Original articleDiagnostic accuracy of self-reported racial composition of residential neighborhood
Introduction
Suffolk County, New York is a large suburb of New York City with a population of approximately 1.5 million residents; 71.6% non-Hispanic white, 6.8% non-Hispanic black, 16.5% Hispanic, and 5.1% other [1]. The county has experienced some substantial demographic changes in the past decade; the nonwhite population increased by 41% between 2000 and 2010. Although Suffolk County is becoming more diverse, it is not becoming more integrated. Regardless of their income, blacks and Hispanics in Suffolk County tend to live in segregated communities [2], and these communities tend to have higher poverty rates, lower median incomes, poorer schools, older housing stock, and lower home ownership rates [2].
Residential segregation is the physical separation of two or more groups into different neighborhoods. There is substantial evidence to demonstrate that place and environment (physical, built, and social) impact health [3], [4], [5], and research has documented associations between segregation and higher mortality and homicide rates, poor birth outcomes, cardiovascular disease, poor self-reported health, infectious diseases, and exposure to toxins [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]. These outcomes are thought to result from the negative effects of segregation on the social and material resources that promote health and from the increased exposure to social and physical environments that adversely affect health [20], [21]. Segregation systematically and spatially contains some populations to areas with concentrated poverty, exposure to chronic stressors, and a landscape characterized by disinvestment and decay. While often just a few miles, there can be starkly different exposures to neighborhood aesthetics and resources [22], [23]—including those that are thought to be fundamental determinants of health—money, knowledge, power prestige, and social support [24]. Thus, segregation is often isolation from opportunity and opportunity structures, which can have grave consequences on health over the life course.
The dissimilarity index is a common measure of segregation that ranges from 0 (perfect integration) to 100 (complete segregation) [25]. The dissimilarity index measures evenness and can be interpreted as the proportion of minority residents who would have to change census tracts in order for the population to be evenly distributed [26]. Based on 2010 U.S. Census data, the Suffolk County black-white dissimilarity index is 62 and the Hispanic-white dissimilarity index is 41. In other words, almost three-fifths of blacks and approximately two-fifths of Hispanics in Suffolk County would need to move out of their current neighborhoods and into predominately white communities to create integrated neighborhoods [27]. In 2010, for a U.S. city with a population of more than 100,000, on average, the black-white dissimilarity index is 57 and the Hispanic-white dissimilarity index is 48 [28], meaning that Suffolk County is slightly more segregated for blacks and less segregated for Hispanics than the average U.S. city.
Residential segregation is one of the many causes of racial disparities in health [16], [29]; as such, residential segregation has become an important construct in health disparities research. Although much of the literature has used objective measures of segregation based on census data [7], [9], [14], [15], [30], others, similarly, have demonstrated that individual perceptions of segregation have an effect on health outcomes such as homicide, crime, and overall longevity [12], [31], [32], [33], [34], [35], [36]. There is a need to understand how accurately individuals' perceptions of their segregation experience within their environment reflects the environment as it is objectively described by data such as the U.S. Census. There are mixed results in the literature about the concordance of objective and subjective segregation measures [37], [38], [39]; this could be because an individual's segregation experience may differ significantly from that of their environment (i.e., an individual may attend a diverse school, but be in a segregated classroom) suggesting that difference between objective and subjective measures may be due to the unit of analysis and that both may have implications for health outcomes similar to the way both structural and personally mediated racism impacts health [40]. The development of measures to assess individuals' perceptions of the racial and ethnic composition of their communities is therefore needed to examine the relationship between segregation experience and health outcomes or status. We examined the diagnostic accuracy of a self-reported measure of racial composition of current neighborhood against 2010 Census data in Suffolk County, New York.
Section snippets
Study design and setting
Waiting room questionnaires were administered at three community health centers managed by the Suffolk County Department of Health Services (SCDHS), Division of Patient Care Services. The SCDHS is a safety net provider for the county with a network of eight family health centers located in minority and medically underserved communities. These centers provide comprehensive health care services to all residents in Suffolk County, accepting Medicaid and Medicare as well as other forms of
Results
Participant characteristics are listed in Table 1. Participants were primarily female (69.8%) with a mean age of 37.4 years, had attained at least a high school education (90.8%), had at least $20,000 per year household income (60.7%), and many had no health insurance (44.8%). There were relatively similar proportions of participants in each race and ethnicity subgroup; 36.5% non-Hispanic white, 36.1% non-Hispanic black, and 27.4% Hispanic. Participants in this analytical sample were similar to
Discussion
Our study adds to the limited studies in the literature assessing diagnostic accuracy of self-reported neighborhood racial and ethnic composition using objective census data as the criterion standard. Findings from this study showed that there were statistically significant differences between self-reported racial composition and 2010 Census data across race and ethnicity groups. Moreover, self-reported racial composition of current neighborhood is significantly correlated with objective racial
Conclusions
The results from this study suggest that there were statistically significant differences between the self-reported racial composition of participants' neighborhoods and 2010 Census data across race and ethnicity groups. Future studies are needed to examine factors that affect differences between subjective perceptions and objective data to study the effects of racial composition on health, as well as to validate self-reported measures of individuals' perceptions of the racial or ethnic
Acknowledgments
The authors thank Meng-Ru Cheng for working on the data analysis and Pravleen Bajwa for creating the GIS maps. The work of M.S.G. is supported by the Barnes-Jewish Hospital Foundation, Siteman Cancer Center, National Institutes of Health, National Cancer Institute grant U54CA153460, Washington University School of Medicine (WUSM), and WUSM Faculty Diversity Scholars Program. The work of B.H. is supported by Robert Wood Johnson Foundation's New Connections Grant Program at the University of
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