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: 10709871
• 负责人: Iona C Cheng
• 金额: $ 53.65万
• 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/10709871
• 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 Population; Exposure to; Geography; Hawaii; Hawaiian population; Health; Health behavior; Healthcare; Hispanic; Housing; Individual; Inequity; Institution; Intervention; Investigation; Japanese American; Knowledge; Latino; Life; Longevity; Malignant Neoplasms; Measures; Mediating; Methods; Native Hawaiian; Native Hawaiian or Other Pacific Islander; Neighborhoods; Not Hispanic or Latino; Outcome; 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; ethnic disparity; experience; follow-up; health inequalities; improved; indexing; mortality; mortality risk; multi-ethnic; multidisciplinary; novel; racial minority; racial minority population; racial population; 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.

抽象的 结构性种族主义是种族/民族死亡率不平等现象持续存在和普遍存在的根本原因。 少数种族/族裔群体通过相互强化的制度体系遭受结构性种族主义 通过住房领域的政策、做法和规范，使健康方面的不平等现象长期存在， 教育、就业、刑事司法、政治参与和医疗保健。然而，很少有研究 研究了跨结构性种族主义多个领域相辅相成的机构的贡献 多个少数种族/族裔人口的死亡率不平等。我们建议调查影响 结构性种族主义的多个领域对黑人（n=30,834）、西班牙裔/族裔特定死亡率的影响 多民族中的拉丁裔 (n=43,538)、日裔美国人 (n=45,115) 和夏威夷原住民 (n=8,202) 成年人 队列（MEC）研究使用新颖的、种族/族裔特定的结构性种族主义综合措施 城市、城镇或人口普查指定地点的地理级别。综合衡量指标将包括 涵盖住房、教育、就业、刑事司法、政治参与等多个领域 卫生保健。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、 和 MEC 的夏威夷原住民参与者，并估计由于结构性种族主义而损失的寿命。在 此外，我们将使用因果推理方法来调查邻里投资是否减少， 歧视、社会支持、健康行为和合并症介导结构性因素之间的关联 种族主义和死亡率，并调查按性别、生命阶段和年龄定义的亚组之间的关联 社会经济地位。我们将寻求多学科外部顾问委员会和区域的指导 和特定种族/民族的社区咨询委员会制定结构性综合措施 种族主义、研究结果的解释以及研究措施和结果的传播。研究结果来自 拟议的研究将提供具体互动机构的关键证据，这些机构应针对 延长黑人、西班牙裔/拉丁裔、日裔美国人和夏威夷原住民的寿命。 这项研究的影响很大，因为它将在提供经验证据方面具有转化意义 社区利益相关者、政策制定者和实施科学家指导干预措施，以减少 少数种族/族裔群体特有的过早死亡。