Residential Segregation & Associated Cancer Risks

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´╗┐Residential Segregation & Associated Cancer Risks
This study examines links between racial residential segregation and estimated ambient air toxics exposures and their associated cancer risks using modeled concentration estimates from the U.S. Environmental Protection Agency's National Air Toxics Assessment. We combined pollutant concentration estimates with potencies to calculate cancer risks by census tract for 309 metropolitan areas in the United States. This information was combined with socioeconomic status (SES) measures from the 1990 Census. Estimated cancer risks associated with ambient air toxics were highest in tracts located in metropolitan areas that were highly segregated. Disparities between racial/ethnic groups were also wider in more segregated metropolitan areas. Multivariate modeling showed that, after controlling for tract-level SES measures, increasing segregation amplified the cancer risks associated with ambient air toxics for all racial groups combined [highly segregated areas: relative cancer risk (RCR) = 1.04; 95% confidence interval (CI), 1.01-107; extremely segregated areas: RCR = 1.32; 95% CI, 1.28-1.36]. This segregation effect was strongest for Hispanics (highly segregated areas: RCR = 1.09; 95% CI, 1.01-1.17; extremely segregated areas: RCR = 1.74; 95% CI, 1.61-1.88) and weaker among whites (highly segregated areas: RCR = 1.04; 95% CI, 1.01-1.08; extremely segregated areas: RCR = 1.28; 95% CI, 1.24-1.33), African Americans (highly segregated areas: RCR = 1.09; 95% CI, 0.98-1.21; extremely segregated areas: RCR = 1.38; 95% CI, 1.24-1.53), and Asians (highly segregated areas: RCR = 1.10; 95% CI, 0.97-1.24; extremely segregated areas: RCR = 1.32; 95% CI, 1.16-1.51). Results suggest that disparities associated with ambient air toxics are affected by segregation and that these exposures may have health significance for populations across racial lines.

Nearly 80% of the approximately 280 million people living in the United States reside in metropolitan areas (U.S. Bureau of the Census 2004). Environmental health researchers and public health practitioners have recently begun to focus on the links between the urban built environment, social inequality, and community health and well-being (Frumkin 2002, 2003; Jackson 2002; Northridge et al. 2003). Despite the proliferation of research on this issue, there is a lack of scientific consensus about what it is about neighborhood and other area-level variables that affect health. Neighborhood-level factors affect individual health by influencing access to quality foods, especially fresh fruits and vegetables and affordable supermarkets, and access to crucial services, such as health care, parks, and open space (Diez-Roux 2003; Morland et al. 2002; Transportation and Land Use Coalition 2002). Other key neighborhood factors that affect health include the social environment (social capital, cohesion, and crime rates) (Kawachi and Berkman 2003; Wallace and Wallace 1998; Wallace 1988) and the physical environment (traffic density, housing quality, and abandoned properties) (Reynolds et al. 2002; Shenassa et al. 2004; Wallace 1990).

Environmental health researchers, sociologists, policy makers, and advocates concerned about environmental justice have argued that residents of color who are concentrated in neighborhoods with high levels of poverty are also disproportionately exposed to physical environments that adversely affect their health and well-being. Research on race and class differences in exposures to toxics varies widely, and although by no means unequivocal, much of the evidence suggests a pattern of disproportionate exposures to toxics and associated health risks among communities of color and the poor, with racial differences often persisting across economic strata (Burke 1993; Morello-Frosch et al. 2001, 2002a, 2002b; Pastor et al. 2001; Perlin et al. 2001; Sadd et al. 1999). Such evidence has important implications for policy making, but few studies elucidate links between social inequality and residential segregation with exposures to environmental hazards (Morello-Frosch 2002; Morello-Frosch et al. 2001).

Wide-ranging and complex political and socioeconomic forces, coupled with patterns of industrialization and development, have segregated people of color, particularly African Americans, into neighborhoods with some of the highest indices of urban poverty and deprivation (Peet 1984; Schultz et al. 2002; Walker 1985; Williams and Collins 2001, 2004). Indeed, uneven industrial development, real estate speculation, discrimination in government and private financing, workplace discrimination, and exclusionary zoning have led to systemic racial segregation among diverse communities with important implications for community health and individual well-being (Logan 1978; Logan and Molotch 1987; Morello-Frosch 2002; Sinton 1997; Wilson 1996). Studies connecting residential segregation to health outcomes and health disparities represent a relatively new direction of research. Much of this work has focused on the health impacts of residential segregation on African Americans (LaVeist 1989, 1992, 1993; Polednak 1991, 1993, 1996a, 1996b, 1997). Results of this research generally show that residential segregation is associated with elevated risks of adult and infant mortality (Collins and Williams 1999; LaVeist 1989, 1992, 1993; Polednak 1991, 1993, 1996a, 1996b, 1997; Williams and Collins 2001) and tuberculosis (Acevedo-Garcia 2001).

Although elements for understanding the relationship between residential segregation and community environmental health can be found separately in the literature of both sociology and environmental justice, only one previous investigation has attempted to combine these two lines of inquiry to analyze the relationship between outdoor air pollution exposure and segregation (Lopez 2002). Some researchers have recently argued that residential segregation is a crucial place to start for understanding the origins and persistence of environmental health disparities (Gee and Payne-Sturges 2004; Lopez 2002; Morello-Frosch 2002; Morello-Frosch et al. 2001; Pulido 1994, 2000; Pulido et al. 1996). Gee and Payne-Sturges (2004) propose a conceptual framework for understanding how race-based segregation may lead to a disproportionate burden of cumulative exposures to potential environmental hazards among certain communities while enhancing their vulnerability or susceptibility to the toxic effects of exposures due to individual and area-level stressors, and lack of neighborhood resources. In this study we seek to operationalize parts of this conceptual framework by examining links between racial residential segregation and estimated cancer risks associated with modeled ambient air toxics exposures. Recent analysis of modeled national estimates suggests that ambient concentrations of hazardous air pollutants (HAPs) exceed benchmark risk levels for cancer and noncancer end points in many areas of the country (Apelberg et al. 2005; Morello-Frosch et al. 2000; Woodruff et al. 1998). Follow-up studies on air quality as well as stationary and mobile sources of air pollution have found a disproportionate burden of exposures and associated cancer and noncancer health risks for communities of color and poor residents. These studies have examined transportation corridors with high traffic density (Gunier et al. 2003), location of Toxics Release Inventory (TRI) and other treatment, storage, and disposal facilities (Morello-Frosch et al. 2002a; Pastor et al. 2001, 2002; Perlin et al. 1999, 2001), and modeled estimates of air toxics from the U.S. Environmental Protection Agency (EPA) Cumulative Exposure Project (CEP) and National Air Toxics Assessment (NATA) (Lopez 2002; Morello-Frosch et al. 2002a, 2002b; Pastor et al. 2002, 2004). For this study, we assessed whether racial and economic disparities in estimated cancer risk associated with air toxics are modified by levels of residential segregation in U.S. metropolitan areas.

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