimensional determinant of health provides additional insight into the mechanisms underlying population health inequity vis-à-vis using multiple unidimensional measures without capturing their joint effects. This project is funded by the Robert J. Jones Urban Research and Outreach-Engagement Center, University of Minnesota. Additional support is provided by the Minnesota Population Center, which is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Grant P2C HD041023).
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