The Loved Ones Left Behind: Examining the Health Implications of Racial Inequities in Mortality

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PROJECT SUMMARY Blacks are more likely than whites to experience the deaths of multiple family members and experience them at earlier ages. Between 1970-2004, an estimated 2.7 million excess black deaths occurred because of blacks’ elevated mortality rates. Further, the estimated 600,000 COVID-19 deaths in the US as of July 2021 have directly impacted the lives of more than 5.3 million individuals in nuclear families according to a bereavement multiplier, with blacks facing twice the risk of death from COVID-19 as whites. Although experiencing death within a family or network powerfully shapes survivors’ health, we know little about how network death contributes to health inequities. The objective of the proposed study is to quantify black–white disparities in familial and household exposure to deaths and their relationship to disparities in psychological distress and all- cause mortality. My specific aims are to: 1) quantify the prevalence of and racial disparities in network mortality by lifecourse stage and socioeconomic status (SES) for blacks and whites, exploring differences before and during COVID-19; 2) identify key perceived mechanisms through which exposure to death may impact the SES–health feedback loop throughout the lifecourse and intergenerationally for blacks and whites using semi- structured interviews, exploring differences before and during COVID-19; and 3a) estimate the contribution of exposure to premature and cumulative deaths to black–white inequalities in psychological distress, before and during COVID-19, and to all-cause mortality; and 3b) determine the extent to which SES mediates the relationship of network mortality with psychological distress and all-cause mortality for blacks and whites. To do this, I will analyze data from the Panel Study of Income Dynamics (PSID) and conduct semi-structured interviews with black and white adults in Atlanta, GA. This project is innovative in its focus on examining racial disparities in death from broader social network ties including extended kin and household members as well as how network deaths can initiate a cascade of SES consequences that contribute to adverse health for survivors. This K01 project will enhance my prior sociological training in race, racism, socioeconomic inequality, and demography with additional training in: 1) social epidemiology, with a focus on racial health inequities; 2) network analysis, survival analysis, and structural equation modeling; 3) qualitative and mixed methods; and 4) use of PSID data. My access to excellent resources and mentoring at Emory University is supplemented with affiliations at Harvard University and the University of Michigan. Study findings will provide an evidence base for efforts to reform bereavement and family leave policies that do not account for the collateral health effects of individuals embedded in networks beyond the traditional nuclear family. The K01 will facilitate my transition to a scientific leader advancing policy-relevant research examining the degree to which racial health inequalities reverberate across social networks and generations to (re)produce health inequities.