Are Racial Disparities in Preterm Birth Larger in Hypersegregated Areas?

• Published in: American journal of epidemiology 2008-06, Vol.167 (11), p.1295-1304
• Main Authors: Osypuk, Theresa L., Acevedo-Garcia, Dolores
• Format: Article
• Language: English
• Subjects: African Americans; Analysis. Health state; Biological and medical sciences; Continental Population Groups; Diseases of mother, fetus and pregnancy; Epidemiology; ethnic groups; Female; General aspects; Gynecology. Andrology. Obstetrics; Health Status Disparities; Humans; infant; Infant, Newborn; Infant, Premature; Likelihood Functions; Logistic Models; low birth weight; Medical sciences; minority health; Miscellaneous; Obstetrics; Pregnancy; Pregnancy. Fetus. Placenta; Prejudice; Premature birth; Premature Birth - epidemiology; Premature Birth - ethnology; Public health. Hygiene; Public health. Hygiene-occupational medicine; Racial differences; Regression analysis; Residence Characteristics; Risk Factors; Segregation; United States - epidemiology; Urban Population; White people
• ISSN: 0002-9262; 1476-6256
• DOI: 10.1093/aje/kwn043

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.