Journal article
School racial segregation and long-term cardiovascular health among Black adults in the US: A quasi-experimental study
PLoS medicine, v 19(6), pp e1004031-e1004031
01 Jun 2022
PMID: 35727819
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Author summary Why was this study done? Inequitable access to educational opportunities among Black Americans may explain a disproportionate burden of cardiovascular disease (CVD) among this group, although it is unclear what aspects of education are most salient.School racial segregation, a manifestation of structural racism in the United States education system, may affect later cardiovascular health. Yet, few studies have rigorously examined the association between school segregation and long-term cardiovascular risk. What did the researchers do and find? We applied an instrumental variables (IV) approach leveraging quasi-random variation in the timing of court decisions since 1991 that released school districts from court-ordered desegregation.Increased school segregation was associated with poorer self-rated health and increased binge drinking among Black adults, and the latter was robust to adjustment for multiple hypothesis testing. What do these findings mean? Continuation of school segregation in the US may be a contributor to the high CVD burden in Black communities.National and local educational policies for school racial integration may help reduce the future burden of CVD among Black people.
BackgroundCardiovascular disease (CVD) disproportionately affects Black adults in the United States. This is increasingly acknowledged to be due to inequitable distribution of health-promoting resources. One potential contributor is inequities in educational opportunities, although it is unclear what aspects of education are most salient. School racial segregation may affect cardiovascular health by increasing stress, constraining socioeconomic opportunities, and altering health behaviors. We investigated the association between school segregation and Black adults' CVD risk. Methods and findingsWe leveraged a natural experiment created by quasi-random (i.e., arbitrary) timing of local court decisions since 1991 that released school districts from court-ordered desegregation. We used the Panel Study of Income Dynamics (PSID) (1991 to 2017), linked with district-level school segregation measures and desegregation court order status. The sample included 1,053 Black participants who ever resided in school districts that were under a court desegregation order in 1991. The exposure was mean school segregation during observed schooling years. Outcomes included several adult CVD risk factors and outcomes. We fitted standard ordinary least squares (OLS) multivariable linear regression models, then conducted instrumental variables (IV) analysis, using the proportion of schooling years spent in districts that had been released from court-ordered desegregation as an instrument. We adjusted for individual- and district-level preexposure confounders, birth year, and state fixed effects. In standard linear models, school segregation was associated with a lower probability of good self-rated health (-0.05 percentage points per SD of the segregation index; 95% CI: -0.08, -0.03; p < 0.001) and a higher probability of binge drinking (0.04 percentage points; 95% CI: 0.002, 0.07; p = 0.04) and heart disease (0.01 percentage points; 95% CI: 0.002, 0.15; p = 0.007). IV analyses also found that school segregation was associated with a lower probability of good self-rated health (-0.09 percentage points; 95% CI: -0.17, -0.02, p = 0.02) and a higher probability of binge drinking (0.17 percentage points; 95% CI: 0.04, 0.30, p = 0.008). For IV estimates, only binge drinking was robust to adjustments for multiple hypothesis testing. Limitations included self-reported outcomes and potential residual confounding and exposure misclassification. ConclusionsSchool segregation exposure in childhood may have longstanding impacts on Black adults' cardiovascular health. Future research should replicate these analyses in larger samples and explore potential mechanisms. Given the recent rise in school segregation, this study has implications for policies and programs to address racial inequities in CVD.
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Details
- Title
- School racial segregation and long-term cardiovascular health among Black adults in the US: A quasi-experimental study
- Creators
- Min Hee Kim - University of California, San FranciscoGabriel L. Schwartz - University of California, San FranciscoJustin S. White - University of California, San FranciscoM. Maria Glymour - University of California, San FranciscoSean F. Reardon - Stanford UniversityKiarri N. Kershaw - Northwestern UniversityScarlett Lin Gomez - University of California, San FranciscoDaniel F. Collin - College Station Medical CenterPushkar P. Inamdar - University of California, San FranciscoGuangyi Wang - University of California, San FranciscoRita Hamad - University of California, San Francisco
- Publication Details
- PLoS medicine, v 19(6), pp e1004031-e1004031
- Publisher
- Public Library Science
- Number of pages
- 19
- Grant note
- UCSF Huntington Fund R01HL151638; RF1AG056164 / National Institute of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA UCSF Research Evaluation and Allocation Committee
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Urban Health Collaborative; Health Management and Policy
- Web of Science ID
- WOS:000829297900002
- Scopus ID
- 2-s2.0-85134360584
- Other Identifier
- 991021871450604721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Public, Environmental & Occupational Health