Abstract Body: Introduction:
Post-Civil War, Richmond emerged as a major center for tobacco cultivation and manufacturing, driven by its exploitation of Black labor. Laborers were often employed in physically demanding positions in unventilated and smoke-filled environments, coupled with forced residence in undesirable neighborhoods due to historic redlining. In response, Black laborers organized strikes leading to lower working hours, increased wages, and improved workplace safety. We investigated whether these changes in social determinants of health (SDOH) may have contributed to the reduction in stroke mortality among Black workers in Richmond in the 20^th century.
Methods:
Data was sourced from the Richmond Cemetery Collaboratory (RCC), which digitized Black Death Records in Richmond, Virginia. Death records were ICD-10 coded by ChatGPT. A total of 1,815 death records (1907-1979), were georeferenced based on their proximity to tobacco factories. We conducted hotspot analysis across the study period to assess stroke mortality across time and space. The age distribution of stroke deaths within the period was compared to the 1940 Vital Statistics, which documented stroke mortality for all non-white races.
Results:
Stroke mortality in RCC data significantly declined following the period of labor activism between 1937 and 1941. Hot spot analysis revealed a geospatial shift in stroke mortality in Richmond, moving from the east side in the early 1900s to the south side in the mid-1900s (Figure 1A). The stroke mortality rate within a 1 km radius of tobacco manufacturing plants was 109.46 per 100,000. The observed K value indicated high levels of stroke death clustering within the sample, likely due to historic redlining (Figure 1B). Additionally, stroke mortality was more common among individuals <45, compared to the 1940 statistics on non-white stroke mortality in Virginia.
Conclusion:
Labor activism was a critical SDOH that played a key role in reducing stroke mortality among Black workers in Richmond's tobacco industry during the 20th century. Through strikes, Black laborers directly targeted social factors that likely contributed to stroke mortality and prevalence. The younger age at death among Richmond’s Black population, compared to statewide stroke mortality statistics, underscores the tobacco industry’s detrimental impact on stroke risk, especially for those living near manufacturing plants. The drop in stroke mortality highlights leadership's role in addressing SDOH.