Prince.Skeletor
Don’t Be Like He-Man
Complaints about excessive use of police force in women’s neighborhoods and subsequent perinatal and cardiovascular health.
There are substantial, unexplained racial disparities in women’s health. Some of the most pronounced involve elevated rates of preterm delivery (PTD) and cardiovascular disease (CVD) among Black women.
Black women are over 50% more likely to deliver preterm as compared with White women, and despite multiple efforts, interventions have generally been unable to narrow this gap (1).
Similarly, CVD prevalence is 30% higher among Black versus White women, and the avoidable death rate is nearly twice as high (2, 3).
Although variations in socioeconomic status (SES) contribute to these disparities, they do not fully account for them. Racial gaps are present at all levels of SES, and disparities in PTD and CVD may widen as women’s income and education increase (4, 5). On top of their impact on well-being, these disparities have substantial economic implications for society, affecting labor market participation and health care expenditures and, with PTD, adversely influencing the health of the next generation (6–9).
Many of the conventional explanations for health disparities, such as access to care and healthy foods, are most applicable to women in low-SES contexts, but they are inadequate for explaining why Black women, particularly those with relatively high levels of income and education, have elevated rates of PTD and CVD, which in some cases are even greater than low-SES White women (10, 11). As a result, there is increasing emphasis on the health impact of exposures that are common for, and salient to, Black women. Neighborhoods are an important focus because Black families are more likely to live in disadvantaged neighborhoods regardless of SES (12). As the recent deaths of Breonna Taylor, George Floyd, and others have illustrated, violent interactions with the police may be one such neighborhood exposure that may adversely contribute to health disparities.
n Chicago, which has the second-largest municipal police department in the United States, policing practices vary by neighborhood racial composition (13). Chicago police are nearly 10 times more likely to use force when interacting with a Black versus White individual (14). Moreover, unarmed Black individuals are nearly six times more likely to be shot by Chicago police as compared with armed White individuals (15). Preliminary evidence suggests these events have repercussions even for individuals who are not personally involved. For example, adults who live in neighborhoods where a greater proportion of police interactions involve frisking or use of force are more likely to endorse psychological distress (16) and to report having diabetes, obesity, and hypertension (17, 18).
Exposure to police violence in the neighborhood may be particularly salient for women. While women are less likely to be stopped by police themselves, women are more likely to experience gendered violence during police encounters, including sexual harassment and assault (19). In addition, starting from a young age, women are vicariously exposed through police stops of neighbors, family members, and friends (20).
These incidents are likely to be stressful for women because they place family and friends at risk of mistreatment, violence, legal difficulties, and incarceration. Stress, in turn, can trigger behavioral and physiological changes that increase vulnerability to subsequent health problems. Even when stress is anticipatory in nature, e.g., concerns about the prospect of a loved one having a violent interaction with police, it can have repercussions for health (21–26). Consistent with these notions, studies have linked neighborhood exposure to fatal police violence with adverse reproductive outcomes, including a higher risk of PTD (27), a higher risk of delivering a low-birthweight infant (28), and a decline in the number of live births, suggestive of an increase in pregnancy loss (29).
We build on this evidence by considering the relationship of negative police interactions with PTD and CVD. As noted, there are pronounced, but not well-understood, racial disparities in PTD and CVD and mounting evidence to suggest that they share common pathologic mechanisms and may even represent different life course manifestations of the same underlying vascular abnormalities (30, 31). We approximate negative police interactions based on formal complaints filed for excessive use of force by police (EFP complaints) and generate two distinct cohorts using electronic health records (EHR) from a single Chicago hospital to capture health over time. We had three hypotheses:
1) That incident PTD and CVD would be more common among women who live in neighborhoods with more excessive force complaints, even following adjustment for other forms of area-level social disadvantage, including neighborhood violence.
2) That these associations would be strongest for Black women, because compared with other racial/ethnic groups in Chicago, they are disproportionately exposed to violent police encounters.
3) That associations between exposure to excessive force complaints and PTD would persist in a maternal fixed-effects analysis. This analysis enhances control for unmeasured and mismeasured time-invariant confounders by comparing pregnancy outcomes within a woman (for women with multiple deliveries during the study period).
These results indicate that in neighborhoods where residents frequently complain about the police using excessive force, Black women have a 19% greater risk of PTD, 16% greater risk of delivering an SGA infant, and a 42% greater risk of CVD, even after accounting for the neighborhood’s socioeconomic conditions and homicide frequency. In comparison, smoking, an established risk factor for both PTD and CVD, is associated with a nearly 30% greater risk of PTD and 70% greater risk of CVD (37–39). Although these findings must be interpreted with caution until replicated and substantiated, they add to growing evidence suggesting that police violence adversely affects the health of Black communities (16–18, 27, 29, 40–42). Our study extends these previous reports by using two large samples, individual-level diagnoses made by physicians, and, in the pregnancy cohort, a fixed-effects analysis that minimizes the potential for confounding by stable maternal characteristics.
AAAS
There are substantial, unexplained racial disparities in women’s health. Some of the most pronounced involve elevated rates of preterm delivery (PTD) and cardiovascular disease (CVD) among Black women.
Black women are over 50% more likely to deliver preterm as compared with White women, and despite multiple efforts, interventions have generally been unable to narrow this gap (1).
Similarly, CVD prevalence is 30% higher among Black versus White women, and the avoidable death rate is nearly twice as high (2, 3).
Although variations in socioeconomic status (SES) contribute to these disparities, they do not fully account for them. Racial gaps are present at all levels of SES, and disparities in PTD and CVD may widen as women’s income and education increase (4, 5). On top of their impact on well-being, these disparities have substantial economic implications for society, affecting labor market participation and health care expenditures and, with PTD, adversely influencing the health of the next generation (6–9).
Many of the conventional explanations for health disparities, such as access to care and healthy foods, are most applicable to women in low-SES contexts, but they are inadequate for explaining why Black women, particularly those with relatively high levels of income and education, have elevated rates of PTD and CVD, which in some cases are even greater than low-SES White women (10, 11). As a result, there is increasing emphasis on the health impact of exposures that are common for, and salient to, Black women. Neighborhoods are an important focus because Black families are more likely to live in disadvantaged neighborhoods regardless of SES (12). As the recent deaths of Breonna Taylor, George Floyd, and others have illustrated, violent interactions with the police may be one such neighborhood exposure that may adversely contribute to health disparities.
n Chicago, which has the second-largest municipal police department in the United States, policing practices vary by neighborhood racial composition (13). Chicago police are nearly 10 times more likely to use force when interacting with a Black versus White individual (14). Moreover, unarmed Black individuals are nearly six times more likely to be shot by Chicago police as compared with armed White individuals (15). Preliminary evidence suggests these events have repercussions even for individuals who are not personally involved. For example, adults who live in neighborhoods where a greater proportion of police interactions involve frisking or use of force are more likely to endorse psychological distress (16) and to report having diabetes, obesity, and hypertension (17, 18).
Exposure to police violence in the neighborhood may be particularly salient for women. While women are less likely to be stopped by police themselves, women are more likely to experience gendered violence during police encounters, including sexual harassment and assault (19). In addition, starting from a young age, women are vicariously exposed through police stops of neighbors, family members, and friends (20).
These incidents are likely to be stressful for women because they place family and friends at risk of mistreatment, violence, legal difficulties, and incarceration. Stress, in turn, can trigger behavioral and physiological changes that increase vulnerability to subsequent health problems. Even when stress is anticipatory in nature, e.g., concerns about the prospect of a loved one having a violent interaction with police, it can have repercussions for health (21–26). Consistent with these notions, studies have linked neighborhood exposure to fatal police violence with adverse reproductive outcomes, including a higher risk of PTD (27), a higher risk of delivering a low-birthweight infant (28), and a decline in the number of live births, suggestive of an increase in pregnancy loss (29).
We build on this evidence by considering the relationship of negative police interactions with PTD and CVD. As noted, there are pronounced, but not well-understood, racial disparities in PTD and CVD and mounting evidence to suggest that they share common pathologic mechanisms and may even represent different life course manifestations of the same underlying vascular abnormalities (30, 31). We approximate negative police interactions based on formal complaints filed for excessive use of force by police (EFP complaints) and generate two distinct cohorts using electronic health records (EHR) from a single Chicago hospital to capture health over time. We had three hypotheses:
1) That incident PTD and CVD would be more common among women who live in neighborhoods with more excessive force complaints, even following adjustment for other forms of area-level social disadvantage, including neighborhood violence.
2) That these associations would be strongest for Black women, because compared with other racial/ethnic groups in Chicago, they are disproportionately exposed to violent police encounters.
3) That associations between exposure to excessive force complaints and PTD would persist in a maternal fixed-effects analysis. This analysis enhances control for unmeasured and mismeasured time-invariant confounders by comparing pregnancy outcomes within a woman (for women with multiple deliveries during the study period).
These results indicate that in neighborhoods where residents frequently complain about the police using excessive force, Black women have a 19% greater risk of PTD, 16% greater risk of delivering an SGA infant, and a 42% greater risk of CVD, even after accounting for the neighborhood’s socioeconomic conditions and homicide frequency. In comparison, smoking, an established risk factor for both PTD and CVD, is associated with a nearly 30% greater risk of PTD and 70% greater risk of CVD (37–39). Although these findings must be interpreted with caution until replicated and substantiated, they add to growing evidence suggesting that police violence adversely affects the health of Black communities (16–18, 27, 29, 40–42). Our study extends these previous reports by using two large samples, individual-level diagnoses made by physicians, and, in the pregnancy cohort, a fixed-effects analysis that minimizes the potential for confounding by stable maternal characteristics.
AAAS
