Racial Disparity in TB Mortality Between and Within States With and Without History of Jim Crow Laws

Lorena Lorena Estrada-Martinez Co-Author
University of Massachusetts Boston
Lingling Zhang Co-Author
University of Massachusetts Boston
Clara Gona Co-Author
MGH Institute of Health Professions
Aaloke Mody Co-Author
Washington University School of Medicine in St. Louis
Sowmya Rao Co-Author
Boston University School of Public Health
Joseph Cooper Co-Author
University of Massachusetts Boston
Kibibi Mack-Shelton Co-Author
University of South Florida
Suzanne Leveille Co-Author
College of Nursing and Health Sciences
Ali Mokdad Co-Author
University of Washington
Philimon Gona Speaker
University of Massachusetts
Sunday, Aug 6: 4:45 PM - 5:05 PM
Topic-Contributed Paper Session 
Metro Toronto Convention Centre 
Tuberculosis deaths declined at an annualized rate of change (AROC) of -4.78% over 30 years in the US (GBD 2019). Country-level estimates, however, mask geographic and racial heterogeneity. In 16 southern states health inequities engendered by Jim Crow laws have not been evaluated for TB. We compared TB mortality in former Jim Crow vs non-Jim Crow states from 1990 to 2019 (GBD 2019). We defined a proxy for racialized segregation by identifying the county with the highest proportion of the White population vs the county with highest proportion of the Black. We compared mortality across states and counties within states using GBD Study data. From 1990 to 2019, most former Jim Crow states had highest TB mortality, non-Jim Crow states had the lowest. Mortality declined in all states. Steepest decline was Washington DC, with a 6-fold decline, i.e., AROC -2.68%. Of the 17 states in the top third in 1990, 11 states had a history of Jim Crow laws, whereas of the 17 in the bottom third none had such history. Even though the Civil Act of 1964 dismantled Jim Crow laws, our results suggest that inequities experienced in the past may be felt in future generations via "intergenerational drag".