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 结构性种族主义是死亡率中持续和普遍的种族/种族不平等现象的基本原因。 通过相互加强的机构制度，少数化种族/族裔群体经历结构性种族主义 这通过整个住房领域的政策，实践和规范来使健康不平等永存， 教育，就业，刑事司法，政治参与和医疗保健。但是，很少有研究 调查了跨结构种族主义的多个领域的相互加强机构对 多个少数种族/族裔人群死亡率的不平等。我们建议调查 黑人（n = 30,834），西班牙裔/ 拉丁裔（n = 43,538），日裔美国人（n = 45,115）和本地夏威夷人（n = 8,202）成年人 队列（MEC）研究使用新颖的种族/种族特异性综合种族主义的研究 城市，城镇或人口普查的地理水平。复合措施将包括指标 来自住房，教育，就业，刑事司法，政治参与等多个领域 卫生保健。具体而言，我们旨在研究结构种族主义的这些综合措施对全能的影响 导致死亡率（AIM 1）和特定原因死亡率（AIM 2）黑色，西班牙裔/拉丁裔，日裔美国人， 以及夏威夷人在MEC的参与者，估计由于结构性种族主义而失去了生命的年代。在 此外，我们将使用因果推理方法来研究邻里撤资是否存在 歧视，社会支持，健康行为和合并症介导结构之间的关联 种族主义和死亡率，并调查性别，生命阶段和生命阶段定义的亚组的这些关联 社会经济地位。我们将向多学科外部顾问委员会和地区寻求指导 以及种族/民族特定的社区顾问委员会，以开发结构性综合度量 种族主义，研究结果的解释以及研究措施和结果的传播。来自 拟议的研究将提供应针对的特定互动机构的关键证据 改善黑人，西班牙裔/拉丁裔，日裔美国人和夏威夷本地人口的寿命。 这项研究的影响很高，因为它将在提供经验证据的经验证据中具有转化性 社区利益相关者，政策制定者和实施科学家指导干预措施减少 特定于少数种族/族裔的过早死亡率。