ABSTRACT
BACKGROUND: Firearm fatalities are a major public health concern, claiming the lives of 40,000 Americans each year. While firearm fatalities have pervasive effects, it is unclear how social determinants of health (SDOH) such as residential racial segregation, income inequality, and community resilience impact firearm fatalities. This study investigates the relationships between these SDOH and the likelihood of firearm fatalities. METHODS: County-level SDOH data from the Agency for Health Care Research and Quality for 2019 were analyzed, covering 72 Wisconsin counties. The dependent variable was the number of firearm fatalities in each county, used as a continuous variable. The independent variable was residential racial segregation (Dissimilarity Index), defined as the degree to which non-White and White residents were distributed across counties, ranging from 0 (complete integration) to 100 (complete segregation), and higher values indicate greater residential segregation (categorized as low, moderate, and high). Covariates were income inequality ranging from zero (perfect equality) to one (perfect inequality) categorized as low, moderate, and high, community resilience risk factors (low, moderate, and high risks), and rural-urban classifications. Descriptive/summary statistics, unadjusted and adjusted negative binomial regression adjusting for population weight, were performed using STATA/MPv.17.0; P-values ≤ 0.05 were considered statistically significant. ArcMap was used for Geographic Information System analysis. RESULTS: In 2019, there were 802 firearm fatalities. The adjusted model demonstrates that the risk of firearm fatalities was higher in areas with high residential racial segregation compared to low-segregated areas (IRR.:1.26, 95% CI:1.04-1.52) and higher in areas with high-income inequality compared to areas with low-income inequality (IRR.:1.18, 95% CI:1.00-1.40). Compared to areas with low-risk community resilience, the risk of firearm fatalities was higher in areas with moderate (IRR.:0.61, 95% CI:0.48-0.78), and in areas with high risk (IRR.:0.53, 95% CI:0.41-0.68). GIS analysis demonstrated that areas with high racial segregation also have high rates of firearm fatalities. CONCLUSION: Areas with high residential racial segregation have a high rate of firearm fatalities. With high income inequality and low community resilience, the likelihood of firearm fatalities increases.
ABSTRACT
OBJECTIVE: To analyze the association between racial bias and postpartum depression among women in Wisconsin. METHODS: Analyzed the Wisconsin Pregnancy Risk Assessment Monitoring System with a weighted sample of 125,581 women/mothers who delivered a live birth in 2016-2017. The outcome was self-reported postpartum depression. The independent variable was racial bias exposure. Survey-weighted logistic regression analyses were performed adjusting for confounders in 6 models-socioeconomic position, psychosocial factors, health risk behaviors, health care access, stress/obesity, and disease condition. All analyses were completed using STATA accounting for complex survey design and sample weights. RESULTS: In this sample, 6.6% of women/mothers experienced racial bias and 11.5% had postpartum depression. In unadjusted analysis, the odds of postpartum depression were higher for women who experienced racial bias than those who did not (OR 2.15; 95% CI, 1.35-3.41). Non-Hispanic Black women had higher odds for racial bias exposure than other racial/ethnic groups (OR 6.01; 95% CI, 1.69-21.41). However, the relationship between racial bias and postpartum depression was not significant after adjusting for socioeconomic position (OR 1.17; 95% CI, 0.69-1.97), psychosocial factors (OR 1.07; 95% CI, 0.63-1.81), health risk behaviors (OR 0.90; 95% CI, 0.55-1.49], health care access (OR 1.01; 95% CI, 0.60-1.70), stress/obesity (OR 0.73; 95% CI, 0.41-1.30), and disease/morbidity (OR 0.85; 95% CI, 0.46-1.57). DISCUSSION/CONCLUSION: Racial bias was associated with significantly increased risk of postpartum depression. Black women had higher odds for racial bias exposure than other groups. The relationship between racial bias and postpartum depression was not significant after adjusting for confounders, suggesting that social determinants potentially influenced this relationship. These findings should inform screening and health education interventions to minimize racism and poor maternal health outcomes.
