Racial-economic spatial polarization in NYC zip codes using data from the American Community Survey
In our study recently published in Health Affairs, we found stark differences between neighborhoods in New York City in incidence of severe complications during childbirth.
Twice as many women from poor black neighborhoods experienced a life-threatening complication during childbirth as women from wealthy white neighborhoods. Further, the harmful effect of living in a racially and economically segregated neighborhood was greatest among Black and Latina women. This disparity landscape is a feature of structural racism, shaping societal privilege and advantage, and we know now, maternal health.
Geographic disparities in positive COVID-19 tests in New York City were apparent in a map released by the New York City Department of Mental Health and Hygiene (NYCDOMH).
I was struck by the similarity of the COVID-19 map to the map of the measure of racial-ethnic spatial polarization I used in the recent Health Affairs study shown here. In the map pictured here, we display levels of extreme racial and economic segregation using a measure called the Index of Concentration at the Extremes (ICE), which is the proportion of poor black households relative to wealthy white households in a zip code. I did some quick data crunching, and found that the percent of positive COVID-19 tests in zip codes with the highest relative concentration of poor black residents was 50 percent (dark red zip codes), compared to only 34 percent in zip codes with the highest relative concentration of wealthy whites (dark blue zip codes).
As we connect the dots between structural racism, our severe maternal morbidity research, and the current coronavirus pandemic, the concern shared by many passionate about maternal health equity is, how might the current coronavirus crisis exacerbate these inequities?
In our analysis, we found that about half of the disparity between poor-black and wealthy-white neighborhoods was due to pre-existing health conditions, such as obesity, asthma, and hypertension, and that an additional third was due to the hospital where women delivered.
Over a decade ago, Philip Blumenshine and co-authors wrote that racial and economic disparities are likely to occur during an influenza pandemic because of differences in exposure to the virus, differences in susceptibility to severe disease, and disparities in treatment once the disease has developed.
Our study suggests that the excess chronic disease and lack of access to quality health care result in higher risk of severe maternal morbidity in racial and economically segregated neighborhoods. To the extent that these same mechanisms fuel the negative effects of the coronavirus or the economic and social impact of the epidemic, health care providers and policy-makers should be on high alert to support birthing women of color as the coronavirus pandemic moves into the next stage.
Teresa Janevic, PhD is an epidemiologist and a member of the Blavatnik Family Women’s Health Research Institute