title: Local Residential Segregation Matters: Stronger Association of Census Tract Compared to Conventional City-Level Measures with Fatal and Non-Fatal Assaults (Total and Firearm Related), Using the Index of Concentration at the Extremes (ICE) for Racial, Economic, and Racialized Economic Segregation, Massachusetts (US), 1995-2010.
abstract: Research on residential segregation and health, primarily conducted in the USA, has chiefly employed city or regional measures of racial segregation. To test our hypothesis that stronger associations would be observed using local measures, especially for racialized economic segregation, we analyzed risk of fatal and non-fatal assault in Massachusetts (1995-2010), since this outcome is strongly associated with residential segregation. The segregation metrics comprised the Index of Concentration at the Extremes (ICE), the Index of Dissimilarity, and poverty rate, with measures computed at both the census tract and city/town level. Key results were that larger associations between fatal and non-fatal assaults and residential segregation occurred for models using the census tract vs. city/town measures, with the greatest associations observed for racialized economic segregation. For fatal assaults, comparing the bottom vs. top quintiles, the incidence rate ratio (and 95% confidence interval (CI)) in models using the census tract measures equaled 3.96 (95% CI 3.10, 5.06) for the ICE for racialized economic segregation, 3.26 (95% CI 2.58, 4.14) for the ICE for income, 3.14 (95% CI 2.47, 3.99) for poverty, 2.90 (95% CI 2.21, 3.81) for the ICE for race/ethnicity, and only 0.93 (95% CI 0.79, 1.11) for the Index of Dissimilarity; in models that included both census tract and city/town ICE measures, this risk ratio for the ICE for racialized economic segregation was higher at the census tract (3.29; 95% CI 2.43, 4.46) vs. city/town level (1.61; 95% CI 1.12, 2.32). These results suggest that, at least in the case of fatal and non-fatal assaults, research on residential segregation should employ local measures, including of racialized economic segregation, to avoid underestimating the adverse impact of segregation on health.
authors.affiliation: Department of Social and Behavioral Sciences (Kresge 717), Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA. nkrieger@hsph.harvard.edu.
authors.forename: Nancy
authors.identifier: 0000-0002-4815-5947
authors.initials: N
authors.lastname: Krieger
authors.affiliation: Department of Social and Behavioral Sciences (Kresge 717), Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Feldman
authors.affiliation: Department of Social and Behavioral Sciences (Kresge 717), Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
authors.forename: Pamela D
authors.initials: PD
authors.lastname: Waterman
authors.affiliation: Department of Social and Behavioral Sciences (Kresge 717), Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
authors.forename: Jarvis T
authors.initials: JT
authors.lastname: Chen
authors.affiliation: Department of Biostatistics and Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Brent A
authors.initials: BA
authors.lastname: Coull
authors.affiliation: Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Hemenway
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019352:Censuses; D002648:Child; D005389:Firearms / Q000706:statistics & numerical data; D006708:Homicide / Q000208:ethnology; D006801:Humans; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012931:Social Environment; D012959:Socioeconomic Factors; D014504:Urban Health; D014505:Urban Population / Q000706:statistics & numerical data*; D014754:Violence / Q000208:ethnology*; D055815:Young Adult
keywords: Assault; Economic segregation; Firearm; Health inequities; Income inequality; Index of Concentration at the Extremes; Racial inequality; Racial segregation; Spatial polarization; Violence