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      Association of community-level inequities and premature mortality: Chicago, 2011–2015

      , , , , , ,
      Journal of Epidemiology and Community Health
      BMJ

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          Abstract

          Background

          Substantial disparities in life expectancy exist between Chicago’s 77 defined community areas, ranging from approximately 69 to 85 years. Prior work in New York City and Boston has shown that community-level racial and economic segregation as measured by the Index of Concentration at the Extremes (ICE) is strongly related to premature mortality. This novel metric allows for the joint assessment of area-based income and racial polarisation. This study aimed to assess the relationships between racial and economic segregation and economic hardship with premature mortality in Chicago.

          Methods

          Annual age-adjusted premature mortality rates (deaths <65 years) from 2011 to 2015 were calculated for Chicago’s 77 community areas. ICE measures for household income (<US$25 000 vs ≥US$100 000), race (black vs non-Hispanic white), combined ICE measure incorporating income and race, and hardship index were calculated from 2015 American Community Survey 5-year estimates.

          Results

          Average annual premature mortality rates ranged from 94 (95% CI 61 to 133) deaths per 100 000 population age <65 to 699 (95% CI 394 to 1089). Compared with the highest ICE quintiles, communities in the lowest quintiles had significantly higher rates of premature mortality (ICE Incomerate ratio (RR)=3.06, 95% CI 2.51 to 3.73; ICE RaceRR=3.07, 95% CI 2.62 to 3.58; ICE Income+RaceRR=3.27, 95% CI 2.84 to 3.77). Similarly, compared with communities in the lowest hardship index quintile, communities in the highest quintile had significantly higher premature mortality rates (RR=2.79, 95% CI 2.18 to 3.57).

          Conclusions

          The strong relationships observed between ICE measures and premature mortality—particularly the combined ICE metric encompassing race and income—support the use of ICE in public health monitoring.

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          Most cited references11

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          Public Health Monitoring of Privilege and Deprivation With the Index of Concentration at the Extremes.

          We evaluated use of the Index of Concentration at the Extremes (ICE) for public health monitoring.
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            Efficient interval estimation for age-adjusted cancer rates

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              Spatial social polarisation: using the Index of Concentration at the Extremes jointly for income and race/ethnicity to analyse risk of hypertension.

              Growing spatial social and economic polarisation may be an important societal determinant of health, but only a few studies have used the recently developed Index of Concentration at the Extremes (ICE) to analyse the impact of joint concentrations of privilege and privation on health outcomes. We explore use of the ICE to investigate risk of hypertension in an urban, multiracial/ethnic, and predominantly working-class study population of US adults.
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                Author and article information

                Journal
                Journal of Epidemiology and Community Health
                J Epidemiol Community Health
                BMJ
                0143-005X
                1470-2738
                November 08 2018
                December 2018
                December 2018
                August 31 2018
                : 72
                : 12
                : 1099-1103
                Article
                10.1136/jech-2018-210916
                29079586
                79c98b87-a67b-4bb2-a6ca-005153563b22
                © 2018
                History

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