Structural Racism and Trajectories of Disease and Disability in Later Life

Health inequities along racial lines are broad and deep. Black Americans have a greater prevalence and severity of an array of illnesses, including chronic diseases and disability. While the vast majority of research on racial inequalities in health has focused on the role of individual-level factors such as socioeconomic resources (e.g., education, insurance, income, and wealth), a nascent line of research has begun to examine how health inequities are shaped by contextual factors stemming from structural racism (SR)—i.e., systemic racial exclusion from power, resources, opportunities, and well-being due to societal policies, practices, ideologies and institutions. Prior research has not examined whether racialized socioeconomic inequality is a mediating mechanism linking macro-level structural racism and individual-level health trajectories among older adults. This information is critical for understanding and addressing pathways through which SR affects health in later life. To address these critical gaps, this pilot will create and disseminate a dataset on SR, spanning economic, social, political, and judicial domains as well as over time between 2000 and 2020.  This data resource will be a valuable tool for the research community to efficiently build the knowledge base on how SR shapes population health and aging processes. Second, the pilot will provide novel information about the longitudinal relationships between SR and trajectories of health. Finally, the pilot will test the following: a) whether higher levels of SR exposure are predictive of worse health trajectories (levels and rates of accumulation of chronic diseases and disability), b) the extent to which cumulative (and changes in) exposure to SR impacts trajectories of health, and c) whether there are lagged effects of SR exposure on chronic disease and disability trajectories.

Academic Year
2022-2023
Duke Principal Investigator(s)
Primary Funding Agency
NIA/CPHA Pilot
Award Year