Measuring Local-Area Racial Segregation for Medicare Hospital Admissions.

Importance: Considerable racial segregation exists in US hospitals that cannot be explained by where patients live. Approaches to measuring such segregation are limited. Objective: To measure how and where sorting of older Black patients to different hospitals occurs within the same health care market. Design, Setting, and Participants: This retrospective cross-sectional study used 2019 Medicare claims data linked to geographic data. Hospital zip code markets were based on driving time. The local hospital segregation (LHS) index was defined as the difference between the racial composition of a hospital's admissions and the racial composition of the hospital's market. Assessed admissions were among US Medicare fee-for-service enrollees aged 65 or older living in the 48 contiguous states with at least 1 hospitalization in 2019 at a hospital with at least 200 hospitalizations. Data were analyzed from November 2022 to January 2024. Exposure: Degree of residential segregation, ownership status, region, teaching hospital designation, and disproportionate share hospital status. Main Outcomes and Measures: The LHS index by hospital and a regional LHS index by hospital referral region. Results: In the sample of 1991 acute care hospitals, 4 870 252 patients (mean [SD] age, 77.7 [8.3] years; 2 822 006 [56.0%] female) were treated, including 11 435 American Indian or Alaska Native patients (0.2%), 129 376 Asian patients (2.6%), 597 564 Black patients (11.9%), 395 397 Hispanic patients (7.8), and 3 818 371 White patients (75.8%). In the sample, half of hospitalizations among Black patients occurred at 235 hospitals (11.8% of all hospitals); 878 hospitals (34.4%) exhibited a negative LHS score (ie, admitted fewer Black patients relative to their market area) while 1113 hospitals (45.0%) exhibited a positive LHS (ie, admitted more Black patients relative to their market area); of all hospitals, 79.4% exhibited racial admission patterns significantly different from their market. Hospital-level LHS was positively associated with government hospital status (coefficient, 0.24; 95% CI, 0.10 to 0.38), while New York, New York; Chicago, Illinois; and Detroit, Michigan, hospital referral regions exhibited the highest regional LHS measures, with hospital referral region LHS scores of 0.12, 0.16, and 0.21, respectively. Conclusions and Relevance: In this cross-sectional study, a novel measure of LHS was developed to quantify the extent to which hospitals were admitting a representative proportion of Black patients relative to their market areas. A better understanding of hospital choice within neighborhoods would help to reduce racial inequities in health outcomes.

7-day patterns in Black-White segregation in 49 metropolitan areas.

While residential segregation is a persistent attribute of metropolitan areas, recent studies find segregation levels fluctuate throughout the day, reaching their lowest levels during daytime hours. This paper shows hourly variations in Black-White segregation from Monday through Sunday for the top 49 most populated metropolitan areas with Global Positioning System (GPS) data collected from mobile phones from October 2018. I find that segregation levels are higher on average over weekends compared to that of weekdays. I use models to identify the characteristics of neighborhoods with higher levels of segregation on weekends, which include all demographic variables and nearly a third of 35 sectors of businesses and organizations, such as retail, personal care, and religious organizations. I also find more than a third of the sectors are associated with higher levels of segregation during business hours on weekdays, including academic institutions, health care, manufacturing, and financial institutions. Findings from this paper display the significance in the distinction between weekdays and weekends with where people spend their time and how this relates to racial segregation. Specifically, Black people, on average, stay in their home census tracts and visit non-White neighborhoods for organizational resources more so than White people. Significant patterns of associations between racial segregation and the majority of businesses demonstrate the salience of race for more industries than previously understood.

High-throughput analysis of the Trypanosoma cruzi minicirculome (mcDNA) unveils structural variation and functional diversity.

Trypanosoma cruzi causes Chagas disease and has a unique extranuclear genome enclosed in a structure called the kinetoplast, which contains circular genomes known as maxi- and minicircles. While the structure and function of maxicircles are well-understood, many aspects of minicircles remain to be discovered. Here, we performed a high-throughput analysis of the minicirculome (mcDNA) in 50 clones isolated from Colombia's diverse T. cruzi I populations. Results indicate that mcDNA comprises four diverse subpopulations with different structures, lengths, and numbers of interspersed semi-conserved (previously termed ultra-conserved regions mHCV) and hypervariable (mHVPs) regions. Analysis of mcDNA ancestry and inter-clone differentiation indicates the interbreeding of minicircle sequence classes is placed along diverse strains and hosts. These results support evidence of the multiclonal dynamics and random bi-parental segregation. Finally, we disclosed the guide RNA repertoire encoded by mcDNA at a clonal scale, and several attributes of its abundance and function are discussed.

Reevaluating the Spatial Scale of Residential Segregation: Racial Change Within and Between Neighborhoods.

This study evaluates the extent to which metropolitan racial segregation occurs between neighborhoods-from tract to tract-and within neighborhoods-from block to block-and is framed theoretically by Putnam's (2007) "hunkering down" hypothesis. Analyses are based on complete-count block, tract, and metropolitan data from the last four U.S. decennial censuses. We document recent patterns of block-to-block segregation between Whites and racial and ethnic minorities (Blacks, Asians, and Hispanics) and between different minority pairs. For example, roughly 40% of all metro Black-White segregation is due to segregation from block to block within neighborhoods. Among Asians, the between-neighborhood component of metropolitan segregation has increased over time but was largely compensated by declines in the within-neighborhood (or block) component. Metropolitan fixed-effects models show that trends and racial and ethnic differences in segregation-overall and within and between neighborhoods-are broadly observed across metro areas but are most evident in the largest, oldest, and most highly segregated metro areas. The results are robust to alternative estimates that adjust for differential privacy, metropolitan reclassification, and neighborhood boundary changes. Analyses of neighborhood change in Atlanta, Georgia, further reinforce the generality of our multiscale approach.

Racial and Economic Segregation Over the Life Course and Incident Hypertensive Disorders of Pregnancy Among Black Women in California.

Black women in the United States have the highest incidence of hypertensive disorders of pregnancy (HDP) and are disproportionately burdened by its adverse sequalae, compared with women of all racial and ethnic groups. Segregation, a key driver of structural racism for Black families, can provide information critical to understanding these disparities. We examined the association between racial and economic segregation at 2 points and incident HDP using intergenerationally linked birth records of 45,204 Black California-born primiparous mothers (born 1982-1997) and their infants (born 1997-2011), with HDP ascertained from hospital discharge records. Women's early childhood and adulthood neighborhoods were categorized as deprived, mixed, or privileged based on the Index of Concentration at the Extremes (a measure of concentrated racial and economic segregation), yielding 9 life-course trajectories. Women living in deprived neighborhoods at both time points experienced the highest odds of HDP (from mixed effect logistic regression, unadjusted odds ratio = 1.26, 95% confidence interval: 1.13, 1.40) compared with women living in privileged neighborhoods at both time points. All trajectories involving residence in a deprived neighborhood in early childhood or adulthood were associated with increased odds of HDP, whereas mixed-privileged and privileged-mixed trajectories were not. Future studies should assess the causal nature of these associations.

Socioeconomic reorganization of communication and mobility networks in response to external shocks.

Socioeconomic segregation patterns in networks usually evolve gradually, yet they can change abruptly in response to external shocks. The recent COVID-19 pandemic and the subsequent government policies induced several interruptions in societies, potentially disadvantaging the socioeconomically most vulnerable groups. Using large-scale digital behavioral observations as a natural laboratory, here we analyze how lockdown interventions lead to the reorganization of socioeconomic segregation patterns simultaneously in communication and mobility networks in Sierra Leone. We find that while segregation in mobility clearly increased during lockdown, the social communication network reorganized into a less segregated configuration as compared to reference periods. Moreover, due to differences in adaption capacities, the effects of lockdown policies varied across socioeconomic groups, leading to different or even opposite segregation patterns between the lower and higher socioeconomic classes. Such secondary effects of interventions need to be considered for better and more equitable policies.

Effects of sound segregation cues on multi-sound intensity discrimination.

The effects of sound segregation cues on the sensitivity to intensity increments were explored. Listeners indicated whether the second and fourth sounds (harmonic complexes) within a five-sound sequence were increased in intensity. The target sound had a fundamental frequency of 250 Hz. In different conditions, nontarget sounds had different fundamental frequencies, different spectral shapes, and unique frequency regions relative to the target. For targets more intense than nontargets, nontarget characteristics did not affect thresholds. For targets less intense than the nontargets, thresholds improved when the targets and nontargets had unique frequency regions.

Association of maternal education, neighborhood deprivation, and racial segregation with gestational age at birth by maternal race/ethnicity and United States Census region in the ECHO cohorts.

Background: In the United States, disparities in gestational age at birth by maternal race, ethnicity, and geography are theorized to be related, in part, to differences in individual- and neighborhood-level socioeconomic status (SES). Yet, few studies have examined their combined effects or whether associations vary by maternal race and ethnicity and United States Census region. Methods: We assembled data from 34 cohorts in the Environmental influences on Child Health Outcomes (ECHO) program representing 10,304 participants who delivered a liveborn, singleton infant from 2000 through 2019. We investigated the combined associations of maternal education level, neighborhood deprivation index (NDI), and Index of Concentration at the Extremes for racial residential segregation (ICERace) on gestational weeks at birth using linear regression and on gestational age at birth categories (preterm, early term, post-late term relative to full term) using multinomial logistic regression. Results: After adjustment for NDI and ICERace, gestational weeks at birth was significantly lower among those with a high school diploma or less (-0.31 weeks, 95% CI: -0.44, -0.18), and some college (-0.30 weeks, 95% CI: -0.42, -0.18) relative to a master's degree or higher. Those with a high school diploma or less also had an increased odds of preterm (aOR 1.59, 95% CI: 1.20, 2.10) and early term birth (aOR 1.26, 95% CI: 1.05, 1.51). In adjusted models, NDI quartile and ICERace quartile were not associated with gestational weeks at birth. However, higher NDI quartile (most deprived) associated with an increased odds of early term and late term birth, and lower ICERace quartile (least racially privileged) associated with a decreased odds of late or post-term birth. When stratifying by region, gestational weeks at birth was lower among those with a high school education or less and some college only among those living in the Northeast or Midwest. When stratifying by race and ethnicity, gestational weeks at birth was lower among those with a high school education or less only for the non-Hispanic White category. Conclusion: In this study, maternal education was consistently associated with shorter duration of pregnancy and increased odds of preterm birth, including in models adjusted for NDI and ICERace.

Spatial segregation and voting behavior among Asian Americans in 2020 general election.

This article explores the link between residential segregation and political engagement among Asian American voters in New York City. Despite frequently being perceived as apolitical and concentrated in ethnic enclaves, Asian Americans constitute a diverse group. This paper investigates how multifaceted spatial isolation based on race, class, and partisan affiliation was associated with the likelihood of Asian American voters participating in the 2020 general election. We demonstrate that a monolithic view of Asian Americans perpetuates stereotypes of political passivity, but a closer examination of distinct ethnic groups reveals varied patterns of political engagement. For instance, Japanese Americans showed a high level of political engagement comparable to that of non-Hispanic whites. Our findings further indicate that spatial isolation across race, class, and partisan dimensions had varying impacts on political engagement.

Segregated Patterns of Hospital Care Delivery and Health Outcomes.

Importance: Residential segregation has been shown to be a root cause of racial inequities in health outcomes, yet little is known about current patterns of racial segregation in where patients receive hospital care or whether hospital segregation is associated with health outcomes. Filling this knowledge gap is critical to implementing policies that improve racial equity in health care. Objective: To characterize contemporary patterns of racial segregation in hospital care delivery, identify market-level correlates, and determine the association between hospital segregation and health outcomes. Design, Setting, and Participants: This cross-sectional study of US hospital referral regions (HRRs) used 2018 Medicare claims, American Community Survey, and Agency for Healthcare Research and Quality Social Determinants of Health data. Hospitalization patterns for all non-Hispanic Black or non-Hispanic White Medicare fee-for-service beneficiaries with at least 1 inpatient hospitalization in an eligible hospital were evaluated for hospital segregation and associated health outcomes at the HRR level. The data analysis was performed between August 10, 2022, and September 6, 2023. Exposures: Dissimilarity index and isolation index for HRRs. Main Outcomes and Measures: Health outcomes were measured using Prevention Quality Indicator (PQI) acute and chronic composites per 100 000 Medicare beneficiaries, and total deaths related to heart disease and stroke per 100 000 residents were calculated for individuals aged 74 years or younger. Correlation coefficients were used to compare residential and hospital dissimilarity and residential and hospital isolation. Linear regression was used to examine the association between hospital segregation and health outcomes. Results: This study included 280 HRRs containing data for 4386 short-term acute care and critical access hospitals. Black and White patients tended to receive care at different hospitals, with a mean (SD) dissimilarity index of 23 (11) and mean (SD) isolation index of 13 (13), indicating substantial variation in segregation across HRRs. Hospital segregation was correlated with residential segregation (correlation coefficients, 0.58 and 0.90 for dissimilarity and isolation, respectively). For Black patients, a 1-SD increase in the hospital isolation index was associated with 204 (95% CI, 154-254) more acute PQI hospitalizations per 100 000 Medicare beneficiaries (28% increase from the median), 684 (95% CI, 488-880) more chronic PQI hospitalizations per 100 000 Medicare beneficiaries (15% increase), and 6 (95% CI, 2-9) additional deaths per 100 000 residents (6% increase) compared with 68 (95% CI, 24-113; 6% increase), 202 (95% CI, 131-274; 8% increase), and 2 (95% CI, 0 to 4; 3% increase), respectively, for White patients. Conclusions and Relevance: This cross-sectional study found that higher segregation of hospital care was associated with poorer health outcomes for both Black and White Medicare beneficiaries, with significantly greater negative health outcomes for Black populations, supporting racial segregation as a root cause of health disparities. Policymakers and clinical leaders could address this important public health issue through payment reform efforts and expansion of health insurance coverage, in addition to supporting upstream efforts to reduce racial segregation in hospital care and residential settings.

Empirical evidence supporting the inclusion of multi-axes segregation in assessing US county health.

To facilitate community action toward health equity, the County Health Rankings & Roadmaps program (CHR&R) assigns health rankings to US counties. The CHR&R conceptual model considers White-Black and White-non-White dissimilarity values to represent residential segregation as part of the family and social support subcomponent. As the US is greying and becoming more multi-racial-ethnic, the two-group White-centered segregation measures are inadequate to capture segregation among population subgroups in the US. Thus, we evaluate the relevancy of segregation measures that consider multiple racial, ethnic, and age groups in assessing US county health. Besides using the two-group dissimilarity index to measure White-centered racial segregation as conceptualized by CHR&R, the study also uses the multi-group generalized dissimilarity index to measure racial-ethnic-age segregation by counties, employing both aspatial and spatial versions of these measures. These indices are computed for counties using the 2015-2019 American Community Survey data at the census tract level. Descriptive statistics and regressions controlling for sociodemographic factors and healthcare access are used to assess the contributions of individual segregation measures to mortality (life expectancy, years of potential life lost and premature mortality) and morbidity (frequent mental distress, frequent physical distress, and low birth weight) indicators representing county health. Overall, correlations between these indicators and most segregation measures are significant but weak. Regression results show that many segregation measures are not significantly related to mortality indicators, but most are significantly associated with morbidity indicators, with the magnitudes of these associations higher for the multi-group racial-ethnic-age segregation index and its spatial version. Results provide evidence that racial-ethnic-age segregation is associated with county-level morbidity and that spatial measures capturing segregation of multiple population axes should be considered for ranking county health.

The Global North Culture as a Palimpsest.

This is a reflection from three Black South African doctors - two women and a man. We studied at the institution that we are currently working in, which is a former white university that was not permitted to train Black medical students by the apartheid government. We experienced the segregation in healthcare and witnessed how our communities did not have access to it. The COVID-19 pandemic unearthed major challenges and asymmetries, particularly for the Black race and poor countries. For countries such as South Africa, it brought back memories of the apartheid past with the history of segregation and discrimination.

The associations of income and Black-White racial segregation with HIV outcomes among adults aged ≥18 years-United States and Puerto Rico, 2019.

OBJECTIVE(S): To examine associations between Index of Concentration at the Extremes (ICE) measures for economic and racial segregation and HIV outcomes in the United States (U.S.) and Puerto Rico. METHODS: County-level HIV testing data from CDC's National HIV Prevention Program Monitoring and Evaluation and census tract-level HIV diagnoses, linkage to HIV medical care, and viral suppression data from the National HIV Surveillance System were used. Three ICE measures of spatial polarization were obtained from the U.S. Census Bureau's American Community Survey: ICEincome (income segregation), ICErace (Black-White racial segregation), and ICEincome+race (Black-White racialized economic segregation). Rate ratios (RRs) for HIV diagnoses and prevalence ratios (PRs) for HIV testing, linkage to care within 1 month of diagnosis, and viral suppression within 6 months of diagnosis were estimated with 95% confidence intervals (CIs) to examine changes across ICE quintiles using the most privileged communities (Quintile 5, Q5) as the reference group. RESULTS: PRs and RRs showed a higher likelihood of testing and adverse HIV outcomes among persons residing in Q1 (least privileged) communities compared with Q5 (most privileged) across ICE measures. For HIV testing percentages and diagnosis rates, across quintiles, PRs and RRs were consistently greatest for ICErace. For linkage to care and viral suppression, PRs were consistently lower for ICEincome+race. CONCLUSIONS: We found that poor HIV outcomes and disparities were associated with income, racial, and economic segregation as measured by ICE. These ICE measures contribute to poor HIV outcomes and disparities by unfairly concentrating certain groups (i.e., Black persons) in highly segregated and deprived communities that experience a lack of access to quality, affordable health care. Expanded efforts are needed to address the social/economic barriers that impede access to HIV care among Black persons. Increased partnerships between government agencies and the private sector are needed to change policies that promote and sustain racial and income segregation.

Segregation and Childhood Blood Lead Levels in North Carolina.

BACKGROUND AND OBJECTIVES: Using a local measure of racial residential segregation, estimate the association between racial residential segregation and childhood blood lead levels between the early 1990s and 2015 in North Carolina. METHODS: This population-based observational study uses individual-level blood lead testing records obtained from the NC Department of Health and Human Services for 320 916 children aged <7 years who were tested between 1992 and 1996 or 2013 and 2015. NC childhood blood lead levels were georeferenced to the census tract. Neighborhood racial residential segregation, assessed using a local, spatial measure of the racial isolation of non-Hispanic Blacks (RINHB), was calculated at the census tract level. RESULTS: From 1990 to 2015, RINHB increased in 50% of 2195 NC census tracts, although the degree of change varied by geographic region. In 1992 to 1996 blood lead testing data, a 1-standard-deviation increase in tract-level RINHB was associated with a 2.86% (95% confidence interval: 0.96%-4.81%) and 2.44% (1.34%-3.56%) increase in BLL among non-Hispanic Black and non-Hispanic White children, respectively. In 2013 to 2015 blood lead testing data, this association was attenuated but persisted with a 1-standard-deviation increase in tract-level RINHB associated with a 1.59% (0.50%-2.70%) and 0.76% (0.08%-1.45%) increase in BLL among non-Hispanic Black and non-Hispanic White children, respectively. In the supplemental information, we show the change in racial residential segregation across the entire United States, demonstrating that RINHB increased in 69% of 72 899 US census tracts. CONCLUSIONS: Racially isolated neighborhoods are associated with higher childhood lead levels, demonstrating the disproportionate environmental burdens borne by segregated communities and warranting attention to providing whole child health care.

Inclusion unlocks the creative potential of gender diversity in teams.

Several studies have highlighted the potential contribution of gender diversity to creativity, also noted challenges stemming from conflicts and a deficit of trust. Thus, we argue that gender diversity requires inclusion as well to see increased collective creativity. We analyzed teams in 4011 video game projects, recording weighted network data from past collaborations. We developed four measures of inclusion, based on de-segregation, strong ties across genders, and the incorporation of women into the core of the team's network. We measured creativity by the distinctiveness of game features compared to prior games. Our results show that gender diversity without inclusion does not contribute to creativity, while at maximal inclusion one standard deviation change in diversity results in .04-.09 standard deviation increase in creativity. On the flipside, at maximal inclusion but low diversity (when there is a 'token' female team member highly integrated in a male network) we see a negative impact on creativity. Considering the history of game projects in a developer firm, we see that adding diversity first, and developing inclusion later can lead to higher diversity and inclusion, compared to the alternative of recruiting developers with already existing cross-gender ties. This suggests that developer firms should encourage building inclusive collaboration ties in-house.

It Is Surprisingly Difficult to Measure Income Segregation.

Recent studies have shown that U.S. Census- and American Community Survey (ACS)-based estimates of income segregation are subject to upward finite sampling bias (Logan et al. 2018; Logan et al. 2020; Reardon et al. 2018). We identify two additional sources of bias that are larger and opposite in sign to finite sampling bias: measurement error-induced attenuation bias and temporal pooling bias. The combination of these three sources of bias make it unclear how income segregation has trended. We formalize the three types of bias, providing a method to correct them simultaneously using public data from the decennial census and ACS from 1990 to 2015-2019. We use these methods to produce bias-corrected estimates of income segregation in the United States from 1990 to 2019. We find that (1) segregation is on the order of 50% greater than previously believed; (2) the increase from 2000 to the 2005-2009 period was much greater than indicated by previous estimates; and (3) segregation has declined since 2005-2009. Correcting these biases requires good estimates of the reliability of self-reported income and of the year-to-year volatility in neighborhood mean incomes.

Effects of flow regimes on the interaction between granular flow and flexible barrier.

Flexible barriers are widely used to mitigate granular flows. In practice, flow regimes may keep changing along a flow path after the initiation of granular flows. The effects of flow regimes should be considered in the design of flexible barriers to intercept granular flow. In this study, flow regimes are divided into three types: dilute flow; dense flow; and quasistatic flow. The impact mechanisms of dense granular flows and dilute granular flows against flexible barriers are investigated using flume tests and the discrete element method. Influences of the ratio of the average particle size to the mesh size of a flexible barrier and particle segregation on the interaction between the flexible barrier and the granular flow are revealed. Differences of the impact mechanisms between rockfall and granular flow are compared. Results show that the impact force of dense granular flow against a flexible barrier will not increase linearly with the average particle size. The tensile force of the bottom cable is usually the maximum tensile force among all cables of the flexible barrier. Particle segregation will lead to increase in impact force of dense flows and tensile force of the upper cables. Impact force of the dilute granular flow increases with the average particle size. Different from the failure of a flexible barrier under the impact of the dense flow, the middle and upper cables are easier to break. Based on these findings, a useful reference for the future design of flexible barriers was proposed.

Structural racism and geographic access to food retailers in the United States: A scoping review.

This scoping review summarized findings and key measures from U.S.-based studies that 1) examined associations between geographic indicators of structural racism (e.g., redlining, racial segregation) and access to food retailers (e.g., supermarkets, convenience stores) or 2) documented disparities in access by neighborhood racial/ethnic composition. In 2022, relevant scientific literature was reviewed using Covidence software. Independent reviewers examined 13,069 citations; 163 citations advanced to the full-text review stage and 70 were selected for inclusion. Twenty-one studies (30%) linked one or more indicator of structural racism to food retailer access while 49 (70%) solely examined differences in access by neighborhood racial/ethnic composition. All studies featuring indicators of structural racism reported significant findings; however, indicators varied across studies making it difficult to make direct comparisons. Key indicators of structural racism in the food access literature included redlining (n = 3), gentrification (n = 3), and racial segregation (n = 4). Many U.S.-based studies have evaluated food retailer access by neighborhood racial/ethnic composition. Moving forward, studies should model indicators of structural racism and determine their influence on geographic access to large and small food retailers.

Deprivation and segregation in ovarian cancer survival among African American women: a mediation analysis.

PURPOSE: Deprivation and segregation indices are often examined as possible explanations for observed health disparities in population-based studies. In this study, we assessed the role of recognized deprivation and segregation indices specifically as they affect survival in a cohort of self-identified Black women diagnosed with ovarian cancer who enrolled in the African American Cancer Epidemiology Study. METHODS: Mediation analysis was used to examine the direct and indirect effects between deprivation or segregation and overall survival via a Bayesian structural equation model with Gibbs variable selection. RESULTS: The results suggest that high socioeconomic status-related indices have an association with increased survival, ranging from 25% to 56%. In contrast, index of concentration at the extremes-race does not have a significant impact on overall survival. In many cases, the indirect effects have very wide credible intervals; consequently, the total effect is not well estimated despite the estimation of the direct effect. CONCLUSIONS: Our results show that Black women living in higher socioeconomic status neighborhoods are associated with increased survival with ovarian cancer using area-level economic indices such as Yost or index of concentration at the extremes-income. In addition, the Kolak urbanization index has a similar impact and highlights the importance of area-level deprivation and segregation as potentially modifiable social factors in ovarian cancer survival.