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State Racism Index and physical function: The REasons for Geographic and Racial Differences in Stroke (REGARDS) study
Hugo G Quezada-Pinedo1, Tyson Brown2, Ene M Enogela3
1Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, United States.
Summary
Structural racism significantly impacts physical function. Higher State Racism Index (SRI) correlated with worse function in Black adults but better function in White adults, particularly in the southern U.S.
Area of Science:
- Public Health
- Social Determinants of Health
- Health Disparities
Background:
- Structural racism is a significant driver of health inequities in the United States.
- This study investigated the relationship between the State Racism Index (SRI) and physical function.
Purpose of the Study:
- To quantify the association between state-level structural racism and physical function in a national cohort.
- To explore racial differences and regional variations in this association.
Main Methods:
- A national U.S. community-based cohort study included 13,661 Non-Hispanic Black and White adults.
- Physical function was assessed using activities of daily living (ADL), instrumental ADL (IADL), timed walk, and chair stand tests.
- Multivariable regression models analyzed the association between SRI and physical function, with interaction analyses for age, sex, and region.
Main Results:
- Among Black participants, increased SRI was linked to worse IADL scores, an effect stronger in the U.S. Stroke Belt.
- Among White participants, increased SRI was associated with better ADL and IADL scores, independent of other factors.
- No significant association was found between SRI and timed walk or chair stands for either racial group.
Conclusions:
- State-level structural racism is associated with differential physical function outcomes based on race.
- Socioeconomic factors modify these associations, which are amplified in southern U.S. states.
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