Black adults don’t generally live as long as white adults. Racism, including discriminatory housing practices and socioeconomic disadvantages, are broad, societal factors contributing to this lower life expectancy, but a more specific influence is racial segregation at the neighborhood level, a recent study finds.

Researchers from Northwestern University’s Feinberg School of Medicine looked at the effect of segregation on life expectancy in more than 63,500 neighborhoods in the U.S. They also studied how socioeconomic factors at the local level affected life expectancy.

“Where someone lives is not necessarily their choice.”

They found that life expectancy was about four years less among those living in more segregated neighborhoods, compared to less segregated areas — evidence that structural racism, the longstanding organizational and institutional policies that support a continued unfair advantage for some people and unfair or harmful treatment of others based on their race or ethnic group, continues to significantly affect health outcomes.

“Where someone lives is not necessarily their choice,” researcher Sadiya Khan told TheDoctor. To close this gap, more investment is needed in neighborhoods that have historically been neglected. “We need to think about how we can invest in these communities and ensure there is equity and opportunities to improve health outcomes,” she added.

In the geographic areas, or census tracts, included in the analysis, the average life expectancy was about 78 years. Residents living in more segregated neighborhoods were 12 percent more likely than those in less segregated areas to lack a college education, 13 percent more likely to live below the federal poverty level and eight percent more likely to be unemployed — all socioeconomic risk factors that also affect a person’s lifespan.

If people become aware that where they live can affect their health, they can raise concerns regarding these possible risk factors for disease with their doctors. Not only should they get their blood pressure and cholesterol levels checked regularly, Khan, an assistant professor at Northwestern University Feinberg School of Medicine, pointed out, they may want to discuss screening for heart disease and diabetes. They can also take into account the damaging effect air pollution can have on residents' lungs.

Khan and her colleagues want to consider where people live when they determine patients’ risk of heart disease. They currently measure blood pressure and cholesterol levels, but Khan said, “We want to know how we can incorporate information from the neighborhood into how we predict risk, and therefore, how we intervene and recommend treatment.”

The study is published in JAMA Health Forum.