Journal of Urban Health

, Volume 85, Issue 1, pp 11–21 | Cite as

Exploring Health Disparities in Integrated Communities: Overview of the EHDIC Study

  • Thomas LaVeist
  • Roland ThorpeJr.
  • Terra Bowen-Reid
  • John Jackson
  • Tiffany Gary
  • Darrell Gaskin
  • Dorothy Browne
Article

Abstract

Progress in understanding the nature of health disparities requires data that are race-comparative while overcoming confounding between race, socioeconomic status, and segregation. The Exploring Health Disparities in Integrated Communities (EHDIC) study is a multisite cohort study that will address these confounders by examining the nature of health disparities within racially integrated communities without racial disparities in socioeconomic status. Data consisted of a structured questionnaire and blood pressure measurements collected from a sample of the adult population (age 18 and older) of two racially integrated contiguous census tracts. This manuscript reports on baseline results from the first EHDIC site, a low-income urban community in southwest Baltimore, Maryland (EHDIC-SWB). In the adjusted models, African Americans had lower rates of smoking and fair or poor self-rated health than whites, but no race differences in obesity, drinking, or physical inactivity. Our findings indicate that accounting for race differences in exposure to social conditions reduces or eliminates some health-related disparities. Moreover, these findings suggest that solutions to the seemingly intractable health disparities problem that target social determinants may be effective, especially those factors that are confounded with racial segregation. Future research in the area of health disparities should seek ways to account for confounding from SES and segregation.

Keywords

Health disparities Confounding Race Socioeconomic status Segregation Integration Urban Community 

References

  1. 1.
    Ferraro KF, Farmer MM. Double jeopardy, aging as leveler, or persistent health inequality? A longitudinal analysis of white and black Americans. J Gerontol B Psychol Sci Soc Sci. 1996;51(6):S319–S328.PubMedGoogle Scholar
  2. 2.
    Ferraro KF, Farmer MM, Wybraniec JA. Health trajectories: long-term dynamics among black and white adults. J Health Soc Behav. 1997;38(1):38–54.PubMedCrossRefGoogle Scholar
  3. 3.
    Miles TP, Bernard MA. Morbidity, disability, and health status of black American elderly: a new look at the oldest-old. J Am Geriatr Soc. 1992;40(10):1047–1054.PubMedGoogle Scholar
  4. 4.
    Smith JP, Kington R. Demographic and economic correlates of health in old age. Demography. 1997;34(1):159–170.PubMedCrossRefGoogle Scholar
  5. 5.
    Sudano JJ, Baker DW. Explaining U.S. racial/ethnic disparites in health declines and mortality in late middle age: the roles of socioeconomic status, health behaviors, and health insurance. Soc Sci Med. 2006;62:909–922.PubMedCrossRefGoogle Scholar
  6. 6.
    LaVeist TA, Bowie JV, Cooley-Quille M. Minority health status in adulthood: the middle years of life. Health Care Financ Rev. 2000;21(4):9–21.PubMedGoogle Scholar
  7. 7.
    Farmer MM, Ferraro KF. Are racial disparities in health conditional on socioeconomic status? Soc Sci Med. 2005;60:191–204.PubMedCrossRefGoogle Scholar
  8. 8.
    LaVeist TA, Arthur M, Morgan A, et al. The cardiac access longitudinal study. A study of access to invasive cardiology among African American and white patients. J Am Coll Cardiol. 2003;41(7):1159–1166.PubMedCrossRefGoogle Scholar
  9. 9.
    Williams DR. Race and health: basic questions, emerging directions. Ann Epidemiol. 1997;7(5):322–333.PubMedCrossRefGoogle Scholar
  10. 10.
    Kochanek KD, Maurer JD, Rosenberg HM. Why did black life expectancy decline from 1984 through 1989 in the United States? Am J Public Health. 1994;84(6):938–944.PubMedGoogle Scholar
  11. 11.
    Jackson JS, Brown TN, Williams DR, Torres M, Sellers SL, Brown K. Racism and the physical and mental health status of African Americans: a thirteen year national panel study. Ethn Dis. 1996;6(1–2):132–147.PubMedGoogle Scholar
  12. 12.
    Ng-Mak DS, Dohrenwend BP, Abraido-Lanza AF, Turner JB. A further analysis of race differences in the National Longitudinal Mortality Study. Am J Public Health. 1999;89(11):1748–1751.PubMedGoogle Scholar
  13. 13.
    Williams DR. Race/ethnicity and socioeconomic status: measurement and methodological issues. Int J Health Serv. 1996;26(3):483–505.PubMedCrossRefGoogle Scholar
  14. 14.
    Lillie-Blanton M, Parsons PE, Gayle H, Dievler A. Racial differences in health: not just black and white, but shades of gray. Annu Rev Public Health. 1996;17:411–448.PubMedGoogle Scholar
  15. 15.
    Williams DR, Collins C. U.S. socioeconomic and racial differences in health: patterns and explanations. Annu Rev Sociology. 1995;21:349.CrossRefGoogle Scholar
  16. 16.
    LaVeist TA. On the study of race, racism, and health: a shift from description to explanation. Int J Health Serv. 2000;30(1):217–219.PubMedCrossRefGoogle Scholar
  17. 17.
    LaVeist TA. Disentangling race and socioeconomic status: a key to understanding health inequalities. J Urban Health. 2005;82(2 Suppl 3):iii26–iii34.PubMedGoogle Scholar
  18. 18.
    Braveman PA, Cubbin C, Egerter S, et al. Socioeconomic status in health research: one size does not fit all. JAMA. 2005;294:2879–2888.PubMedCrossRefGoogle Scholar
  19. 19.
    Hayward MD, Crimmins EM, Miles TP, Yang Y. The significance of socioeconomic status in explaining the racial gap in chronic health conditions. Sociol Rev. 2000;65:910–930.CrossRefGoogle Scholar
  20. 20.
    Kilbourne AM, Switzer G, Hyman K, Crowley-Matoka M, Fine MJ. Advancing health disparities research within the health care system: a conceptual framework. Am J Public Health. 2006;96(12):2113–2121.PubMedCrossRefGoogle Scholar
  21. 21.
    LaVeist TA. Data sources for aging research on racial and ethnic groups. Gerontologist. 1995;35(3):328–339.PubMedGoogle Scholar
  22. 22.
    LaVeist TA, Thorpe RJ Jr, Mance G, Jackson J. Overcoming confounding of race with socioeconomic status and segregation to explore race disparities in smoking. Journal of Addiction. In Press.Google Scholar
  23. 23.
    LaVeist TA. Racial segregation and longevity among African Americans: an individual-level analysis. Health Serv Res. 2003;38(6 Pt 2):1719–1733.PubMedCrossRefGoogle Scholar
  24. 24.
    Kaufman JS, Cooper RS, McGee DL. Socioeconomic status and health in blacks and whites: the problem of residual confounding and the resiliency of race. Epidemiology. 1997;8(6):621–628.PubMedCrossRefGoogle Scholar
  25. 25.
    Krieger N, Williams DR, Moss NE. Measuring social class in U.S. public health research: concepts, methodologies, and guidelines. Annu Rev Public Health. 1997;18:341–378.PubMedCrossRefGoogle Scholar
  26. 26.
    Navarro V. Race or class or race and class: growing mortality differentials in the United States. Int J Health Serv. 1991;21(2):229–235.PubMedCrossRefGoogle Scholar
  27. 27.
    Navarro V. Race or class versus race and class: mortality differentials in the United States. Lancet. 1990;336(8725):1238–1240.PubMedCrossRefGoogle Scholar
  28. 28.
    LaVeist TA. Beyond dummy variables and sample selection: what health services researchers ought to know about race as a variable. Health Serv Res. 1994;29(1):1–16.PubMedGoogle Scholar
  29. 29.
    Laveist TA. Segregation, poverty, and empowerment: health consequences for African Americans. Milbank Q. 1993;71(1):41–64.PubMedCrossRefGoogle Scholar
  30. 30.
    Collins CA, Williams DR. Segregation and mortality: the deadly effects of racism? Sociological Forum. 1999;14:495–523.CrossRefGoogle Scholar
  31. 31.
    Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001;116(5):404–416.PubMedGoogle Scholar
  32. 32.
    Morland K, Wing S, Diez Roux A, Poole C. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med. 2002;22(1):23–29.PubMedCrossRefGoogle Scholar
  33. 33.
    LaVeist TA, Wallace JM Jr. Health risk and inequitable distribution of liquor stores in African American neighborhood. Soc Sci Med. 2000;51(4):613–617.PubMedCrossRefGoogle Scholar
  34. 34.
    Lillie-Blanton M, Anthony JC, Schuster CR. Probing the meaning of racial/ethnic group comparisons in crack cocaine smoking. JAMA. 1993;269(8):993–997.PubMedCrossRefGoogle Scholar
  35. 35.
    Morrison RS, Wallenstein S, Natale DK, Senzel RS, Huang LL. “We don’t carry that”—failure of pharmacies in predominantly nonwhite neighborhoods to stock opioid analgesics. N Engl J Med. 2000;342(14):1023–1026.PubMedCrossRefGoogle Scholar
  36. 36.
    Luke D, Esmundo E, Bloom Y. Smoke signs: patterns of tobacco billboard advertising in a metropolitan region. Tob Control. 2000;9(1):16–23.PubMedCrossRefGoogle Scholar
  37. 37.
    Balbach ED, Gasior RJ, Barbeau EM. R.J. Reynolds’ targeting of African Americans: 1988–2000. Am J Public Health. 2003;93(5):822–827.PubMedGoogle Scholar
  38. 38.
    Acevedo-Garcia D. Residential segregation and the epidemiology of infectious diseases. Soc Sci Med. 2000;51(8):1143–1161.PubMedCrossRefGoogle Scholar
  39. 39.
    LaVeist TA. Linking residential segregation and the infant mortality race disparity. Sociol Soc Res. 1989;73:90–94.Google Scholar
  40. 40.
    Yankauer A. The relationship of fetal and infant mortality to residential segregation. Am Sociol Rev. 1950;15:644–648.CrossRefGoogle Scholar
  41. 41.
    Polednak AP. Black-white differences in infant mortality in 38 standard metropolitan statistical areas. Am J Public Health. 1991;81(11):1480–1482.PubMedGoogle Scholar
  42. 42.
    Fang J, Madhavan S, Bosworth W, Alderman MH. Residential segregation and mortality in New York City. Soc Sci Med. 1998;47(4):469–476.PubMedCrossRefGoogle Scholar
  43. 43.
    Jackson SA, Anderson RT, Johnson NJ, Sorlie PD. The relation of residential segregation to all-cause mortality: a study in black and white. Am J Public Health. 2000;90(4):615–617.PubMedGoogle Scholar
  44. 44.
    Acevedo-Garcia D. Zip code-level risk factors for tuberculosis: neighborhood environment and residential segregation in New Jersey, 1985–1992. Am J Public Health. 2001;91(5):734–741.PubMedCrossRefGoogle Scholar
  45. 45.
    Hart KD. Racial segregation and ambulatory care-sensitive admissions. Health Aff (Millwood). 1997;16(1):224–225; author reply 225.CrossRefGoogle Scholar
  46. 46.
    Gary TL, Stark SA, Laveist TA. Neighborhood characteristics and mental health among African Americans and whites living in a racially integrated urban community. Health Place. 2007;13(2):569–575.PubMedCrossRefGoogle Scholar
  47. 47.
    Casagrande SS, Gary TL, LaVeist TA, Gaskin J, Cooper LA. Perceived discrimination and adherence to medical care in a racially integrated community. J Gen Intern Med. 2007;22(3):389–395.PubMedCrossRefGoogle Scholar
  48. 48.
    National Center for Health Statistics. 2003 National Health Interview Survey Adult Core. 2004.Google Scholar
  49. 49.
    National Center for Health Statistics. 2003 National Health Interview Survey Description. 2004.Google Scholar
  50. 50.
    National Center for Health Statistics. National Health Interview Survey Description. 2006; available at: http://www.cdc.gov/nchs/about/major/nhis/hisdesc.htm. Accessed December 10, 2006.
  51. 51.
    Bullard RD. Solid waste sites and the black Houston community. Sociol Inq. 1983;53(2–3):273–288.PubMedCrossRefGoogle Scholar
  52. 52.
    National Institute on Drug Abuse. National Household Survey on Drug Abuse: Main Findings 1988. Washington, DC: U.S. Department of Health and Human Services Publication ADM 90-1692. 1990.Google Scholar
  53. 53.
    Massey D, Denton N. American Apartheid: Segregation and the Making of the Underclass. Boston: Harvard University Press; 1998.Google Scholar
  54. 54.
    Oliver M, Shapiro T. Black Wealth/White Wealth: A New Perspective on Racial Inequality. United Kingdom: Routledge; 1995.Google Scholar
  55. 55.
    Shapiro T. The Hidden cost of Being African American: How Wealth Perpetuates Inequality. USA: Oxford University Press; 2005.Google Scholar

Copyright information

© The New York Academy of Medicine 2007

Authors and Affiliations

  • Thomas LaVeist
    • 1
  • Roland ThorpeJr.
    • 1
  • Terra Bowen-Reid
    • 2
  • John Jackson
    • 1
  • Tiffany Gary
    • 1
  • Darrell Gaskin
    • 1
  • Dorothy Browne
    • 2
  1. 1.Hopkins Center for Health Disparities SolutionsJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.School of Public Health and PolicyMorgan State UniversityBaltimoreUSA

Personalised recommendations