title: Association between an Internet-Based Measure of Area Racism and Black Mortality.
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 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.
authors.affiliation: Department of Epidemiology and Biostatistics, University of Maryland, College Park, School of Public Health, College Park, Maryland, United States of America.
authors.forename: David H
authors.initials: DH
authors.lastname: Chae
authors.affiliation: Department of Preventive Medicine, Stony Brook University, Health Sciences Center, Stony Brook, New York, United States of America.
authors.forename: Sean
authors.initials: S
authors.lastname: Clouston
authors.affiliation: Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, New York, United States of America.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Hatzenbuehler
authors.affiliation: Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia, United States of America.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Kramer
authors.affiliation: Department of Behavioral Sciences and Health Education, Emory University, Rollins School of Public Health, Atlanta, Georgia, United States of America.
authors.forename: Hannah L F
authors.initials: HL
authors.lastname: Cooper
authors.affiliation: Maryland Institute for Applied Environmental Health, University of Maryland, College Park, School of Public Health, College Park, Maryland, United States of America.
authors.forename: Sacoby M
authors.initials: SM
authors.lastname: Wilson
authors.affiliation: Department of Economics, Harvard University, Cambridge, Massachusetts, United States of America.
authors.forename: Seth I
authors.initials: SI
authors.lastname: Stephens-Davidowitz
authors.affiliation: Department of Epidemiology and Biostatistics, University of Maryland, College Park, School of Public Health, College Park, Maryland, United States of America.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Gold
authors.affiliation: Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, New York, United States of America.
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Link
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D002423:Cause of Death; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009026:Mortality; D063505:Racism; D062211:Spatio-Temporal Analysis; D014481:United States