Dynamic changes in place-based measures of structural racism and preterm birth in the USA

• Published in: Journal of epidemiology and community health (1979) 2024-09, Vol.78 (9), p.550-555
• Main Authors: Das, Abhery, Casey, Joan A, Gemmill, Alison, Catalano, Ralph, Lee, Hedwig, Stolte, Allison, Bustos, Brenda, Bruckner, Tim A
• Format: Article
• Language: English
• Subjects: Adult; Birth; Black or African American - statistics & numerical data; Censuses; Cross-Sectional Studies; Estimates; Ethnicity; Female; Health disparities; Health Status Disparities; Households; Humans; INFANT, NEWBORN; LONGITUDINAL STUDIES; MATERNAL HEALTH; Minority & ethnic groups; Morbidity; Mortality; Neighborhoods; Original research; POVERTY; Pregnancy; Premature birth; Premature Birth - epidemiology; Premature Birth - ethnology; PUBLIC HEALTH; Race; Racism; Risk reduction; Segregation; Systemic Racism; United States - epidemiology; White People - statistics & numerical data
• ISSN: 0143-005X; 1470-2738; 1470-2738
• DOI: 10.1136/jech-2023-221750

BackgroundStructurally racist systems, ideologies and processes generate and reinforce inequities among minoritised racial/ethnic groups. Prior cross-sectional literature finds that place-based structural racism, such as the Index of Concentration at the Extremes (ICE), correlates with higher infant morbidity and mortality. We move beyond cross-sectional approaches and examine whether a decline in place-based structural racism over time coincides with a reduced risk of preterm birth across the USA.MethodsWe used as the outcome count of preterm births overall and among non-Hispanic (NH) black and NH white populations across three epochs (1998–2002, 2006–2010, 2014–2018) in 1160 US counties. For our measure of structural racism, we used ICE race/income county measures from the US Census Bureau. County-level fixed effects Poisson models include a population offset (number of live births) and adjust for epoch indicators, per cent poverty and mean maternal age within counties.ResultsAn SD increase in ICE (0.11) over time corresponds with a 0.6% reduced risk of preterm birth overall (incidence rate ratio (IRR): 0.994, 95% CI 0.990, 0.998), a 0.6% decrease in preterm risk among NH black births (IRR: 0.994, 95% CI 0.989, 0.999) and a 0.4% decrease among NH white births (IRR: 0.996, 95% CI 0.992, 0.999).ConclusionsMovement away from county-level concentrated NH black poverty preceded reductions in preterm risk, especially among NH black populations. Our longitudinal design strengthens inference that place-based reductions in structural racism may improve perinatal health. These improvements, however, do not appear sufficient to redress large disparities.