School racial segregation and long-term cardiovascular health among Black adults in the US: A quasi-experimental study.
School racial segregation and long-term cardiovascular health among Black adults in the US: A quasi-experimental study.
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DOI：
10.1371/journal.pmed.1004031
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发表时间：
2022-06
期刊：
影响因子：
15.8
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中科院分区：
文献类型：
--
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心血管疾病(CVD)在美国对黑人成年人的影响不成比例。越来越多的人承认，这是由于促进健康的资源分配不公造成的。一个潜在的因素是教育机会的不平等，尽管目前还不清楚教育的哪些方面最突出。学校种族隔离可能会通过增加压力、限制社会经济机会和改变健康行为来影响心血管健康。我们调查了学校隔离与黑人成年人心血管疾病风险的关系。我们利用了一个自然的实验，这个实验是由1991年以来地方法院裁决的准随机(即任意)时间安排创造的，这些裁决将学区从法院下令的废除种族隔离中解放出来。我们使用了收入动态小组研究(PSID)(1991至2017年)，与地区一级的学校隔离措施和取消种族隔离的法院命令状况联系在一起。样本包括1,053名黑人参与者，他们曾居住在1991年法院废除种族隔离令所在的学区。暴露在观察到的上学年中的中等学校隔离。结果包括几个成人心血管疾病危险因素和结果。我们对标准的普通最小二乘(OLS)多元线性回归模型进行了拟合，然后进行了工具变量(IV)分析，以法院下令解除种族隔离的地区的受教育年限比例为工具。我们对个人和地区层面的暴露前混杂因素、出生年份和州固定影响进行了调整。在标准线性模型中，学校隔离与较低的自我评价健康(−0.05%/SD分离指数；95%CI：−0.08，−0.03；p<；0.001)和较高的酗酒(0.04个百分点；95%CI：0.002，0.07；p=0.04)和心脏病(0.01个百分点；95%CI：0.002，0.15；p=0.007)相关。IV分析还发现，学校隔离与较低的自测健康概率(−0.09个百分点；95%CI：−0.17，−0.02，p=0.02)和较高的酗酒概率(0.17个百分点；95%CI：0.04，0.3，p=0.008)有关。对于IV估计，只有酗酒对多重假设检验的调整是稳健的。限制包括自我报告的结果和潜在的残留混杂和暴露错误分类。儿童时期的学校隔离暴露可能会对黑人成年人的心血管健康产生长期影响。未来的研究应该在更大的样本中重复这些分析，并探索潜在的机制。鉴于最近学校种族隔离的上升，这项研究对解决心血管疾病中种族不平等的政策和计划具有一定的意义。金敏熙和他的同事调查了美国黑人成年人在童年时期暴露于学校种族隔离与长期心血管健康之间的联系。美国黑人获得教育机会的不平等可能解释了这一群体患心血管疾病(CVD)的不成比例的负担，尽管尚不清楚教育的哪些方面最突出。学校种族隔离是美国教育系统结构性种族主义的一种表现，可能会影响后来的心血管健康。然而，很少有研究严格检查学校隔离和长期心血管风险之间的联系。我们应用了工具变量(IV)方法，利用自1991年以来法院裁决的准随机变化，使学区从法院下令的废除种族隔离中解脱出来。学校隔离程度的增加与黑人成年人中较差的自我评估健康和更多的酗酒有关，而后者对多重假设检验的调整是稳健的。美国持续的学校隔离可能是黑人社区心血管疾病负担沉重的原因之一。关于学校种族融合的国家和地方教育政策可能有助于减轻未来黑人患心血管疾病的负担。
Cardiovascular disease (CVD) disproportionately affects Black adults in the United States. This is increasingly acknowledged to be due to inequitable distribution of health-promoting resources. One potential contributor is inequities in educational opportunities, although it is unclear what aspects of education are most salient. School racial segregation may affect cardiovascular health by increasing stress, constraining socioeconomic opportunities, and altering health behaviors. We investigated the association between school segregation and Black adults’ CVD risk. We leveraged a natural experiment created by quasi-random (i.e., arbitrary) timing of local court decisions since 1991 that released school districts from court-ordered desegregation. We used the Panel Study of Income Dynamics (PSID) (1991 to 2017), linked with district-level school segregation measures and desegregation court order status. The sample included 1,053 Black participants who ever resided in school districts that were under a court desegregation order in 1991. The exposure was mean school segregation during observed schooling years. Outcomes included several adult CVD risk factors and outcomes. We fitted standard ordinary least squares (OLS) multivariable linear regression models, then conducted instrumental variables (IV) analysis, using the proportion of schooling years spent in districts that had been released from court-ordered desegregation as an instrument. We adjusted for individual- and district-level preexposure confounders, birth year, and state fixed effects. In standard linear models, school segregation was associated with a lower probability of good self-rated health (−0.05 percentage points per SD of the segregation index; 95% CI: −0.08, −0.03; p < 0.001) and a higher probability of binge drinking (0.04 percentage points; 95% CI: 0.002, 0.07; p = 0.04) and heart disease (0.01 percentage points; 95% CI: 0.002, 0.15; p = 0.007). IV analyses also found that school segregation was associated with a lower probability of good self-rated health (−0.09 percentage points; 95% CI: −0.17, −0.02, p = 0.02) and a higher probability of binge drinking (0.17 percentage points; 95% CI: 0.04, 0.30, p = 0.008). For IV estimates, only binge drinking was robust to adjustments for multiple hypothesis testing. Limitations included self-reported outcomes and potential residual confounding and exposure misclassification. School segregation exposure in childhood may have longstanding impacts on Black adults’ cardiovascular health. Future research should replicate these analyses in larger samples and explore potential mechanisms. Given the recent rise in school segregation, this study has implications for policies and programs to address racial inequities in CVD. Min Hee Kim and colleagues investigate the association between exposure to school racial segregation in childhood and long-term cardiovascular health among Black adults in the United States. Inequitable access to educational opportunities among Black Americans may explain a disproportionate burden of cardiovascular disease (CVD) among this group, although it is unclear what aspects of education are most salient. School racial segregation, a manifestation of structural racism in the United States education system, may affect later cardiovascular health. Yet, few studies have rigorously examined the association between school segregation and long-term cardiovascular risk. We applied an instrumental variables (IV) approach leveraging quasi-random variation in the timing of court decisions since 1991 that released school districts from court-ordered desegregation. Increased school segregation was associated with poorer self-rated health and increased binge drinking among Black adults, and the latter was robust to adjustment for multiple hypothesis testing. Continuation of school segregation in the US may be a contributor to the high CVD burden in Black communities. National and local educational policies for school racial integration may help reduce the future burden of CVD among Black people.
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