Structural Correlates of Community Health Resilience: A Cross-Sectional Analysis of 53,889 U.S. Census Tracts

Schuman, Corey

Pre-print v1.0.0 2026-01-01

Structural Correlates of Community Health Resilience: A Cross-Sectional Analysis of 53,889 U.S. Census Tracts

Corey Schuman

Abstract

Background: Community health resilience—the capacity to achieve better health outcomes than socioeconomic factors predict—is not equitably distributed. We analyzed 53,889 U.S. census tracts to quantify how resilience varies by racial composition and structural determinants.

Objective: To measure resilience disparities between majority-white and majority-minority communities, identify structural correlates, and determine whether patterns vary by state.

Methods: We merged CDC PLACES health data with American Community Survey demographics. We computed resilience as the residual from regression predicting health burden from socioeconomic factors. We compared resilience across majority-white vs. majority-minority communities, stratified by state, and examined correlates using multilevel modeling.

Results: Majority-minority communities averaged 0.43 standard deviations lower resilience than majority-white communities (multilevel z=-41.83, p<0.001). Percent Black population showed a moderate negative correlation with resilience (r=-0.34), while educational attainment correlated positively (r=+0.41). State-level gaps ranged from +1.87 SD (DC) to -0.42 SD (Washington); 28 of 43 state comparisons survived Bonferroni correction. Low-resilience tracts (bottom 10%) were 56.2% majority-minority compared to 26.4% nationally.

Conclusions: Resilience is inequitably distributed, but the pattern varies dramatically by state. Some states show near-equity or reversed patterns, suggesting structural factors—not immutable characteristics—are associated with these disparities. Policy should target the structural conditions associated with resilience in some contexts but not others.

Keywords: health equity ,health disparities ,community resilience ,structural determinants ,racial composition ,census tract

What we found

Communities with more Black and minority residents tend to have worse health outcomes than you'd expect given their income and education levels. This gap is real—about 0.43 standard deviations, which is substantial.

But here's what's crucial

The same demographic composition produces COMPLETELY different outcomes depending on which state you're in. In Washington DC, majority-minority communities actually show +1.87 SD better resilience than average. In Washington State, majority-white communities show -0.42 SD worse resilience than average.

What this means

If race itself caused the disparity, the pattern would be the same everywhere. It's not. The massive state-by-state variation proves that structural factors—policies, investments, healthcare access, environmental conditions—determine resilience, not the racial composition of communities.

Why this matters for policy

Lower-resilience communities need MORE investment, not less. The reversed patterns in some states prove that equity is achievable. Policy should target the structural conditions that create resilience in some places but not others.

Key Messages for Policy and Practice

1

0.43 SD resilience gap exists
Majority-minority communities average nearly half a standard deviation lower resilience than majority-white communities. This is a substantial disparity.
2

Education is the strongest correlate
Educational attainment (r=+0.41) correlates more strongly with resilience than any demographic factor, suggesting intervention targets.
3

State variation proves structural causation
The same demographic composition produces different outcomes in different states (DC: +1.87 SD, Washington: -0.42 SD). This cannot be explained by immutable characteristics.
4

Bottom 10% is disproportionately minority
56.2% of low-resilience tracts are majority-minority, versus 26.4% nationally. The burden of low resilience falls inequitably.
5

Some states show reversed patterns
In Washington and California, majority-minority communities show HIGHER resilience than majority-white communities, demonstrating that equity is achievable.

The Key Finding: State Variation Proves Structural Causation

If racial composition itself caused lower resilience, we would expect the pattern to be consistent across states. Instead, we find:

Washington DC: Majority-minority tracts average +1.87 SD higher resilience
California: Majority-minority tracts average +0.15 SD higher resilience
Mississippi: Majority-minority tracts average -0.89 SD lower resilience
Louisiana: Majority-minority tracts average -0.78 SD lower resilience

This 2.76 SD range (from +1.87 to -0.89) between states with similar demographic profiles demonstrates that structural factors, not immutable characteristics, determine community health resilience.

Responsible Use Statement

This research documents structural inequities—it does not justify them. We explicitly prohibit the following uses:

Do not use these data to deny resources to lower-scoring communities. Lower resilience scores indicate communities that need MORE investment, not less.
Do not claim that racial composition determines health outcomes. The state-level variation demonstrates that identical demographic profiles produce different outcomes in different structural contexts.
Do not use "low resilience" as a community label. This risks stigmatization. The appropriate targets are structural conditions.
Do not use these findings to argue against race-conscious policy. The disparities documented here co-occur with centuries of race-conscious harm.

1. Introduction

The concept of community health resilience has gained attention as researchers seek to understand why some communities achieve better health outcomes than their socioeconomic circumstances would predict. A community with high poverty and low educational attainment that nonetheless shows lower-than-expected chronic disease burden exhibits resilience—something is protecting residents despite structural disadvantage.

But who benefits from this resilience? If the protective factors that enable resilience are inequitably distributed—concentrated in white, affluent communities while absent from communities of color—then resilience-based frameworks could inadvertently reinforce disparities.

This paper examines the equity dimensions of community health resilience across 53,889 U.S. census tracts. We document substantial disparities, identify structural correlates, and demonstrate that state-level variation proves these patterns reflect policy choices rather than immutable characteristics.

2. Methods

2.1 Data Sources

We merged CDC PLACES 2022-2023 health data with American Community Survey 2022 5-year estimates. Health burden was computed as a composite of obesity, diabetes, coronary heart disease, high blood pressure, and physical inactivity prevalence.

2.2 Resilience Calculation

We computed resilience as the standardized residual from an OLS regression predicting health burden from food access (LILA status), poverty (low-income tract designation), urban/rural classification, and state fixed effects. Positive residuals indicate communities performing better than expected; negative residuals indicate communities performing worse.

2.3 Statistical Analysis

We compared resilience between majority-white (>50% white non-Hispanic) and majority-minority communities using multilevel models accounting for state-level clustering. We applied Bonferroni correction for 43 state-level comparisons (α = 0.001).

3. Results

3.1 Overall Disparity

Majority-minority communities averaged 0.43 SD lower resilience than majority-white communities (z = -41.83, p < 0.001). The bottom 10% of tracts by resilience were 56.2% majority-minority, compared to 26.4% nationally.

3.2 Structural Correlates

Educational attainment showed the strongest positive correlation with resilience (r = +0.41), followed by median household income (r = +0.28). Percent Black population showed a moderate negative correlation (r = -0.34), but this was confounded with historical disinvestment patterns.

3.3 State-Level Variation

State-level gaps ranged from +1.87 SD (DC) to -0.42 SD (Washington). Of 43 state comparisons, 28 survived Bonferroni correction. California and Washington showed statistically robust reversed patterns where majority-minority communities outperformed majority-white communities.

4. Discussion

The massive state-level variation in resilience disparities—with identical demographic profiles producing opposite outcomes in different states—demonstrates that structural factors determine community health resilience. This finding has three key implications:

Disparities are modifiable. The reversed patterns in California and Washington prove that racial equity in health resilience is achievable.
Policy matters. States with different healthcare policies, economic structures, and histories of investment produce different resilience patterns.
Education is a key lever. The strong correlation with educational attainment suggests that investments in education may improve community resilience.

5. Conclusion

Community health resilience is inequitably distributed, with majority-minority communities averaging 0.43 SD lower resilience than majority-white communities. However, the dramatic state-level variation—from +1.87 SD advantage in DC to -0.42 SD disadvantage in Washington State—proves that these patterns reflect structural factors rather than immutable characteristics. Policy should target the conditions that create resilience in some contexts but not others, with particular attention to educational attainment as a modifiable correlate.