Unequal burdens: assessing the determinants of elevated COVID-19 case and death rates in New York City's racial/ethnic minority neighbourhoods.

BACKGROUND: The disproportionate burden of the COVID-19 pandemic on racial/ethnic minority communities has revealed glaring inequities. However, multivariate empirical studies investigating its determinants are still limited. We document variation in COVID-19 case and death rates across different racial/ethnic neighbourhoods in New York City (NYC), the initial epicentre of the U.S. coronavirus outbreak, and conduct a multivariate ecological analysis investigating how various neighbourhood characteristics might explain any observed disparities. METHODS: Using ZIP-code-level COVID-19 case and death data from the NYC Department of Health, demographic and socioeconomic data from the American Community Survey and health data from the Centers for Disease Control's 500 Cities Project, we estimated a series of negative binomial regression models to assess the relationship between neighbourhood racial/ethnic composition (majority non-Hispanic White, majority Black, majority Hispanic and Other-type), neighbourhood poverty, affluence, proportion of essential workers, proportion with pre-existing health conditions and neighbourhood COVID-19 case and death rates. RESULTS: COVID-19 case and death rates for majority Black, Hispanic and Other-type minority communities are between 24% and 110% higher than those in majority White communities. Elevated case rates are completely accounted for by the larger presence of essential workers in minority communities but excess deaths in Black neighbourhoods remain unexplained in the final model. CONCLUSIONS: The unequal COVID-19 case burden borne by NYC's minority communities is closely tied to their representation among the ranks of essential workers. Higher levels of pre-existing health conditions are not a sufficient explanation for the elevated mortality burden observed in Black communities.

Race-Ethnicity, Union Status, and Change in Body Mass Index in Young Adulthood.

This study used data from three waves of the National Longitudinal Study of Adolescent to Adult Health (Add Health) and fixed-effects regression to consider whether associations between change in union status and change in BMI were moderated by race/ethnicity. The results indicated that intimate unions were differentially associated with gains in BMI along race/ethnic lines, especially for women. Compared to White women, marriage was associated with larger increases in BMI for Black, Hispanic and Multiracial women, and cohabitation was associated with larger increases for Black and Hispanic women. In contrast, both marriage and cohabitation were associated with less weight gain for Asian compared to White women. Among men, racial/ethnic differences in the relationship between union status and BMI were similarly patterned but less pronounced. The results suggest that, particularly for women, marital status-already its own source of stratification, further exacerbates racial/ethnic disparities in BMI from adolescence to young adulthood.

Black-white metropolitan segregation and self-rated health: Investigating the role of neighborhood poverty.

While black-white segregation has been consistently linked to detrimental health outcomes for blacks, whether segregation is necessarily a zero-sum arrangement in which some groups accrue health advantages at the expense of other groups and whether metropolitan segregation impacts the health of racial groups uniformly within the metropolitan area, remains unclear. Using nationally representative data from the 2008-2013 National Health Interview Survey linked to Census data, we investigate whether the association between metropolitan segregation and health is invariant within the metropolitan area or whether it is modified by neighborhood poverty for black and white Americans. In doing so, we assess the extent to which segregation involves direct health tradeoffs between blacks and whites. We conduct race-stratified multinomial and logistic regression models to assess the relationship between 1) segregation and level of neighborhood poverty and 2) segregation, neighborhood poverty, and poor health, respectively. We find that, for blacks, segregation was associated with a higher likelihood of residing in high poverty neighborhoods, net of individual-level socioeconomic characteristics. Segregation was positively associated with poor health for blacks in high poverty neighborhoods, but not for those in lower poverty neighborhoods. Hence, the self-rated health of blacks clearly suffers as a result of black-white segregation - both directly, and indirectly through exposure to high poverty neighborhoods. We do not find consistent evidence for a direct relationship between segregation and poor health for whites. However, we find some suggestive evidence that segregation may indirectly benefit whites through decreasing their exposure to high poverty environments. These findings underscore the critical role of concentrated disadvantage in the complex interconnection between metropolitan segregation and health. Weakening the link between racial segregation and concentrated poverty via local policy and planning has the potential for broad population-based health improvements and significant reductions in black-white health disparities.

Hispanic Segregation and Poor Health: It's Not Just Black and White.

Despite the importance of understanding the fundamental determinants of Hispanic health, few studies have investigated how metropolitan segregation shapes the health of the fastest-growing population in the United States. Using 2006-2013 data from the National Health Interview Survey, we 1) examined the relationship between Hispanic metropolitan segregation and respondent-rated health for US-born and foreign-born Hispanics and 2) assessed whether neighborhood poverty mediated this relationship. Results indicated that segregation has a consistent, detrimental effect on the health of US-born Hispanics, comparable to findings for blacks and black-white segregation. In contrast, segregation was salutary (though not always significant) for foreign-born Hispanics. We also found that neighborhood poverty mediates some, but not all, of the associations between segregation and poor health. Our finding of divergent associations between health and segregation by nativity points to the wide range of experiences within the diverse Hispanic population and suggests that socioeconomic status and structural factors, such as residential segregation, come into play in determining Hispanic health for the US-born in a way that does not occur among the foreign-born.

New faces in new spaces in new places: Residential attainment among newly legalized immigrants in established, new, and minor destinations.

UNLABELLED: Immigrants at the beginning of the twenty-first century are located in a more diverse set of metropolitan areas than at any point in U.S. HISTORY: Whether immigrants' residential prospects are helped or hindered in new versus established immigrant-receiving areas has been the subject of debate. Using multilevel models and data from the New Immigrant Survey (NIS), a nationally representative sample of newly legalized immigrants to the U.S., we move beyond aggregate-level analyses of residential segregation to specify the influence of destination type on individual-level immigrant residential outcomes. The findings indicate that immigrants in new and minor destinations are significantly more likely to live in tracts with relatively more non-Hispanic whites and relatively fewer immigrants and poor residents. These residential advantages persist net of individual-level controls but are largely accounted for by place-to-place differences in metropolitan composition and structure. Our exclusive focus on newly legalized immigrants means that our findings do not necessarily contradict the possibility of worse residential prospects in new areas of settlement, but rather qualifies it as not extending to the newly authorized population.

Segmented assimilation, neighborhood disadvantage, and Hispanic immigrant health.

We use a subset of Hispanics from the New Immigrant Survey, a nationally representative data set on immigrants recently granted legal permanent residency (n = 2245), to examine whether the relationship between assimilation and health is modified by neighborhood disadvantage and, in doing so, carry out an empirical test of the segmented assimilation hypothesis. Results indicate that assimilation in the least disadvantaged neighborhoods can be protective against poor health. Specifically, more assimilated men and women in the lowest disadvantage neighborhoods have a lower likelihood of self-reported poorer health and being overweight, respectively; no link was found in higher disadvantage neighborhoods. Assimilation was not found to be associated with self-reported health for women or BMI for men, regardless of neighborhood disadvantage level. Overall, we find some evidence supporting the hypothesis that the effects of assimilation on health depend on the context in which immigrants experience it.

Social patterning in body mass index (BMI) among contemporary immigrant groups: the emergence of a gradient.

Although adult body mass index (BMI) displays considerable social patterning worldwide, the direction and strength of the relationship between BMI and socioeconomic status (SES) varies cross nationally. We examine social gradients in BMI for contemporary U.S. immigrants and evaluate whether their SES-BMI gradient patterns are shaped by underlying gradients in immigrant origin countries and whether they are further patterned by time in the United States. Data come from the New Immigrant Survey, the only nationally representative survey of contemporary immigrants. Results indicate that the inverse SES-BMI gradients observed among this population are strongest among women originating in highly developed countries. After arrival in the United States, however, inverse gradient patterns are driven largely by higher weights among low-SES individuals, particularly those from less-developed countries. We conclude that although certain immigrants appear to be uniquely protected from weight gain, poorer individuals from less-developed countries are doubly disadvantaged; this raises concerns about worsening inequalities in both diet and behavior between the rich and poor upon arrival to the United States.

Does SES explain more of the black/white health gap than we thought? Revisiting our approach toward understanding racial disparities in health.

Studies of racial health gaps often find that disparities persist even after adjusting for socioeconomic status (SES). We contend that the persistent residual variation may, in part, be the result of conceptual and methodological problems in the operationalization of SES. These include inadequate attention to the content validity of SES measures and insufficient adjustments for SES differences across racial groups. Using data from the 1997-2007 U.S. Panel Study of Income Dynamics (N = 9932), we use longitudinal and multi-level measures of SES and apply a propensity score adjustment strategy to examine the black/white disparity in self-rated health. Compared to conventional regression estimates that yield unexplained racial health gaps, propensity score adjustment accounts for the entire racial disparity in self-rated health. Results suggest that previous studies may have inadequately adjusted for differences in SES across racial groups, that social factors should be carefully and conscientiously considered, and that acknowledgment of the possibility of incomplete SES adjustments should be weighed before any inferences to non-SES etiology can be made.

A tale of two cities: residential context and risky behavior among adolescents in Los Angeles and Chicago.

This article evaluates whether the at-risk behavior of adolescents is differentially influenced by community context across two metropolitan areas. Our focus is on Latino youth in particular. The data come from the Los Angeles Family and Neighborhood Survey (L.A.FANS) and the Project on Human Development in Chicago Neighborhoods (PHDCN). Multi-level models are employed to estimate the effects of community-level influences on adolescent risky behavior in Los Angeles and Chicago. Neighborhood-level influences on the at-risk behavior of youth are found to operate similarly across the two cities, such that native-born children of Latino immigrants are at greatest risk of problem behavior in co-ethnic highly segregated neighborhoods in both Los Angeles and Chicago. Similar patterns are observed for African-Americans, particularly in Chicago and Non-Latino Whites in both cities. We argue that the findings are best interpreted through a segregation framework. Members of each racial/ethnic group appear to exhibit negative health risk behaviors when they reside in areas that are disproportionately populated with their co-ethnic peers.

The relationship between remittances and health care provision in Mexico.

OBJECTIVES: We examined whether remittances sent from the United States to Mexico were used to access health care in Mexico. METHODS: Data were from a 2006 survey of 2 localities in the municipal city of Tepoztlán, Morelos, Mexico. We used logistic regression to determine whether household remittance expenditure on health care was associated with type of health insurance coverage. RESULTS: Individuals who lacked insurance coverage or who were covered by the Seguro Popular program were significantly more likely to reside in households that spend remittances on health care than were individuals covered by an employer-based insurance program. CONCLUSIONS: Improving the coverage and quality of care within Mexico's health care system will help ensure that remittances serve as a complement, and not a substitute, to formal access to care.

Health selection among new immigrants.

OBJECTIVES: We sought to quantify the extent of health selection (i.e., the degree to which potential immigrants migrate, or fail to migrate, on the basis of their health status) among contemporary US immigrant groups and evaluate the degree that selection explains variation in self-rated health among US legal permanent residents. METHODS: Data came from the New Immigrant Survey 2003 cohort. We estimated the extent of positive and negative health selection through a unique series of questions asking immigrants in the United States to evaluate their health and compare it to that of citizens in their country of origin. RESULTS: The extent of positive health selection differed significantly across immigrant groups and was related to compositional differences in the socioeconomic profiles of immigrant streams. CONCLUSIONS: The salience of socioeconomic status and English-language ability in explaining health differentials across immigrant groups reinforces the importance of further research on the role of these factors in contributing to the health of immigrants above and beyond the need for additional attention to the health selection process.

Barrios and burbs: residential context and health-risk behaviors among Angeleno adolescents.

The increasing size of the Latino immigrant population in the United States underscores the need for a more complete understanding of the role that social context plays in influencing the health of immigrants and their children. This analysis explores the possibility that residential location influences the health-risk behaviors of Latino youth in Los Angeles County, California. The data come from the Los Angeles Family and Neighborhood Survey. We apply multivariate, multilevel Rasch models to two scales of adolescent health-risk behaviors (substance use and delinquency). The findings suggest that residence in Census tracts characterized by above-county-average levels of Latinos and above-county-average levels of poverty is associated with increased odds of health-risk behaviors for Latino adolescents, particularly for those born in the United States. The findings lend support to the contention, put forth in the segmented assimilation literature, that disadvantaged urban contexts increase the risk that U.S.-born children of immigrants will experience downward assimilation.

What to make of it? The (Re)emergence of a biological conceptualization of race in health disparities research.

The debate over the role of race/ethnicity in determining disease susceptibility has re-emerged since it was declared that race was arbitrary biological fiction more than 50 years ago. Partly due to advancements in the Human Genome Project and related technologies, the idea that race/ethnicity does have a genetic basis is enjoying a resurgence. A rise in the use of race in genetic studies has left many researchers who are committed to a social conceptualization of race at a loss regarding how to evaluate these developments. The commentary attempts to correct the problem by providing a critical review of the state of research on race, genetics and health. This review aims to bring social health disparities researchers up-to-date on developments in the genetic literature and to facilitate a more critical engagement of research that purports to find a genetic basis to racial disparities in health.

Low birth weight in Mexico: new evidence from a multi-site postpartum hospital survey.

OBJECTIVE: To identify factors related to cases of low birth weight among a sample of Mexican women. MATERIAL AND METHODS: The present analysis utilizes data from a post partum survey of 565 women implemented in eight different social security hospitals in western Mexico during 2001. Women giving birth to low weight infants (2.5 kgs) were oversampled and make up half of the sample. RESULTS: A series of logistic regression equations are presented that estimate the risk of low birth weight. Study findings indicate that, although behavioral factors appear to be highly significant in predicting the odds of low birth weight, socioeconomic and sociodemographic factors were found to be important in determining utilization of prenatal care. CONCLUSIONS: The key role of behavioral characteristics in determining low birth weight risk and the role of socioeconomic and sociodemographic factors in determining prenatal care usage highlights the need to improve prenatal care utilization by disadvantaged populations.