Black-white metropolitan segregation and self-rated health: Investigating the role of neighborhood poverty.

While black-white segregation has been consistently linked to detrimental health outcomes for blacks, whether segregation is necessarily a zero-sum arrangement in which some groups accrue health advantages at the expense of other groups and whether metropolitan segregation impacts the health of racial groups uniformly within the metropolitan area, remains unclear. Using nationally representative data from the 2008-2013 National Health Interview Survey linked to Census data, we investigate whether the association between metropolitan segregation and health is invariant within the metropolitan area or whether it is modified by neighborhood poverty for black and white Americans. In doing so, we assess the extent to which segregation involves direct health tradeoffs between blacks and whites. We conduct race-stratified multinomial and logistic regression models to assess the relationship between 1) segregation and level of neighborhood poverty and 2) segregation, neighborhood poverty, and poor health, respectively. We find that, for blacks, segregation was associated with a higher likelihood of residing in high poverty neighborhoods, net of individual-level socioeconomic characteristics. Segregation was positively associated with poor health for blacks in high poverty neighborhoods, but not for those in lower poverty neighborhoods. Hence, the self-rated health of blacks clearly suffers as a result of black-white segregation - both directly, and indirectly through exposure to high poverty neighborhoods. We do not find consistent evidence for a direct relationship between segregation and poor health for whites. However, we find some suggestive evidence that segregation may indirectly benefit whites through decreasing their exposure to high poverty environments. These findings underscore the critical role of concentrated disadvantage in the complex interconnection between metropolitan segregation and health. Weakening the link between racial segregation and concentrated poverty via local policy and planning has the potential for broad population-based health improvements and significant reductions in black-white health disparities.