Annals of the New York Academy of Sciences

By Douglas Braaten, Ph.D., NYAS Staff

Annals of the New York Academy of Sciences is the premier publication of the Academy, offering original research articles and commissioned review articles.

Racial Residential Segregation and Economic Disparity Jointly Exacerbate COVID–19 Fatality in Large American Cities

It has become increasingly clear that the rate of fatalities during the current SARS-CoV-2/COVID–19 pandemic is relatively higher for racial and ethnic minorities in the United States, especially among Blacks and Hispanics, who are almost three times more likely to be infected by SARS-CoV-2 than Whites.

The disproportionate suffering of minority groups likely results from many social structural factors including unequal distribution of wealth and other resources, such as adequate housing and access to health care and other social services. Racial biases during medical treatment at hospitals and clinics may also be relevant. These factors highlight the structural inequality that exists in many large metropolitan areas.

Yu et al. focused on two central aspects of this inequality, systemic racism (racial residential segregation) and social class disparity (income inequality), which are inherently related: when racial and ethnic minorities are residentially segregated, income inequality often results in the area.

The authors explore the hypothesis that metropolitan areas in the United States become more vulnerable to COVID–19 if wealth is unevenly distributed in these areas and, consequently, poverty is concentrated in them as well. Concentrated poverty, in turn, can lead to deprivation of social, medical, and community-related resources in these communities.

Metropolitan areas are also more likely to have inadequate access to medical and social services, and to suffer from congested housing and compromised hygienic conditions. Residents are more likely to work in essential service jobs—with no option to work at home—and may therefore have a higher risk of being exposed to the virus. These conditions increase residents’ vulnerability to infectious diseases such as COVID–19.

The authors report that growth curves for COVID–19 cases and deaths are steeper in metropolitan counties in which Blacks and Hispanics are residentially segregated from Whites. They also found that income inequality augmented the negative effect of racial residential segregation within each county.

The data presented convincingly show that racial residential segregation and income inequality synergistically produce a “lethal spiral” that leads to a greater number of fatalities during a pandemic such as COVID-19.

Racial residential segregation and economic disparity jointly exacerbate COVID–19 fatality in large American cities

Ann. N.Y. Acad. Sci. https://doi.org/10.1111/nyas.14567

Published online ahead of print:
31 January 2021

Twenty Years of Pediatric Diabetes Surveillance

At the beginning of the twenty-first century, important gaps existed in the understanding of diabetes in youth under 20 years of age. Some of these gaps included sparse and incomplete incidence and prevalence data by type of diabetes, the uncertainty of whether the natural history of type 2 diabetes (T2D) was the same in youth and adults, the burden and risk factors for diabetes-related early complications, and the quality of health care and quality of life of youths with diabetes.

In addition, data on demographics, social determinants of health and patient-reported outcomes—including race and ethnicity, income, education, health insurance, geographic location, neighborhood characteristics, healthcare utilization, and diabetes education—were largely unknown on a population basis for youth with diabetes and their families.

The SEARCH for Diabetes in Youth (SEARCH) study was initiated in 2000 with funding from the Division of Diabetes Translation of the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health to address these gaps and to respond to emerging issues in the field of youth-onset diabetes. The study, funded for ~20 years, ended in September 2020.

In their article, Dabelea and colleagues describe the design and methods in the SEARCH study and its major findings. Both T1D and T2D are becoming more common in U.S. youth, with increases in cardiovascular and microvascular risk occurring early, especially among youth with T2D and those of ethnic backgrounds. Multiple barriers to care are identified, especially among persons of color and those with low education, health insurance, and income.

It is crucial, the authors emphasize, to continue to invest in youth-onset diabetes surveillance and longitudinal studies focused on contemporary cohorts because these populations will bear the consequences of chronic diseases for much of their life.

Twenty years of pediatric diabetes surveillance: what do we know and why it matters

Ann. N.Y. Acad. Sci. https://doi.org/10.1111/nyas.14573

Published online ahead of print:
05 February 2021

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