Table 1.
Population Studies of Racial Residential Segregation and Health, United States
| Author, Year (Reference No.) | Study Design (Population) | Measure of Segregation (Geographic Unit (Neighborhood Unit))a |
Outcome | Results |
|---|---|---|---|---|
| Mortality studies | ||||
| Hearst, 2008 (142) | Cross-sectional, multilevel (infants born to black mothers in 64 central cities with ≥250,000 population) | Isolation dichotomized at 0.6 into “segregated” or “not segregated” (central city (census tracts)) | Infant mortality | Propensity score matched analysis demonstrated no significant infant mortality rate difference in segregated vs. nonsegregated cities |
| Inagami, 2006(121) | Cross-sectional, ecologic (black, white, and Hispanic adults in New York City, 1999–2000) | “Black areas” (≥70% black), “white areas” (≥70% white); “Hispanic area” (≥70% Hispanic) (New York City (zip code areas)) | All-cause mortality | Mortality lowest for blacks, whites, and Hispanics living in neighborhoods of the same ethnicity |
| Laveist, 2003 (143) | Prospective cohort (National Survey of Black Americans respondents enrolled in 1979–1980) | Multidimensional segregation index compiled from self-reported segregation in school, work, residence, and church | Survival over 13 years of follow-up | Segregation in 3-level ordinal variable, with increasing segregation-associated mortality; adjusted HR = 1.2(95% CI: 1.02, 1.41) fori-unit change in segregation |
| Cooper, 2001 (122) | Cross-sectional, ecologic (white adults and black adults in 267 MSAs, 1989–1991) | Dissimilarity (metropolitan area (census tract)) | Premature mortality (prior to age 65 years) | Increasing dissimilarity associated with premature mortality |
| Jackson, 2000(144) | Retrospective cohort (National Longitudinal Mortality Study, enrolled in 1978–1985) | % Black in 1980 in census tract of residence at enrollment | All-cause mortality | 2- to 3-fold increased mortality rate for blacks aged 25–44 years living in predominantly black neighborhoods compared with <10% black neighborhoods; associations modest to null for older blacks and for whites |
| Collins, 1999(112) | Cross-sectional, ecologic (black adults and white adults in cities with >100,000 total population and > 10% black, 1990) | Isolation and dissimilarity (metropolitan area (census block group)) | Age-adjusted all-cause, leading cause, and homicide mortality | Isolation associated with increased all-cause, cancer, and heart disease mortality in blacks; associated with higher cancer rates in white males |
| Fang, 1998(123) | Cross-sectional, ecologic (non-Hispanic black adults and white adults, New York City, 1988-1994) | “Black areas” (≥75% black), “white areas” (≥75% white) (New York City (zip code areas)) | All-cause and cause-specific mortality | Higher mortality for older blacks living in predominantly white areas; higher mortality for whites living in predominantly black areas; lower mortality for blacks living in predominantly black areas |
| Guest, 1998(124) | Cross-sectional, ecologic (blacks and nonblacks in Chicago, Illinois, 1989-1991) | Isolation (Chicago (census tract)) | Infant and adult mortality | Nonsignificant, positive effect between increasing black isolation and black infant and working adult mortality; no effect for nonblacks |
| Hart, 1998(125) | Cross-sectional, ecologic (black adults and white adults aged 25–64 years in 124 MSAs with >200,000 population, 1990–1991) | Dissimilarity (metropolitan area (census tract)) | Metropolitan age- and race-adjusted mortality rates | Higher dissimilarity associated with higher black mortality for males and females, but no association for whites |
| LeClere, 1997(145) | Prospective cohort (National Health Interview Survey respondents, 1986–1990) | % Black in census tract | Survival over follow-up (maximum 6 years of follow-up) | Increasing concentration of blacks in census tract associated with lower survival for whites and blacks, with moderate dose response |
| Polednak, 1996(148) | Time-series, ecologic (black births and white births in 38 MSAs with ≥1 million population, 1982-1991) | Dissimilarity with MSAs divided into quintiles of segregation (metropolitan area (census tract)) | Yearly black infant and white infant mortality rates for 1982–1991 | For the highest quintile of segregated cities: higher than average black infant mortality for every year; for the lowest quintile: lower black infant mortality for 1982–1988, but similar black infant mortality risk between the lowest and highest quintiles in 1988–1991; no effect for whites |
| Bird, 1995(126) | Cross-sectional, ecologic (black infants and white infants born in 1986–1988 in 34 US states) | Dissimilarity (state (metropolitan area (census tract))) | Infant mortality | Dissimilarity associated with black but not white infant mortality |
| Laveist, 1993 (103) | Cross-sectional, ecologic (births to black women and white women in MSAs with >50,000 population and >10% black, 1981–1985) | Dissimilarity (metropolitan area (census tract)) | Black-white disparity (risk ratio) for infant mortality for each city | Increase in the black-white gap as dissimilarity increases |
| Polednak, 1993(127) | Cross-sectional, ecologic (black adults and white adults in 38 MSAs with ≥1 million population, 1982-1986) | Dissimilarity (metropolitan area (census tract)) | Black-white adult mortality risk difference | Increasing dissimilarity associated with increasing black-white mortality gap |
| Polednak, 1991 (128) | Cross-sectional, ecologic (black births and white births in 38 MSAs with ≥1 million population, 1982-1986) | Dissimilarity (metropolitan area (census tract)) | Black-white infant mortality risk difference | Increasing dissimilarity associated with larger difference between black infant and white infant mortality |
| Yankauer, 1950 (1) | Cross-sectional, ecologic (black women and white women delivering in New York City, 1945–1947) | % Black in 318 “residential areas” of New York City | Infant mortality | Increase in black infant and white infant mortality as proportion black in neighborhood of residence increased |
| Pregnancy outcome studies | ||||
| Kramer, 2008(129) | Cross-sectional, ecologic (black women and white women with livebirths in 168 MSAs, 2002–2004) | Isolation and dissimilarity (metropolitan area (census tract)) | Very preterm birth (<32 weeks) | Increased risk of very preterm birth with isolation but decreased risk with unevenness for black women; no effect for white women |
| Osypuk, 2008(120) | Cross-sectional, multilevel (black women and white women delivering livebirths in 237 MSAs, 2000) | Hypersegregation defined as highly segregated on ≥4 of 5 dimensions (metropolitan area (census tract)) | Preterm birth (<37 weeks) | Increased odds of preterm birth to black women in hypersegregated cities compared with not; black-white disparities also larger in hypersegregated cities |
| Vinikoor, 2008 (134) | Cross-sectional, multilevel (black women delivering livebirths in Wake and Durham Counties, North Carolina, 1999–2001) | Predominantly black census tracts (>75%) vs. mixed census tracts (≤75%) | Low birth weight (<2,500 g); preterm birth (<37 weeks) | Income incongruity (living in a higher median income tract than expected based on individual education and marital status) protective against low birth weight and preterm birth in predominantly black neighborhoods but not in mixed tracts |
| Grady, 2007 (29) | Cross-sectional, multilevel (foreign- and US-born black women delivering livebirths in New York City, 2000) | Local spatial segregation index (New York City (census tract)) | Low birth weight (<2,500 g) | Increased isolation associated with increased low birth weight risk for US-born black women after control for individual and neighborhood poverty; for foreign-born women, excess risk explained by individual risk factors |
| Masi, 2007(135) | Cross-sectional, multilevel (black, white, and Hispanic women delivering live singleton births in Chicago, Illinois, in 1991) | Census tracts categorized as < 10% black, 10%-90% black, >90% black | Birth weight (continuous); preterm birth (<37 weeks) | No association of racial concentration on birth weight or preterm birth for black women; modest association for white women, with higher risk in predominantly black tracts |
| Bell, 2006(102) | Cross-sectional, multilevel (livebirths to black women in 225 US MSAs, 2002) | Isolation and spatial proximity (metropolitan area (census tract)) | Birth weight (continuous); preterm birth (<37 weeks); intrauterine growth restriction | Decreased birth weight (68 g) and increased preterm birth for high vs. very low isolation (OR = 1.27); high vs. very low clustering associated with higher birth weight (25 g) and lower preterm birth (OR = 0.86) |
| Grady, 2006 (28) | Cross-sectional, multilevel (black women with livebirths in New York City, 2000) | Local spatial segregation index (New York City (census tract)) | Low birth weight (<2,500 g) | Segregation associated with low birth weight independent of neighborhood poverty and individual SES |
| Pickett, 2005 (37) | Cross-sectional, multilevel (black women delivering livebirths in Chicago, Illinois, 1991) | Predominantly black census tracts (>90%) vs. mixed census tracts (≤90%) | Low birth weight (<2,500 g); preterm birth (<37 weeks) | Income incongruity (living in a higher median income tract than expected based on individual education and marital status) protective against low birth weight and preterm birth in predominantly black neighborhoods, but not in mixed tracts |
| Ellen, 2000(136) | Cross-sectional, multilevel (black women and white women delivering in 261 MSAs with >100,000 population and >5,000 black, 1990) | Dissimilarity and centralization (metropolitan area (census tract)) | Low birth weight (<2,500 g) | Increasing segregation associated with increased risk of low birth weight for black women but not white women |
| Sucoff, 1998(146) | Retrospective cohort (black female Panel Study of Income Dynamics participants born in 1953-1968) | Neighborhoods (tracts) categorized by racial concentration | Time to teenage premarital first birth | Black girls in highly segregated neighborhoods 50% more likely than black girls in racially mixed tracts to have premarital births before age 20 years |
| Other health outcomes | ||||
| Haas, 2008 (133) | Cross-sectional, multilevel (black, white, and Hispanic adults aged >65 years in the SEER database, 1992–2002) | Isolation (counties (census tract)); categorized into high- vs. low-segregated counties | Early- vs. late-stage diagnosis of primary lung, colorectal, breast, or prostate cancer | Black-white disparity in early-stage diagnosis smallest in high-segregation, low-income neighborhoods |
| Cooper, 2007(130) | Cross-sectional, ecologic (blacks in MSAs with ≥500,000 population in 1993) | Isolation and concentration (metropolitan area (census tract)) | Injection drug use prevalence | Isolation, but not concentration, associated with black injection drug use prevalence |
| Do, 2007(137) | Cross-sectional, multilevel (NHANES III participants, 1988–1994) | % Black or % Hispanic (census tract) | Body mass index | Proportion black and Hispanic in a neighborhood marginally associated with body mass index in black and Hispanic males but not females |
| Rodriguez, 2007 (147) | Retrospective cohort (black adults and white adults beginning dialysis between 1995 and 2002) | % Black in patient zip code area divided into quartiles | Time to death or kidney transplant | Increased mortality for whites but not blacks as black concentration increased; time to transplantation longer for both blacks and whites living in predominantly black neighborhoods |
| Chang, 2006(138) | Cross-sectional, multilevel (black respondents and white respondents to BRFSS, 2000) | Isolation index (metropolitan area (census tract)) | Body mass index (continuous) % with body mass index ≥30 kg/m2 | One standard deviation increase in isolation associated with a 0.42 increase in body mass index, and obesity OR = 1.14 for blacks; no association for whites |
| Mobley, 2006 (69) | Cross-sectional, multilevel (uninsured, low-income women enrolled from 5 US states) | Isolation index, although scale of neighborhood and broader area not defined | Body mass index 10-year predicted heart disease risk | No association between segregation and body mass index for any group, and reduced coronary heart disease risk for blacks and Hispanics as segregation increased |
| Robert, 2006(139) | Cross-sectional, multilevel (black adults and white adults aged >65 years from the Americans Changing Lives survey and the National Survey of Families and Households, 1986–1988) | Dissimilarity and isolation (counties (census tract)) | Self-rated health | No association for whites or blacks between segregation and self-rated health |
| White, 2006(140) | Cross-sectional, multilevel (adults in New York City Social Indicator Survey, 1999–2002) | % Minority by zip code area, categorized into tertiles | Self-rated health (fair/poor vs. excellent/very good/good) | Poor self-rated health associated with higher density minority in zip code area (aOR = 1.7, 95% CI: 1.1, 2.7) |
| Subramanian, 2005 (141) | Cross-sectional, multilevel (black adults and white adults living in MSAs with > 100,000 population and >5,000 black, 2000) | Dissimilarity and isolation (metropolitan area (census tract)) | Self-rated health (fair/poor vs. excellent/very good/good) | High isolation associated with increased odds of poor self-rated health among blacks but not whites |
| Fabio, 2004 (131) | Cross-sectional, ecologic (Pennsylvania, 1995-1997) | Gini coefficient of racial unevenness (counties (census tract)) | Intentional injury diagnosis on hospital discharge | Increasing segregation (unevenness) associated with increased intentional injury discharge |
| Skinner, 2003(132) | Cross-sectional, ecologic (black beneficiaries and white beneficiaries of Medicare, 1998–2000) | Dissimilarity (metropolitan area (census tract)) | Rates of knee arthroplasty | Smaller difference in black and white knee arthroplasty for women living in low-segregation cities (rate difference = 0.46/1,000) vs. high-segregation cities (rate difference = 1.05/1,000); no effect for men |
| Thomas, 2003 (78) | Cross-sectional, ecologic (counties in 14 southeastern US states, 1986–1995) | Dissimilarity and isolation (counties (census tract)) | County gonorrhea rates categorized as endemically high or endemically low | Black isolation index >0.2 associated with endemically high counties controlling for proportion black and poverty indicators (aOR = 248, 95% CI: 22, 999) |
| Acevedo-Garcia, 2001 (75) | Cross-sectional, ecologic (New Jersey adults) | Isolation and concentration (New Jersey (zip code area)) | Annual incidence of tuberculosis by race | Higher isolation associated with tuberculosis in blacks, and, to a lesser extent, Hispanics; no association for whites |
Abbreviations: aOR, adjusted odds ratio; BRFSS, Behavioral Risk Factor Surveillance System; CI, confidence interval; HR, hazard ratio; MSA, Metropolitan Statistical Area; NHANES, National Health and Nutrition Examination Survey; OR, odds ratio; SEER, Surveillance, Epidemiology, and End Results.
a
Geographic units for measuring segregation are displayed in terms of the nesting of 2 scales: (macro area (neighborhood subarea)).