. 2024 Feb 26;46(1):1–26. doi: 10.1093/epirev/mxae002

Table 2.

Structural racism measures derivation.

Structural Racism Measure	Data Sources	Methodology for Estimation	Health Outcome	First Author, Year, Reference No.
Residential dissimilarity index	American Community Survey	Where: a_i = the population of group A in the i^th area (eg, census tract) A = the total population in group A in the large geographic entity for which the index of dissimilarity is being calculated b_i = the population of group B in the i^th area B = the total population in group B in the large geographic entity for which the index of dissimilarity is being calculated n = number of large geographic entities	Atopic dermatitis Firearm homicides Self-reported health Cardiovascular risk Pancreatic adenocarcinoma Firearm homicides Cognitive performance incident dementia Breast cancer Hepatocellular carcinoma Prostate cancer Colorectal cancer Fatal police shootings No health outcome Black-White county-level mobility ratio	Tackett, 2020⁷¹ Houghton, 2021⁴⁵ Owens-Young and Bell, 2020³² Allgood, 2021³¹ Blanco, 2021³⁴ Knopov, 2019⁴⁷ Pohl, 2021⁷⁸ Pouslon, 2021a⁵⁵ Poulson, 2021b⁵⁶ Poulson, 2021c⁵⁷ Poulson, 2021d⁵⁸ Siegel, 2019⁶⁰ Stermon, 2021⁸⁰ White, 2021²⁶
School dissimilarity index	Department of Education Common Core of Data	Similar to above for the residential dissimilarity index but the smaller and large units of measurement in the equation are school and school district, respectively For more information, see Reardon and Townsend²⁷	Body mass index	Dougherty, 2020²⁷
Isolation index	US Census of Population and Housing	Where: n = the number of areas (census tracts) in the metropolitan area, ranked smallest to largest by land area x_i = the minority population of area i X = the sum of all xi (the total minority population) t_i = the total population of area i	Cardiovascular risk Cognitive performance incident dementia	Allgood, 2021³¹ Pohl, 2021⁷⁸
Interaction index	American Community Survey Data	Where: n = the number of areas (census tracts) in the metropolitan area, ranked smallest to largest by land area x_i = the minority population of area i X = the sum of all x_i (the total minority population) y_i = the majority population (non-Hispanic white) of area i t_i = the total population of area i	Cognitive performance incident dementia	Pohl, 2021⁷⁸
Evenness	US Census data	Evenness was assessed using divergence scores that quantify the difference between Black-White racial composition at the tract-level to the broader Atlanta, GA, metropolitan statistical area.	Systemic lupus erythematosus	Martz, 2021⁶⁹
ICE	American Community Survey (for census tract measure) Elementary/Secondary Information System (for school district measure)	Can be used for race, income, and race plus income, in various geographic unit (e.g., census tract, school district) Where: A = number of white households with income of $100 000 or higher (privileged group) P = number of Black households with income lower than $25 000 (deprived group) T = total number of Black and White households in the PUMA ICE ranges from −1 (all households are in the deprived group) to 1 (all households are in the privileged group).	Infant mortality Preterm birth Infant mortality Pregnancy-associated mortality Discrimination life expectancy Cardiovascular risk Neonatal mortality and morbidity Characteristics of sexual partner	Bishop-Royse, 2021³³ Krieger, 2020⁴⁸ Chambers, 2019³⁶ Dyer, 2021⁴⁰ Chambers, 2020⁶⁶ Graetz and Esposito, 2021³⁰ Allgood, 2021³¹ Janevic, 2021⁴⁶ Linton, 2020⁷⁵
School-district-level ICE		The average ICE in the school districts overlapping with each Census tract.	Cardiovascular risk Life expectancy	Allgood, 2021³¹ Graetz and Esposito, 2021³⁰
Black-White spatial exposure score (P*)	American Community Survey	Where: = weighted proportion of White individuals within census tract q’s local environment = total number of Black individuals within county = total number of Black individuals within census tract q = each census tract	COVID-19 cases at a county level	Tan, 2021²⁵
Spatial Information Theory Index, H	American Community Survey	Where: E = overall county entropy of the total population calculated as =population density at q T = total population in county	COVID-19 cases at a county level	Tan, 2021⁶¹
ISP	American Community Survey	Where: and (g,G) = (x,X), (y,Y), (t,T) n = number of areas in the metropolitan areas, ranked smallest to largest by land area x_i = the minority population of area i X = the sum of all x_i y_i = the majority population of area i Y = the sum of all y_i t_i = the total population of area i T = the sum of all t_i P = the ratio of X to T	Low birthweight	Larimore, 2019⁴⁹
Black-White disproportionality ratios	American Community Survey Robert Wood Johnson Foundation County Health Rankings Vera Institute of Justice (consolidation of data from the US Department of Justice Bureau of Justice Statistics Census of Jails and the Annual Survey of Jails, National Prisoner Statistics)	Ratios span measures of socioeconomic status, political participation, ambulatory care, and incarceration rates. Ratio = rate for Black people to rate for White people	Obesity and obesogenic environment Self-rated health Low birthweight Infant mortality rate Neonatal mortality Preterm birth COVID-19 cases at a county level Severe maternal morbidity Early sexual initiation, multiple sex partners No health outcome	Bell, 2019²⁸ Bell, 2020³² Larimore, 2019⁴⁹ Owens-Young, 2020³² Pabayo, 2019⁵⁴ Pabayo, 2019⁵⁴ Blebu, 2019⁷² Tan, 2021⁶¹ Brown, 2020³⁵ Liu, 2019⁵⁰ Leos, 2020⁷⁴ Stermon, 2021⁸⁰
Multidimensional measure of structural racism	American Community Survey	Multidimensional typologies derived from 5 structural racism measures: (1) Black-white residential segregation (measured with a dissimilarity index); (2) Black-white education inequity; (3) Black-white employment inequity; (4) Black-white homeownership; (5) Income equity (measured by the index of concentration at the extremes). Multidimensional typologies are identified with the latent class analysis model.	COVID-19 vaccination rate	Chantarat, 2021³⁷
State racism index	American Community Survey Vera Institute of Justice Jail Incarceration	Average of segregation index, incarceration index, education index, economic index, and employment index—all measured at the state level. See Siegel et al.²³ (Table 2) for the equations for all the measures.	Black-White proportion of COVID-19 vaccination rate	Siegel, 2021²³
State racism index (adapted from Mesic et al. J Natl Med Assoc. 2018;110(2):106–16)	US Census data, US Bureau of Justice Statistics and US Census data	Each individual indicator, other than the dissimilarity index and isolation index, consisted of the state Black-White ratio. For each indicator, ratios were converted into a scale from 0 to 100. To derive an overall racism index for each dimension, scores for each component within that dimension were averaged. Then, to obtain a single, overall state racism index, scores for each of the 5 dimensions were averaged together. Then, each score across the years was averaged. Indicators used included: dissimilarity index, isolation index, incarceration rate, educational attainment, poverty status, median annual household income, rental housing percentage, nonlabor force participation, and unemployment.	Psychological and behavioral outcomes (depression, burdensomeness as a proximal cause of suicidal desire, alcohol use disorder, HIV testing)	English, 2021⁴¹
Structural intersectionality (state-level)	US Census Bureau data, Bureau of Labor Statistics Center for American women and Politics Guttmacher Institute	Summation of the score from the following measures: Black-White ratios of incarceration, proportion with a bachelor’s degree, unemployed rate, poverty rate, proportion who are homeowners, proportion who voted in 2008 Blacks’ disproportionate level of disenfranchisement Level of political underrepresentation of Black people in state legislatures State-level dissimilarity index (Black-White) of residential segregation	Self-rated health	Homan, 2021⁴⁴
IPC Index	The Urban Institute Center for Health Journalism Kaiser Family Foundation Medicaid.gov National Immigration Law Center Georgetown University Health Policy Institute uLEAD National Council of State Legislatures FindLaw Law Logix Homeland Security Today Department of Homeland Security Immigration Forum Immigration and Customs Enforcement	Fourteen policies were included across 5 domains (Wallace et al. SSM Popul Health. 2019;7:016–016): public health and welfare benefits (5 policies), higher education (2 policies), labor and employment (2 policies), driver’s license and identification (2 policies), and immigration enforcement (3 policies). The research team coded the values in the IPC index, in alignment with the Young and Wallace (Am J Public Health. 2019;109:1171–1176) framework, considering “-1 = exclusionary,” “0 = neither,” and “1 = inclusionary” to capture both exclusive and inclusive state environments. The IPC index was then calculated by summing the values for all 14 policies, with more-negative scores indicating exclusionary contexts and positive scores indicating inclusive environments.	No health outcome	Samari, 2021⁸⁵
Criminalizing and integration immigrant policies variables	National Council of State Legislatures Health care coverage maps National Immigration Law Center National Employment Law Project US Department of Agriculture, Food and Nutrition Service National Health Law Program	Six criminalizing immigrant policies, categorized as such because they create mechanisms of surveillance and immigration enforcement across the following 3 sectors: work authorization, immigration enforcement and criminal justice, and identification and licensing, and 14 inclusive immigrant policies across the following 4 sectors: health and social service benefits, education, labor and employment, and language access. States were coded “1” if the policy was in effect and “0” if not. These values were then summed to create continuous criminalizing (0–6) and inclusive immigrant policy indices (0–14) for each state.	Preterm birth	Sudhinaraset, 2021⁸⁶
County structural racism	Census of jail inmates Department of Education Common Core of Data American Community Survey Dartmouth Atlas of Health Care	A factor score from confirmatory factor analysis combining the following measures: Ratios of Black-White jail incarceration, high school graduation, poverty, ratio of proportion of Medicare beneficiaries discharged from a hospital for an ambulatory care sensitive condition, average annual proportion of Medicare enrollees having at least 1 ambulatory visit to a primary care clinician School dissimilarity index H entropy index	Body mass index	Dougherty, 2020²⁷
County Structural Racism score	American Community Survey Vera Institute of Justice Jail Incarceration data	Summation of 3 dichotomizing county-level structural racism measures. For each measure, the value higher than the 75th percentile of all US counties is considered “high” (score 1), or “low” (score 0) otherwise The 3 structural racism measures that make up the county structural racism score are: Black-White ratios in proportions of the population age 25 years and older with a bachelor’s degree or higher, median household income, and jail incarceration	Infant mortality rate	Vilda, 2021⁶²
Overall measure of state structural racism	US Decennial Census Current population survey US Department of Justice, Bureau of Justice Statistics data	Summation of 8 dichotomized state-level structural racism measures. For each measure, the value higher than the median of all US states is considered “high” (score 1), or “low” (score 0) otherwise. The 8 structural racism measures that make up the state structural racism score are: Black-White ratios in proportions of the population who: earned a bachelor’s degrees or higher, registered to vote, voted, are in civilian labor force, are employed, hold executive position, have a professional specialty, and incarceration	Health care access	Volpe, 2021⁶⁴
Agénor’s typology of structural racism policies	Westlaw Next, LexisNexis, Hein Online, 2010–2013	“Typology of contemporary legal domains pertaining to state level structural racism.” 10 domains: voting rights, stand-your-ground laws, racial profiling laws, mandatory minimum prison sentencing laws, immigrant protections, fair-housing laws, minimum-wage laws, predatory lending laws, laws concerning punishment in schools, and stop-and-identify laws. The scholars then identified the scope and features (eg, population covered or affected, length of related sentence, exceptions, enforcement mechanisms) of each law using primary and secondary (ie, law review articles, legal reports) sources. The authors then characterized each law using a set of mutually exclusive categories (assigned a numeric value) and compiled the categories into a preliminary coding scheme, and used the scheme to assign a numerical value to each state for each law in that year. The coding scheme was then revised and finalized on the basis of this process. The authors developed a guide defining each law and its categories and outlining key questions to consider when assigning a numerical value to each state and the District of Columbia for each law using the scheme.	No health outcome	Agénor, 2021⁸⁷
Dual mortgage market political economies measures	Project of Human Development in Chicago Neighborhoods Home Mortgage Disclosure Act Neighborhood Change Database	A set of 4 measures includes: Neighborhood credit refusals: Ratio of the rate of access to the mortgage market for ethnoracially marginalized applicants (Black people and Latinx people) to the rate for ethnoracially privileged applicants (White people) for a specific area. Racialized credit refusals: Ratio of the rate of access to the mortgage market for ethnoracially marginalized applicants (Black people and Latinx people) to the rate for ethnoracially privileged applicants (White people) across areas. Neighborhood credit privateness: Ratio of the rate of the federal oversight of originated loans for ethnoracially marginalized applicants (Black people and Latinx people) to the rate for ethnoracially privileged applicants (White people) for a specific area. Racialized credit privateness: Ratio of the rate of the federal oversight of originated loans for ethnoracially marginalized applicants (Black people and Latinx people) to the rate for ethnoracially privileged applicants (White people) across areas.	Acute illnesses of cold or flu, sinus trouble, sore throat or tonsils, headache, upset stomach, bronchitis, skin infection, pneumonia, urinary tract infections, fungal disease, mononucleosis	Sewell, 2021⁵⁹
HOLC-assessed redlining measure	HOLC data Richmond Mapping Project	1930s HOLC neighborhood grading map	Life expectancy Preterm birth Healthy Start initiative participation Fatal police shootings Firearm homicides Breast cancer deaths Ideal cardiovascular health, health behaviors, and health factors No health outcome Mortality	Graetz and Esposito, 2021³⁰ Krieger, 2020⁴⁸ Matoba, 2019⁵² Hollenbach, 2021⁴³ Butler, 2020⁶⁵ Mitchell, 2021⁸³ Poulson, 2021⁸² Collin, 2020³⁸ Mujahid, 2021⁷⁷ Stermon, 2021⁸⁰ Diaz, 2021³⁹
Lending bias or denial	Home Mortgage Disclosure Act data	The odds of denial of a mortgage application from a non-Hispanic Black or Hispanic applicant compared with denial of a non-Hispanic White applicant desiring to move in the same census tract, controlling for applicant sex and the ratio of the loan amount to applicants reported annual income	Breast cancer deaths Characteristics of sexual partner	Collin, 2021³⁸ Linton, 2020⁷⁵
Parish-level jail incarceration prevalence among Black individuals	Vera Institute of Justice (jail incarceration data)	Count of Black individuals aged 16 to 64 years in jail per 1000 Black, nonincarcerated residents.	Preterm birth and low birthweight	Dyer, 2019⁶⁷
Racialized event (ie, Flint Water Crisis)	N/A	Vicarious exposure to structural racism-related events. Residency in the areas after the racialized event occurs is treated as an exposure in a quasi-experimental model (eg, difference-in-difference).	Birthweight, gestational age, size for gestational age	Allgood, 2021³¹
No. of police encounters	AddHealth	Response to survey question: “How many times have you been stopped or detained by the police for questioning about your activities? Do not count minor traffic violations.” This 5-level categorical variable includes response options ranging from 0 (never) to 6 or more times.	Cardiovascular risk	Allgood, 2021³¹
No. of police killings	The Guardian’s The Counted Database	The number of police killings of non-Hispanic Black people in 2015	Syphilis, gonorrhea, chlamydia	Ibragimov, 2019⁶⁸
Lynching	Equal Justice Initiative lynching database	Population adjusted rate of historic lynchings 1877–1950	Life expectancy	Kihlström, 2021²⁹
Economic mobility gap	Opportunity Atlas	Intergenerational gap in upward economic mobility conditional on parental income for Black adults and White adults For details, see Chetty et al. National Bureau of Economic Research working paper 25 147; 2019.	All-cause mortality gap Racial mortality gap	Farhad, 2021⁴² O’Brien, 2020⁵³
Racial opportunity gap	Opportunity Insights Data Library	The difference in the average national income percentile ranking in adulthood achieved between White individuals and Black individuals in the same county born to parents at the 25th percentile of the national income distribution	Racial mortality gap	O’Brien, 2020⁵³
County-level urban renewal projects	Richmond Renewing Project	The average of urban renewal projects in the counties overlapping with each Census tract	Life expectancy	Graetz and Esposito, 2021³⁰
Tract-level home values	Zillow Home Value Index	See detailed description at https://www.zillow.com/research/zhvi-methodology-2019-highlights-26221/	Life expectancy	Graetz and Esposito, 2021³⁰
Racial equity index	National Equity Atlas	Uses an inclusion score and a prosperity score, also uses a formula for index of disparity (Pearcy and Keppel. Public Health Rep. 2022;117(3):273–280).	N/A
Wage theft	Survey question	“In your last full day as a day laborer, would you say you were paid what was promised/agreed upon?” Responses ranged from 1 = strongly disagree to 4 = strongly agree. Responses for the wage-theft item were reverse scored so that higher scores indicated greater disagreement with the statement that the participant was paid what was promised or agreed upon.	Depression, isolation, alcohol use, severe injury, deportation stress	Fernandez-Esquer, 2021⁷³
Participation on editorial team	Survey of editors-in-chief	Participation in editorial team (editor-in-chief, editorial board members) in psychiatry journals by race and ethnicity	None	Shim, 2021¹¹⁰

Abbreviations: Black-White, Black and White (as with Latino-White, Hispanic-White, and so forth); HOLC, Home Owners’ Loan Corporation; ICE, index of concentration at the extremes; IPC, Immigration Policy Climate; ISP, Index of Spatial Proximity; N/A, not applicable; PUMA, public use microdata area.