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Background: A higher risk of preterm birth among black women than among white women is well established in the United States. We compared differences in preterm birth between nonHispanic black and white women in Canada and the US, hypothesizing that disparities would be less extreme in Canada given the different historical experiences of black populations and Canada's universal health care system. Methods:Using data on singleton live births in Canada and the US for 2004-2006, we estimated crude and adjusted risk ratios and risk differences in preterm birth (< 37 wk) and very preterm birth (< 32 wk) among non-Hispanic black versus non-Hispanic white women in each country. Adjusted models for the US were standardized to the covariate distribution of the Canadian cohort. = 0.003). Adjusted risk ratios for preterm birth (p H = 0.1) were slightly higher in Canada than in the US, whereas adjusted risk differences were similar in both countries. Similar patterns were observed for racial disparities in very preterm birth. ResultsInterpretation: Relative disparities in preterm birth and very preterm birth between nonHispanic black and white women were similar in magnitude in Canada and the US. Absolute disparities were smaller in Canada, which reflects a lower overall risk of preterm birth in Canada than in the US in both black and white populations. AbstractSee also www.cmaj.ca/lookup