Metropolitan Racial Residential Segregation and Cardiovascular Mortality: Exploring Pathways
Metropolitan Racial Residential Segregation and Cardiovascular Mortality: Exploring Pathways
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DOI：
10.1007/s11524-013-9834-7
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发表时间：
2014-06-01
影响因子：
6.6
通讯作者：
Casper, Michele L.
中科院分区：
文献类型：
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作者：
Greer, Sophia;Kramer, Michael R.;Casper, Michele L.
种族居住隔离与心脏病和中风死亡的风险增加有关。然而，很少有人研究候选人介导途径在隔离与心脏病或中风死亡之间的关系中可能发挥的作用。在这项研究中，我们研究了大都市统计区（MSA）水平隔离与心脏病和中风死亡率之间的关系，按年龄和种族，还估计了各种教育，经济，社会和医疗保健指标（我们称之为路径）对这种关系的影响。我们使用泊松混合模型来评估265个美国MSA的隔离指数与县级（心脏病，中风）死亡率之间的关系。所有模型均按种族（非西班牙裔黑人，非西班牙裔白色），年龄组（35-64岁，千分之一日元65岁）和死因（心脏病，中风）分层。我们在模型中分别包括每个潜在的途径，以评估其对分离-死亡率关联的影响。在黑人中，种族隔离与两个年龄组的心脏病死亡率呈正相关，但仅与老年组的中风死亡率呈正相关。在白人中，种族隔离与较年轻年龄组的心脏病死亡率略有相关，与较年长年龄组的心脏病死亡率呈正相关。我们探讨了三种可能的途径，它们削弱了黑人和白人之间的隔离和死亡率之间的关系：女性户主家庭的百分比，生活在贫困中的居民的百分比和家庭收入中位数。由于女性户主家庭的比例可以被视为社会解体程度的代表，我们的发现，它对种族隔离与心脏病和中风死亡率之间的关系具有最大的衰减作用，这表明社会解体可能在种族隔离的大都市地区心脏病和中风的发病率升高中发挥重要作用。
Racial residential segregation has been associated with an increased risk for heart disease and stroke deaths. However, there has been little research into the role that candidate mediating pathways may play in the relationship between segregation and heart disease or stroke deaths. In this study, we examined the relationship between metropolitan statistical area (MSA)-level segregation and heart disease and stroke mortality rates, by age and race, and also estimated the effects of various educational, economic, social, and health-care indicators (which we refer to as pathways) on this relationship. We used Poisson mixed models to assess the relationship between the isolation index in 265 U.S. MSAs and county-level (heart disease, stroke) mortality rates. All models were stratified by race (non-Hispanic black, non-Hispanic white), age group (35-64 years, a parts per thousand yen65 years), and cause of death (heart disease, stroke). We included each potential pathway in the model separately to evaluate its effect on the segregation-mortality association. Among blacks, segregation was positively associated with heart disease mortality rates in both age groups but only with stroke mortality rates in the older age group. Among whites, segregation was marginally associated with heart disease mortality rates in the younger age group and was positively associated with heart disease mortality rates in the older age group. Three of the potential pathways we explored attenuated relationships between segregation and mortality rates among both blacks and whites: percentage of female-headed households, percentage of residents living in poverty, and median household income. Because the percentage of female-headed households can be seen as a proxy for the extent of social disorganization, our finding that it has the greatest attenuating effect on the relationship between racial segregation and heart disease and stroke mortality rates suggests that social disorganization may play a strong role in the elevated rates of heart disease and stroke found in racially segregated metropolitan areas.