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

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 all-cause 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

Nested negative binomial regression models estimating associations with Black all-cause mortality rates.

<p>Note: MRR = Mortality Rate Ratio; CI = confidence interval; AIC = Akaike Information Criteria; R_L = Relative Likelihood.</p><p>Among ≥ 25 years of age. Race-specific age and sex-adjusted mortality rates weighted using the US 2000 standard population per 100,000 person-years from death certificates and mid-year population counts collated by the National Center for Health Statistics, 2004–2009. Area characteristics at the designated market area level from the American Community Survey, 2004–2009 for urbanicity (% living in a city with ≥ 50,000 people); % Black; education among Blacks (% with up to high school education); and poverty among Blacks (% households in poverty). All models adjusted for individual age, sex, year of death, and Census region.</p><p>Nested negative binomial regression models estimating associations with Black all-cause mortality rates.</p

Proportion of Google queries containing the “N-word” by designated market area, 2004–2007.

<p>Proportion of Google queries containing the “N-word” by designated market area, 2004–2007.</p

Negative binomial regression models estimating associations between area racism and Black cause-specific mortality rates.

<p>Note: MRR = Mortality Rate Ratio; CI = confidence interval.</p><p>Among ≥ 25 years of age. Race-specific age and sex-adjusted mortality rates weighted using the US 2000 standard population per 100,000 person-years from death certificates and mid-year population counts collated by the National Center for Health Statistics (NCHS), 2004–2009. All models adjusted for individual age, sex, year of death, and Census region; area characteristics at the designated market area (DMA) level (urbanicity, % Black, % high school education among Blacks, Black poverty rate) from the American Community Survey, 2004–2009; and corresponding DMA-level White cause-specific mortality rates per 100,000 person-years from NCHS.</p><p>Negative binomial regression models estimating associations between area racism and Black cause-specific mortality rates.</p

Descriptive characteristics.

<p>Note: Among ≥ 25 years of age. Area characteristics at the designated market area level from the American Community Survey, 2004–2009 for urbanicity (% living in a city with ≥ 50,000 people); % Black; education among Blacks (% with up to high school education); and poverty among Blacks (% households in poverty). Race-specific age and sex-adjusted mortality rates weighted using the US 2000 standard population per 100,000 person-years from death certificates and mid-year population counts collated by the National Center for Health Statistics, 2004–2009.</p><p>Descriptive characteristics.</p