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

摘要 结构性种族主义是长期和普遍存在的种族/族裔死亡率不平等的根本原因。 少数族裔群体通过一种相辅相成的制度经历结构性种族主义 这通过住房领域的政策、做法和规范使健康方面的不平等永久化， 教育、就业、刑事司法、政治参与和医疗保健。然而，很少有研究表明 调查了结构性种族主义多个领域的相辅相成的机构对 多个少数族裔人口的死亡率不平等现象。我们建议调查以下方面的影响 黑人(n=30,834)，西班牙裔/西班牙裔的种族/民族死亡率的结构性种族主义的多个领域 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) 队列研究(MEC)，使用新的、种族/民族特定的结构性种族主义综合衡量标准 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 来自住房、教育、就业、刑事司法、政治参与和 医疗保健。具体地说，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-- 黑人、西班牙裔/拉丁裔、日裔美国人的原因死亡率(目标1)和原因特定死亡率(目标2) 和夏威夷原住民参加MEC，并估计由于结构性种族主义而损失的寿命。在……里面 此外，我们将使用因果推理方法来调查邻里撤资， 歧视、社会支持、健康行为和共病在结构性疾病之间的关系中起中介作用 种族主义和死亡率，并调查按性别、生命阶段和性别定义的子组之间的这些关联 社会经济地位。我们将寻求多学科外部咨询委员会和区域组织的指导 和种族/族裔社区咨询委员会在制定结构性综合措施方面的作用 种族主义、研究结果的解释以及研究措施和结果的传播。调查结果来自 拟议的研究将提供应针对的具体互动机构的关键证据 提高黑人、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翻译相关性 社区利益相关者、政策制定者和实施科学家指导减少 少数族裔群体特有的过早死亡。

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.