A State-Level Examination into Structural Racism and Racialized Disparities in Sexually Transmitted Infections.

The population health literature recognizes structural racism as a fundamental determinant of racialized health disparities. However, the role of structural racism in the continued persistence of racialized disparities in sexually transmitted infections (STIs) has not been investigated despite Black Americans' disproportionate experience of STIs in comparison to White Americans. Past research has largely investigated individual racial/ethnic identity as an individual-level factor predictive of STIs, failing to engage with the multitude of racially structured contexts which likely shape STI rates. This study combines multiple datasets, including data from the Centers for Disease Control and Prevention, the American Community Survey, and the Current Population Survey, to conduct a state-level analysis investigating the role of structural racism in contributing to Black-White racialized disparities in STIs between 2010 and 2020. Random effects spatial autoregressive models suggest that structural racism contributes to Black-White racialized disparities in STIs. This research contributes to literatures on structural racism and population health by better understanding how racialized state-level institutions shape the contraction of infections. The results have important implications for understanding states as institutional actors relevant for patterns of population health and the geography of racism.