Friday, May 16, 2025
5/16/2025
After the Dust Settles: Changes in Local Healthcare Access and Utilization after Civil Unrest - Project Summary In recent years, police violence has become a more visible occurrence in American society, largely due to the fast-paced availability of information and footage via social media.1 The resulting civil unrest following these events represents a form of structural violence with profound implications for marginalized communities. This violence leads to lasting effects on health through disruptions to education, transportation, economic opportunities, and other social determinants of health. The overarching goal of the proposed research is to examine connections between forms of structural racism and healthcare access, quality, and outcomes. The immediate goal of this dissertation proposal is to analyze the impact of civil unrest on long-term healthcare utilization and mental healthcare utilization for older adults in affected communities. We hypothesize that civil unrest events will increase preventable hospitalizations, emergency department (ED) visits, decrease primary care visits, and raise the volume of mental health visits related to anxiety and depression. The specific aims are to: (1) Evaluate the impact of civil unrest, following incidents of police violence, on healthcare utilization, specifically focusing on preventable hospitalizations, emergency department (ED) visits, and primary care visits, and (2) Analyze sustained changes in the volume of mental health visits related to anxiety and depression within communities affected by civil unrest. Our proposal will include older adults enrolled in traditional fee-for-service Medicare in Minneapolis, Minnesota, Baltimore, Maryland, and Ferguson, Missouri, whose healthcare utilization will be tracked 6 months before and 24 to 36 months following incidents of unrest related to police violence. Using a quasi-experimental econometric design, we will compare healthcare utilization between Black and white beneficiaries within these regions before and after incidents of civil unrest. This approach is innovative because it uses sophisticated models to longitudinally analyze the impact of structural racism on healthcare at the regional level, rather than nationally. Previous research on structural racism and its relationship to health outcomes is limited to measures related to socioeconomic status, health system quality, and more, but not structural violence, such as police brutality and civil unrest. This proposal is the first analysis to use Medicare claims to examine if there is a relationship between structural racism and healthcare utilization through localized incidents of unrest. This dissertation proposal is significant because it is a direct response to the NIA's scientific priority of understanding “health disparities related to aging and develop strategies to improve the health status of older adults in diverse populations.”2 We expect this analysis to highlight the nuanced relationship between structural racism and healthcare utilization among traditional fee-for-service Medicare beneficiaries. Though the results will be specific to the isolated incidents at the community level, the findings will have salient implications for future racial health equity research.
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