Despite persistent racial disparities in preterm birth in the United States among non-Hispanic black women compared with non-Hispanic white women, it remains controversial whether sociodemographic factors can explain these differences. We sought to evaluate whether disparities in preterm birth persist among non-Hispanic black women with high socioeconomic status. STUDY DESIGN: We conducted a population-based cohort study of all live births in the United States from 2015 through 2017 using birth certificate data from the National Vital Statistics System. We included singleton, nonanomalous live births among women who were of high socioeconomic status (defined as having !16 years of education, private insurance, and not receiving Women, Infants, and Children benefits) and who identified as non-Hispanic white, non-Hispanic black, or mixed non-Hispanic black and white race. The primary outcome was preterm birth <37 weeks; secondary outcomes included preterm birth <34 and <28 weeks. In addition, analyses were repeated considering birthweight <2500 g as a surrogate for preterm birth <37 weeks, birthweight <1500 g as a surrogate for preterm birth <34 weeks, and birthweight <750 g as a surrogate for preterm birth <28 weeks' gestation. Data were analyzed with c 2 , Student t test, and logistic regression.RESULTS: A total of 2,170,686 live births met inclusion criteria, with 92.9% non-Hispanic white, 6.7% non-Hispanic black, and 0.4% both non-Hispanic white and black race. Overall, 5.9% delivered <37, 1.3% <34, and 0.3 % <28 weeks. In unadjusted analyses of women with high

BACKGROUND: Non-Hispanic black maternal race is a known risk factor for preterm birth. However, the contribution of paternal race is not as well established. OBJECTIVE: We sought to evaluate the risk of preterm birth among non-Hispanic black, non-Hispanic white, and mixed non-Hispanic black and non-Hispanic white dyads. STUDY DESIGN: This was a population-based cohort study of all live births in the United States from 2015 to 2017, using live birth records from the National Vital Statistics System. Singleton, nonanomalous infants whose live birth record included maternal and paternal self-reported race as either non-Hispanic white or non-Hispanic black were included. The primary outcome was preterm birth at <37 weeks' gestation; secondary outcomes included preterm birth at <34 and <28 weeks' gestation and delivery gestational age (as a continuous variable). Data were analyzed using chi-square, t test, analysis of variance, and logistic regression. A Kaplan-Meier survival curve was also generated. RESULTS: There were 11,809,599 live births during the study period; 4,008,622 births met the inclusion criteria. Of included births, 291,647 (7.3%) occurred at <37 weeks' gestation. Using the convention of maternal race first followed by paternal race, preterm birth at <37 weeks' gestation was most common among non-Hispanic black and non-Hispanic black dyads (n=70,987 [10.8%]), followed by non-Hispanic black and non-Hispanic white (n=3137 [9.5%]), non-Hispanic white and non-Hispanic black (n=9136 [8.3%]), and non-Hispanic white and non-Hispanic white dyads (n=209,387 [6.5%]; P<.001 for trend). Births at <34 weeks' (n=74,474) and <28 weeks' gestation (n=18,474) were also more common among non-Hispanic black and non-Hispanic black dyads. Specifically, 24,351 (3.7%) non-Hispanic black and non-Hispanic black, 1017 (3.1%) non-Hispanic black and non-Hispanic white, 2408 (2.2%) non-Hispanic white and non-Hispanic black, and 46,698 non-Hispanic white and non-Hispanic white dyads delivered at <34

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OBJECTIVE: To quantify the extent to which a standardized pain management order set reduced racial/ethnic inequities in post-Cesarean pain evaluation and treatment. STUDY DESIGN: A follow-up retrospective cohort study comparing previously reported racial/ethnic inequities in post-Cesarean pain management (baseline period: 07/01/14e06/30/16) to data after implementation of a standardized pain management order set (03/ 01/17e02/28/18). Medical records were queried for number of pain assessments; pain scores> 7; scheduled non-opiate doses, and as needed opiate doses (converted to 5mg oxycodone tablet equivalents, OTE). Outcomes were grouped into 0-< 24 and 24-48 hours postpartum, and stratified by race/ethnicity (Hispanic, non-Hispanic Black (NHB), non-Hispanic White (NHW), Asian, and other). Analyses included logistic regression for the categorical outcome of pain score> 7 (severe pain), and linear regression. Main effect and interaction terms were used to calculate the difference-in-difference from baseline to follow-up. RESULTS: Before order set implementation (N¼1701), we demonstrated NHW women had lower pain scores, more frequent pain assessments, and received more opiates than NHB women (% pain scores> 7 NHW/NHB 0-< 24h: 20%/28%; 24-48h: 25%/37%). After implementation (N¼888), severe pain remained more common among NHB women (% pain scores> 7 NHW/NHB 0-< 24h: 23%/31%; 24-48h: 26%/38%). Pain management processes changed after implementation (Table ), with overall fewer assessments, less opiates and more non-opiate analgesics. However, racial/ethnic inequities in number of assessments and treatment were unchanged (Table, all p for interaction > 0.05), with the exception of an increase in NSAID doses 24-48 hours postpartum for Hispanic women. CONCLUSION: A standardized pain management order set reduced overall postpartum opiate use, but did not reduce racial/ethnic inequities in pain evaluation and treatment. Future work should investigate racial equity-focused education and interventions designed to eliminate inequities in pain management.

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