The Impact of Institutional Racism on the Environment and Asthma/Allergy-Related Outcomes in AdultsSchuyler, Alexander (2024) The Impact of Institutional Racism on the Environment and Asthma/Allergy-Related Outcomes in Adults. Doctoral Dissertation, University of Pittsburgh. (Unpublished)
AbstractAsthma, a chronic respiratory disease shaped by gene-environment interactions, exhibits troubling racial disparities in the US, with Black people experiencing the worst asthma-related morbidity and mortality compared to other racial groups. This dissertation explores the role of institutional racism in perpetuating unequal distributions of environmental risk in Pennsylvania and Black-White disparities in environmental quality and asthma/allergy-related outcomes among adults. Residential redlining, or anti-Black mortgage lending/refinancing discrimination, exemplifies institutional racism in the US that commenced early in the 20th century and persisted despite anti-redlining legislation, namely the HMDA of 1975. “Historical” redlining (pre-dating HMDA of 1975) was defined through analysis of 1930s residential security maps, whereas “present-day” redlining (post-HMDA of 1975) was estimated by calculating Black-White mortgage loan/refinancing denial bias using 2007-2021 HMDA data. The study population included adults living with asthma enrolled in The University of Pittsburgh’s Asthma and Environmental Lung Health Institute@UPMC registry. Data collection included spirometry and self-reported data on asthma control/severity, asthma-related healthcare utilization, and other asthma/allergy-related outcomes. Measures of redlining were assigned to geocoded residential addresses, linked to individual-level data, and associated with environmental and neighborhood-level variables. Additional biological studies included adults living with and without asthma enrolled in a local study, which included the collection of BALF and bronchial brushings. Black compared to White registry participants were more likely to live in neighborhoods subjected to historical and present-day redlining. Historically redlined neighborhoods experienced persistently poor environmental quality. Registry participants living in historically redlined neighborhoods also exhibited the worst asthma/allergy-related outcomes and may have received sub-optimal specialist care. These effects disproportionately impacted Black compared to White registry participants. Structural indicators of poor housing and air quality increased with the degree of present-day redlining. Additionally, residence in neighborhoods with higher degrees of present-day redlining was associated with an increased risk of an eczema diagnosis, with a greater impact on Black compared to White registry participants. Finally, preliminary studies explored oxidative stress in relation to antioxidant metabolism and EVs to initiate insight into mechanisms by which environmental exposures negatively impact asthmatic lungs. These studies underscore the contribution of institutional racism to the environment and Black-White asthma/allergy-related health disparities. Share
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