UCSF Researchers Receive Grant to Study the Relationship of Structural Racism to Mortality

Salma Shariff-Marco, PhD, MPH, and Iona Cheng, PhD, MPH
Salma Shariff-Marco, PhD, MPH, and Iona Cheng, PhD, MPH

Two professors in the UC San Francisco Department of Epidemiology and Biostatistics have received a $2.8 million grant to study the effect of structural racism on mortality in a variety of racial and ethnic minoritized groups. The grant, from the National Institute on Minority Health and Health Disparities, will fund research by Salma Shariff-Marco, PhD, MPH, and Iona Cheng, PhD, MPH, through June 2027. Using geographically specific and longitudinal data from the Multiethnic Cohort (MEC) Study in Southern California and Hawaii, the scientists will investigate the impact of composite measures of structural racism on both all-cause and cause-specific mortality in Black/African American, Filipino, Hispanic/Latino, Japanese American and Native Hawaiian MEC participants. The goal is to measure the domains of structural racism that place racial/ethnic minoritized groups at increased risk of death.

“Our work is focused on understanding the impact of the structural and social determinants of health on outcomes, and in particular, in perpetuating inequities in mortality,” said Shariff-Marco. “We want to examine structural racism as the most fundamental upstream cause driving health inequities in different populations, and the MEC gives us that opportunity.”

The researchers, in collaboration with researchers from UCSF, UCLA and the University of Hawaii, will develop novel composite measures of structural racism that incorporate multiple domains and are linked to MEC participants based on where they lived during their time in the study. These measures are broken out by city, town, or census-designated place, and include characteristics beyond redlining and residential segregation.

“We felt there was a gap in previous studies in assessing the interaction of the multiple domains of structural racism,” said Cheng. “Housing is one, but so are civic engagement, the health care system, education, employment and criminal justice. We will build composite measures of structural racism to assess its impact on the leading causes of death for specific racial and ethnic groups.”

The team will evaluate the associations between these measures and mortality by race and ethnicity and estimate the years of life lost due to structural racism in each group. They will further investigate whether factors such as neighborhood disinvestment, health behaviors, comorbidities and social support mediate the associations between structural racism mortality and race and ethnicity. Finally, they will assess these associations across subgroups, defined by sex, adult life stage, and both individual and neighborhood SES.

Because the MEC data offer such rich detail, the team will be able to drill down into unusually specific aspects of health outcomes. “The data give us a unique ability to look at whether the associations we see between structural racism and mortality differ by specific subgroups,” Cheng explained.

For example, because the MEC contains data about Japanese Americans in both Hawaii and Southern California, the researchers could compare outcomes in the two groups.

“That might tell us whether there are regional or state practices and policies in place that perpetuate structural racism in these communities,” Shariff-Marco said. “We’ve been meeting with our community advisory boards to talk about the measures we’re developing. People are reflecting on their lived experiences, which vary by place and by group. We’re having conversations about what domains people think are relevant for their communities, and hearing from them the kinds of data that we might want to include in our measures.”

Ideally, the study will provide empirical evidence for community stakeholders, policymakers and others to design interventions that reduce premature mortality specific to different racial and ethnic groups.