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Association of community-level inequities and premature mortality: Chicago, 2011–2015
  1. Brittney S Lange-Maia1,2,
  2. Fernando De Maio3,4,
  3. Elizabeth F Avery1,2,
  4. Elizabeth B Lynch1,2,
  5. Emily M Laflamme5,
  6. David A Ansell1,6,
  7. Raj C Shah1,7,8
  1. 1 Center for Community Health Equity, Rush University Medical Center, Chicago, Illinois, USA
  2. 2 Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois, USA
  3. 3 Center for Community Health Equity, DePaul University, Chicago, Illinois, USA
  4. 4 Department of Sociology, DePaul University, Chicago, Illinois, USA
  5. 5 Office of Epidemiology, Chicago Department of Public Health, City of Chicago, Chicago, Illinois, USA
  6. 6 Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
  7. 7 Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
  8. 8 Department of Family Medicine, Rush University Medical Center, Chicago, Illinois, USA
  1. Correspondence to Dr Brittney S Lange-Maia, Department of Preventive Medicine and Center for Community Health Equity, Rush University Medical Center, Chicago, IL 60612, USA; Brittney_lange-maia{at}rush.edu

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 (ICEIncomerate ratio (RR)=3.06, 95% CI 2.51 to 3.73; ICERaceRR=3.07, 95% CI 2.62 to 3.58; ICEIncome+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.

  • mortality
  • health inequalities
  • measurement
  • socio-economic

https://doi.org/10.1136/jech-2018-210916

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    Footnotes

    • Contributors FDM, DAA and RCS conceived the original study idea. All coauthors (BSL-M, FDM, EFA, EBL, EML, DAA and RCS) contributed to the design of this study. BSL-M, FDM and EML acquired the data. BSL-M conducted data analyses with input from EFA. All coauthors (FDM, EFA, EBL, EML, DAA and RCS) provided input on the interpretation of the results. BSL-M was the lead writer of the manuscript draft, and all coauthors (FDM, EFA, EBL, EML, DAA and RCS) contributed to the revision of this draft and approved the final version for submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval This work was deemed to be exempt from review by the Rush University Medical Center Institutional Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Presented at A preliminary version of this work was presented as a poster at the 145th annual meeting of the American Public Health Association on 6 November 2017 in Atlanta, GA.