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Utibe R. Essien, MD MPH Profile picture
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17 May, 11 tweets, 5 min read
1/ Folks have recommended Richard Rothstein’s “The Color of Law” to me for a minute now. Finally had a chance to finish it this weekend.

Absolutely rocked.

The insidiousness of state & federal policy to maintain racial segregation in the US is devastating.

A thread of quotes.
2/ “...said that black students were concentrated in the city, not spread throughout the Detroit suburbs because of ‘unknown and perhaps unknowable factors such as in/migration, birthrates, economic changes, or cumulative acts of private racial fears.’”

wdet.org/posts/2019/11/…
3/ “That the SF region was segregated by policy is striking bc in contrast to other metropolitan areas, Northern CA had few African-Americans before migrants arrived during WWII for jobs. The government was not following pre-existing racial patterns...”
a24films.com/films/the-last…
4/ “There will be an enormous practical impact on innocent communities who have to bear the burden of the housing, who will have to house a plaintiff class from Chicago which they have wronged in no way.”

Non-discriminatory housing policy as “punishment visited on the innocent.”
5/ ”In 1924 Virginia adopted a law banning interracial marriage, so the city (Richmond) then prohibited anyone from residing on a street where they were ineligible to marry a majority of those already living there.”

nytimes.com/2017/06/11/us/…
6/ “The National Association of Real Estate Boards’ code of ethics included ‘A realtor should never be instrumental in introducing into a neighborhood... members of any race or nationality... whose presence will clearly be detrimental to property values in that neighborhood.”
7/ “In this Oklahoma suit homeowners alleged that ‘it is well known that the purchase, rental, or leasing of real property by African-Americans will always cause the remainder of the property in the same block to decrease in value at least from 50-75%.’”
theguardian.com/books/2021/may…
8/ “It is obvious from a glance at the... transit plans that an attempt has been made to eliminate the Negro and Puerto Rican areas... by building highways that benefit white suburbanites, facilitating their movement from suburbs to work and back.”

washingtonpost.com/nation/2019/10…
9/ “One of the most commonly used American history textbooks, ‘The Americans: Reconstruction to the 21st-century’ had this to say about segregation in the North: ‘African Americans found themselves forced into segregated neighborhoods.’

That’s it. One passive voice sentence.”
10/10 So what does this mean for #HealthEquity?

Not only are 40% of homeless folks AA, home ownership affects access to employment (-> insurance & income), generation wealth, education, clean air, green space and so much more.

This history is essential.
jamanetwork.com/journals/jamai…
P.S. For another recent and important example of how the legacy of racial segregation directly impacts our patients check out a recent thread and @CircOutcomes paper from @ekownyankah & team below. 👇🏾

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More from @UREssien

Utibe R. Essien, MD MPH Profile picture
19 Oct 20
Inpatient Lesson of the Day 7:

I remember the findings from this 2018 @NEJM study that aspirin ⬆️ bleeding risk but didn't ⬇️ CVD risk in the elderly.

What I didn't remember is that "elderly" was defined as >70 for White and >65 for Black/Hispanic.

🧵1/ nejm.org/doi/10.1056/NE…
According to the study Supplement, the following eligibility criteria were provided:

"...the age differential was permitted to ensure that Black and Hispanic populations could be represented in the trial, given evidence of higher burden of disease necessitating aspirin use." 2/
According the study design manuscript, "minority recruitment has been challenging due to a ⬇️ number of minorities w/o prior cardiovascular events, disability or dementia, who are not taking aspirin, and a reluctance to cease aspirin..." 3/
ncbi.nlm.nih.gov/pmc/articles/P…
Read 7 tweets
Utibe R. Essien, MD MPH Profile picture
17 May 20
🚨New Paper (Pre-Print)🚨

As many have noted, one of the keys to addressing the racial disparities in #COVID19 is ensuring comprehensive race/ethnicity data. Yet, as late as mid-April, 22 states were still not reporting such data on mortality. Here's what else we found...

1/
As of April 21st, of the 28 states reporting race/ethnicity data related to #COVID19 mortality, we found significant variation in the quality of such reporting, with some states reporting as high as >40% missingness in these data.

2/
Among the states (any NYC) that reported race/ethnicity data, we estimated a 3.5-fold higher mortality rate in Blacks vs. whites and a nearly 2-fold higher mortality rate in the Latinx vs. white population.

3/
Read 5 tweets
Utibe R. Essien, MD MPH Profile picture
28 Apr 20
The health inequities observed in the #COVID19 pandemic have been devastatingly alarming.

Grateful my friend and one of the smartest people I know, ⁦@atheendar⁩ joined me to share some solutions to address this problem in ⁦@JAMAHealthForum⁩. jamanetwork.com/channels/healt…
"Now, emerging data illustrate that Black and Hispanic Americans are dying at far higher rates from Covid-19 than any other groups in the nation. These disparities are just the most recent manifestation of centuries’ worth of racial and ethnic gaps in health outcomes." 2/
"The prevalence of cardiometabolic disease in black and Hispanic communities has continued to rise. However, focusing on individual clinical factors may mislead from identifying the true root causes of racial and ethnic disparities observed in COVID-19 mortality." 3/
Read 8 tweets
Utibe R. Essien, MD MPH Profile picture
3 Apr 20
Before the grants are reviewed, the IRBs are submitted, the data are analyzed, and the manuscripts are in press, reporters will likely continue to shed light on the issues related to #COVID19 and #HealthEquity.

A thread of articles, to be daily updated, on this topic. 1/
"Public health experts caution that the nature of this virus means that inequality in health outcomes puts the entire population at risk. Pockets of people who are untested or don't get the appropriate medical treatment can quickly become new clusters." 2/
nytimes.com/interactive/20…
“What black folks are accustomed to in Milwaukee and anywhere in the country, really, is pain not being acknowledged and constant inequities that happen in health care delivery." Also quoted, the remarkable Dr. @CamaraJones. 2/

H/T @RobertTessler
propublica.org/article/early-…
Read 35 tweets
Utibe R. Essien, MD MPH Profile picture
22 Jan 20
Thrilled to share my first VA paper (and first visual abstract!) with my all-star @vaequity @PittGIM mentor team, on racial and ethnic differences in the medical treatment of opioid use disorder within the VA following a non-fatal opioid overdose. 1/n

link.springer.com/article/10.100…
@vaequity @PittGIM Prior studies (@LarochelleMarc et al.) showed that opioid prescribing and the use of medications for opioid use disorder (MOUDs) remains low, even after a non-fatal overdose. Further, a recent paper by @PoojaLagisetty showed racial disparities in MOUD. 2/n
jamanetwork.com/journals/jamap…
@vaequity @PittGIM @LarochelleMarc @PoojaLagisetty In our study we examined patients managed in the VA to assess whether race/ethnicity was associated with:

1) opioid prescribing before and after a non-fatal opioid overdose and,

2) receipt of MOUD (i.e., buprenorphine, methadone, and naltrexone) following opioid overdose. 3/n
Read 6 tweets
Utibe R. Essien, MD MPH Profile picture
20 Aug 19
In case you missed it, @iamjohnoliver hosted an episode Sunday night on gender and racial bias in medicine. Here are a few of the studies on racial disparities he highlighted on the episode. 1/
@iamjohnoliver In a study of patients admitted to trauma centers in PA, authors found that patients admitted to hospitals with high concentrations of blacks had a 43% higher odds of death compared with patients admitted to hospitals treating low proportions of blacks. 2/
onlinelibrary.wiley.com/doi/full/10.11…
@iamjohnoliver In a well-cited 2016 paper, researchers found ~50% of medical students and residents surveyed reported at least one false belief about biological differences between blacks and whites (e.g. “black people’s skin is thicker than white people’s skin”). 3/
pnas.org/content/113/16…
Read 5 tweets

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