Understanding the impact of structural racism on racial/ethnic inequities in mortality: The Multiethnic Cohort Study

了解结构性种族主义对种族/民族死亡率不平等的影响：多民族队列研究

• 批准号: 10531782
• 负责人: Iona C Cheng
• 金额: $ 56.77万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-24 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10531782
• 关键词: Address; Adult; Alaska Native; Alcohol consumption; Alcohols; Alzheimer' s Disease; American; American Indians; Asian Americans; Attention; Black Populations; Black race; California; Cardiovascular Diseases; Cause of Death; Censuses; Cessation of life; Chronic; Cities; Cohort Studies; Communities; Community Surveys; Criminal Justice; Data; Development; Diabetes Mellitus; Diet; Discrimination; Disease; Education; Employment; Environment; Environmental Hazards; Ethnic Origin; Ethnic group; Exposure to; Geography; Hawaii; Hawaiian population; Health; Health behavior; Healthcare; Hispanic; Housing; Individual; Institution; Intervention; Investigation; Japanese American; Knowledge; Latino; Life; Longevity; Malignant Neoplasms; Measures; Mediating; Methods; Native Hawaiian; Neighborhoods; Not Hispanic or Latino; Outcome; Pacific Islander; Participant; Physical activity; Policies; Policy Maker; Politics; Population; Population Study; Premature Mortality; Prospective Studies; Race; Research; Research Personnel; Respiratory Disease; Scientist; Smoking; Social support; Socioeconomic Status; Source; Structural Racism; Subgroup; System; Tobacco; cohort; comorbidity; density; experience; follow-up; health inequalities; improved; indexing; mortality; mortality risk; multi-ethnic; multidisciplinary; novel; racial and ethnic; residential segregation; segregation; sex; socioeconomic disadvantage; socioeconomics; years of life lost

ABSTRACT Structural racism is a fundamental cause of the persistent and pervasive racial/ethnic inequities in mortality. Minoritized racial/ethnic groups experience structural racism via a system of mutually reinforcing institutions that perpetuates inequities in health through policies, practices, and norms across the domains of housing, education, employment, criminal justice, political participation, and healthcare. Yet, few studies have investigated the contribution of mutually reinforcing institutions across multiple domains of structural racism on inequities in mortality for multiple minoritized racial/ethnic populations. We propose to investigate the impact of multiple domains of structural racism on racial/ethnic-specific mortality for Black (n=30,834), Hispanic/ Latino (n=43,538), Japanese American (n=45,115) and Native Hawaiian (n=8,202) adults in the Multiethnic Cohort (MEC) Study using novel, racial/ethnic-specific composite measures of structural racism at the geographic level of city, town, or Census designated place. The composite measure will include indicators from multiple domains including housing, education, employment, criminal justice, political participation and health care. Specifically we aim to examine the impact of these composite measures of structural racism on all- cause mortality (Aim 1) and cause-specific mortality (Aim 2) for Black, Hispanic/Latino, Japanese American, and Native Hawaiian participants in the MEC and estimate years of life lost due to structural racism. In addition, we will use causal inference methods to investigate whether neighborhood disinvestment, discrimination, social support, health behaviors, and comorbidities mediate the associations between structural racism and mortality, and investigate these associations across subgroups defined by sex, life stage, and socioeconomic status. We will seek guidance from a multidisciplinary External Advisory Board and regional and racial/ethnic-specific Community Advisory Boards in the development of composite measures of structural racism, interpretation of study findings, and dissemination of the study measures and results. The findings from the proposed study will provide key evidence of the specific interacting institutions that should be targeted to improve the lifespan for Black, Hispanic/Latino, Japanese American, and Native Hawaiian populations. The impact of this research is high as it will have translational relevance in providing empirical evidence for community stakeholders, policy makers, and implementation scientists to direct interventions for reducing premature mortality specific to minoritized racial/ethnic groups.

摘要 结构性种族主义是死亡率方面持续和普遍存在的种族/族裔不平等的根本原因。 少数种族/族裔群体通过一个相互加强的机构系统遭受结构性种族主义 通过住房领域的政策、做法和规范， 教育、就业、刑事司法、政治参与和医疗保健。然而，很少有研究 调查了在结构性种族主义的多个领域中相互加强的机构在以下方面的贡献： 多个少数民族/族裔人口的死亡率不平等。我们建议调查 结构性种族主义对黑人（n= 30，834）、西班牙裔/ 多种族研究中的拉丁裔（n= 43，538）、日裔美国人（n= 45，115）和夏威夷原住民（n= 8，202）成人 采用新颖的、针对种族/族裔的结构性种族主义综合衡量标准进行的队列研究， 城市、城镇或人口普查指定地点的地理级别。综合衡量标准将包括指标 包括住房、教育、就业、刑事司法、政治参与和 保健具体来说，我们的目标是研究这些结构性种族主义的综合措施对所有人的影响- 黑人、西班牙裔/拉丁裔、日裔美国人的原因死亡率（目标1）和原因特异性死亡率（目标2）， 和夏威夷原住民参与MEC，并估计由于结构性种族主义而损失的生命年数。在 此外，我们将使用因果推理的方法来调查是否邻里撤资， 歧视、社会支持、健康行为和合并症介导了结构性 种族主义和死亡率，并调查这些协会跨亚组定义的性别，生命阶段， 社会经济地位。我们将寻求多学科外部咨询委员会和区域咨询委员会的指导， 和种族/族裔社区咨询委员会在制定结构性 种族主义、研究结果的解释以及研究措施和结果的传播。的结果 拟议的研究将提供关键证据，说明应针对哪些具体的相互作用的机构， 提高黑人、西班牙裔/拉丁裔、日裔美国人和夏威夷土著人口的寿命。 这项研究的影响是高的，因为它将在提供经验证据方面具有翻译相关性， 社区利益相关者、决策者和实施科学家指导干预措施， 少数种族/族裔群体特有的过早死亡率。