Are racial disparities in preterm birth larger in hypersegregated areas?

The causes of the racial/ethnic disparity in preterm birth (PTB) remain largely unknown; traditional risk factors such as smoking and prenatal care fail to account for it. The authors examined whether living in metropolitan areas (MAs) with high levels of residential racial segregation along multiple dimensions (hypersegregation) was associated with higher rates of PTB or larger racial disparities in PTB and whether segregation modified the established race-age association in PTB. The authors merged 2000 natality data (n = 1,944,703) with US Census measures of Black-White hypersegregation. They executed two-level hierarchical logistic regression analyses among White and Black mothers in 237 MAs to estimate the odds of PTB by hypersegregation, race, and age, after controlling for covariates. In unadjusted and adjusted models, Black infants in hypersegregated MAs were more likely to be preterm than Black infants in nonhypersegregated MAs (p < 0.001). Black-White PTB disparities were larger in hypersegregated areas than in nonhypersegregated areas (p < 0.001), and the age-race association with PTB was modified by hypersegregation (p < 0.001). Living in a hypersegregated MA had a more pronounced association with PTB among older Black women, and racial disparities in PTB were larger in hypersegregated areas among older mothers (p < 0.001). Since over 40% of Black childbearing women live in hypersegregated areas, residential segregation may be an important social determinant of racial birth disparities.

[1]  A. Geronimus.  Black/white differences in the relationship of maternal age to birthweight: a population-based test of the weathering hypothesis. , 1996, Social science & medicine.

[2]  A. Drolet,et al.  Advancing maternal age and infant birth weight among urban African Americans: the effect of neighborhood poverty. , 2006, Ethnicity & disease.

[3]  T. Laveist.  Racial segregation and longevity among African Americans: an individual-level analysis. , 2003, Health services research.

[4]  V. Chang,et al.  Racial residential segregation and weight status among US adults. , 2006, Social science & medicine.

[5]  N. Smelser,et al.  Residential Segregation and Neighborhood Conditions in U . S . Metropolitan Areas , 2005 .

[6]  P. Braveman,et al.  The relationship of neighborhood socioeconomic characteristics to birthweight among 5 ethnic groups in California. , 2001, American journal of public health.

[7]  Dolores Acevedo-Garcia,et al.  Future directions in residential segregation and health research: a multilevel approach. , 2003, American journal of public health.

[8]  J. S. Rawlings,et al.  Prevalence of low birth weight and preterm delivery in relation to the interval between pregnancies among white and black women , 1995, The New England journal of medicine.

[9]  Stephen L. Ross,et al.  Discrimination in Metropolitan Housing Markets Phase II: Asians and Pacific Islanders , 2003 .

[10]  Mary J. Fischer,et al.  Does Rising Income Bring Integration? New Results for Blacks, Hispanics, and Asians in 1990 , 1999 .

[11]  K. Fiscella,et al.  Racial disparities in preterm births. The role of urogenital infections. , 1996, Public health reports.

[12]  Assuring Healthy Outcomes,et al.  Committee on Understanding Premature Birth and Assuring Healthy Outcomes , 2007 .

[13]  C. Stevens-Simon.  The weathering hypothesis. , 2002, American journal of public health.

[14]  Godfrey Fowler,et al.  THE STRATEGY OF PREVENTIVE MEDICINE , 1992 .

[15]  S. Kessel,et al.  Racial differences in low birth weight. Trends and risk factors. , 1987, The New England journal of medicine.

[16]  Assuring Healthy Outcomes,et al.  Sociodemographic and Community Factors Contributing to Preterm Birth , 2007 .

[17]  J. Morenoff,et al.  Neighborhood Mechanisms and the Spatial Dynamics of Birth Weight1 , 2003, American Journal of Sociology.

[18]  S. Kessel,et al.  Racial Differences in Low Birth Weight , 1987 .

[19]  Assuring Healthy Outcomes,et al.  Preterm Birth : Causes , Consequences , and Prevention , 2005 .

[20]  Russ P Lopez.  Black-white residential segregation and physical activity. , 2006, Ethnicity & disease.

[21]  I. Ellen.  Is Segregation Bad for Your Health? The Case of Low Birth Weight , 2000 .

[22]  G. A. Marcoulides,et al.  Multilevel Analysis Techniques and Applications , 2002 .

[23]  D. Strobino,et al.  Testing a sociomedical model for preterm delivery. , 2001, Paediatric and perinatal epidemiology.

[24]  P. O’Campo,et al.  Racial inequalities in preterm delivery: issues in the measurement of psychosocial constructs. , 2005, American journal of obstetrics and gynecology.

[25]  G Rose,et al.  Sick individuals and sick populations. , 1985, International journal of epidemiology.

[26]  M. Kotelchuck,et al.  An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. , 1994, American journal of public health.

[27]  J. Kaufman,et al.  Neighborhood crime, deprivation, and preterm birth. , 2006, Annals of epidemiology.

[28]  E. Glaeser,et al.  Are Ghettos Good or Bad? , 1995 .

[29]  S. Galea,et al.  The Distribution of Neighborhood Poverty and Racial Disparities in Neighborhood Context: The Unequal American Geography of Opportunity , 2007 .

[30]  Camille Z. Charles,et al.  The Dynamics of Racial Residential Segregation , 2003 .

[31]  D. Massey.  SEGREGATION AND STRATIFICATION: A Biosocial Perspective , 2004, Du Bois Review: Social Science Research on Race.

[32]  H. Andrews,et al.  The contribution of maternal age to racial disparities in birthweight: a multilevel perspective. , 2001, American journal of public health.

[33]  Dolores Acevedo-Garcia,et al.  Low birthweight among US Hispanic/Latino subgroups: the effect of maternal foreign-born status and education. , 2007, Social science & medicine.

[34]  S. Subramanian,et al.  Racial residential segregation and geographic heterogeneity in black/white disparity in poor self-rated health in the US: a multilevel statistical analysis. , 2005, Social science & medicine.

[35]  David R. Williams,et al.  Toward a policy-relevant analysis of geographic and racial/ethnic disparities in child health. , 2008, Health affairs.

[36]  David R. Williams,et al.  Racial Residential Segregation: A Fundamental Cause of Racial Disparities in Health , 2001, Public health reports.

[37]  N. Denton,et al.  The Dimensions of Residential Segregation , 1988 .

[38]  Mei-Cheng Wang,et al.  Neighborhood risk factors for low birthweight in Baltimore: a multilevel analysis. , 1997, American journal of public health.

[39]  D. Massey,et al.  The Dimensions of Segregation Revisited , 1996 .

[40]  S. Raudenbush,et al.  Neighborhood support and the birth weight of urban infants. , 2003, American journal of epidemiology.

[41]  R. David.  Commentary: Birthweights and bell curves. , 2001, International journal of epidemiology.

[42]  F. Earls,et al.  Diverging associations of maternal age with low birthweight for black and white mothers. , 2003, International journal of epidemiology.

[43]  S. Ventura,et al.  Delayed Childbearing by Education Level in the United States, 1969–1994 , 1997, Maternal and Child Health Journal.

[44]  R. Farley,et al.  Product Review: Racial and Ethnic Residential Segregation in the United States: 1980 to 2000 , 2004 .

[45]  N. Reichman,et al.  Maternal age and birth outcomes: data from New Jersey. , 1997, Family planning perspectives.

[46]  N. Smelser,et al.  America becoming : racial trends and their consequences , 2000 .

[47]  Timothy J. Robinson,et al.  Multilevel Analysis: Techniques and Applications , 2002 .

[48]  C. Aneshensel,et al.  The neighborhood context of adolescent mental health. , 1996, Journal of health and social behavior.

[49]  E. Brunner.  Towards a new social biology , 2000 .

[50]  J. Martin,et al.  Births: final data for 2004. , 2006, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

[51]  E. Roberts.  Neighborhood social environments and the distribution of low birthweight in Chicago. , 1997, American journal of public health.

[52]  T. Osypuk,et al.  Impacts of housing and neighborhoods on health: Pathways, racial/ethnic disparities, and policy directions , 2008 .

[53]  Lisa F. Berkman,et al.  The Differential Effect of Foreign-Born Status on Low Birth Weight by Race/Ethnicity and Education , 2005, Pediatrics.

[54]  A. Roux,et al.  Commentary: causes of incidence and causes of cases--a Durkheimian perspective on Rose. , 2001, International journal of epidemiology.

[55]  R. Hayward,et al.  Pregnancy intention and birth outcomes: does the relationship differ by age or race? , 2007, Journal of women's health.