Measures of Structural Racism Tied to Poor Health

Duke researchers related neighborhood-level indicators of structural racism to increased chronic

Provider holding black patient's hand

Duke researchers collaborated on a first-of-its-kind study to quantify associations of neighborhood-level indicators of structural racism with the increased prevalence of chronic diseases. Epidemiological studies have shown a higher prevalence of chronic health conditions among minority groups, but there has been a dearth of studies on specific determinants. 
To address this lack, the Duke researchers collaborated with colleagues from Wake Forest University School of Medicine and the Icahn School of Medicine at Mount Sinai in a first-of-its kind study published in JAMA Network Open. The study looked at the association of neighborhood levels of global and discrete measures of structural racism with the prevalence of chronic kidney disease, diabetes, and hypertension. 
“We found a greater prevalence of chronic kidney disease, diabetes, and hypertension within neighborhoods that had higher levels of structural racism,” according to study author Nrupen Bhavsar, PhD, a Duke associate professor and epidemiologist.
This greater prevalence was evident in models evaluating global indicators as well as models evaluating discrete indicators.  
The global indicators of structural racism used were a lower percentage of White residents, greater economic and racial segregation, and greater area deprivation. Discrete indicators included number of neighborhood child-care centers, bus stops, tree cover, reported violent crime, impervious areas, evictions, election participation, income, poverty, education, unemployment, health insurance coverage, and police shootings. 

The study compared the residents of 150 residential neighborhoods in Durham County defined using U.S. census block groups—with the neighborhood characteristics defined using the Durham Neighborhood Compass, a data set created by public health officials—and used de-identified electronic health record data from the Duke system. 
The authors wrote that their study “found numerous indicators of structural racism associated with inequities in residential neighborhood health…These structural racism constructs could be considered in future efforts to mitigate neighborhood health inequities.” 
Bhavsar said that the study might inform efforts to address some of the underlying problems: “Are there ways to prevent evictions or address violence and other measures of structural racism? People often view poverty as an abstract concept, so if we can identify discrete elements that are a target for intervention, perhaps we can reduce some of the downstream health impacts.” 
On an individual treatment level, the study might serve to remind clinicians to consider the context in which their patients live. These patients often have closely related conditions that could benefit from the comprehensive approach to care that is one of Duke’s signatures.
For example, the Duke Cardiometabolic Prevention Clinic brings together specialists who treat diabetes, cardiovascular disease, kidney disease, liver disease, and related comorbidities to provide the multidisciplinary care needed for optimum treatment.