Association between an Internet-Based Measure of Area Racism and Black Mortality

• Type of Material: Article
• Authors: David H. Chae, University of Maryland; Sean Clouston, Stony Brook University; Mark L. Hatzenbuehler, Columbia University; Michael Kramer, Emory University; Hannah Cooper, Emory University; Sacoby M. Wilson, University of Maryland; Seth I. Stephens-Davidowitz, Harvard University; Robert S. Gold, University of Maryland; Bruce G. Link, Columbia University
• Language: English
• Date: 2015-04-24
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2015 Chae et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0122963
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 10
• Issue: 4
• Start Page: e0122963
• End Page: e0122963
• Grant/Funding Information: The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Robert Wood Johnson Foundation.; DHC was supported by the National Institute on Aging of the National Institutes of Health under Award Number K01AG041787.; BGL was supported by grants from the Robert Wood Johnson Foundation during the course of the study. SIS-D received funding in the form of salary from Google, Inc.
• Keywords: UNITED-STATES; ALLOSTATIC LOAD; DISPARITIES; RACIAL/ETHNIC DISCRIMINATION; Multidisciplinary Sciences; RESIDENTIAL SEGREGATION; INFLAMMATION; Science & Technology; HEALTH CONSEQUENCES; Science & Technology - Other Topics; AFRICAN-AMERICAN MEN; STRESS; BIAS
• Research Categories: Psychology, Social; Psychology, Behavioral; Health Sciences, Epidemiology

Abstract

Racial disparities in health are well-documented and represent a significant public health concern in the US. Racism-related factors contribute to poorer health and higher mortality rates among Blacks compared to other racial groups. However, methods to measure racism and monitor its associations with health at the population-level have remained elusive. In this study, we investigated the utility of a previously developed Internet search-based proxy of area racism as a predictor of Black mortality rates. Area racism was the proportion of Google searches containing the "N-word" in 196 designated market areas (DMAs). Negative binomial regression models were specified taking into account individual age, sex, year of death, and Census region and adjusted to the 2000 US standard population to examine the association between area racism and Black mortality rates, which were derived from death certificates and mid-year population counts collated by the National Center for Health Statistics (2004-2009). DMAs characterized by a one standard deviation greater level of area racism were associated with an 8.2% increase in the all-cause Black mortality rate, equivalent to over 30,000 deaths annually. The magnitude of this effect was attenuated to 5.7% after adjustment for DMA-level demographic and Black socioeconomic covariates. A model controlling for the White mortality rate was used to further adjust for unmeasured confounders that influence mortality overall in a geographic area, and to examine Black-White disparities in the mortality rate. Area racism remained significantly associated with the allcause Black mortality rate (mortality rate ratio = 1.036; 95% confidence interval = 1.015, 1.057; p = 0.001). Models further examining cause-specific Black mortality rates revealed significant associations with heart disease, cancer, and stroke. These findings are congruent with studies documenting the deleterious impact of racism on health among Blacks. Our study contributes to evidence that racism shapes patterns in mortality and generates racial disparities in health.