Black–White Disparities in Preterm Birth: Geographic, Social, and Health Determinants

Abstract

Introduction: Reducing racial/ethnic disparities in preterm birth is a priority for U.S. public health programs. The study objective was to quantify the relative contribution of geographic, sociodemographic, and health determinants to the black, non-Hispanic and white, non-Hispanic preterm birth disparity. Methods: Cross-sectional 2016 U.S. birth certificate data (analyzed in 2018−2019) were used. Black−white differences in covariate distributions and preterm birth and very preterm birth rates were examined. Decomposition methods for nonlinear outcomes based on logistic regression were used to quantify the extent to which black−white differences in covariates contributed to preterm birth and very preterm birth disparities. Results: Covariate differences between black and white women were found within each category of geographic, sociodemographic, and health characteristics. However, not all covariates contributed substantially to the disparity. Close to 38% of the preterm birth and 31% of the very preterm birth disparity could be explained by black−white covariate differences. The largest contributors to the disparity included maternal education (preterm birth, 11.3%; very preterm birth, 9.0%), marital status/paternity acknowledgment (preterm birth, 13.8%; very preterm birth, 14.7%), source of payment for delivery (preterm birth, 6.2%; very preterm birth, 3.2%), and hypertension in pregnancy (preterm birth, 9.9%; very preterm birth, 8.3%). Interpregnancy interval contributed a more sizable contribution to the disparity (preterm birth, 6.2%, very preterm birth, 6.0%) in sensitivity analyses restricted to all nonfirstborn births. Conclusions: These findings demonstrate that the known portion of the disparity in preterm birth is driven by sociodemographic and preconception/prenatal health factors. Public health programs to enhance social support and preconception care, specifically focused on hypertension, may provide an efficient approach for reducing the racial gap in preterm birth.

Socioeconomic Risk Factors for Preterm Birth in Qatar: A Population-based Study

“…It became well recognized that Socio-demographic and preconception/prenatal health factors do affect preterm birth rates [7][8][9][10][11]. The Peristat registry records all preterm births in the state of Qatar.…”

Biological Embedding of Chronic Stress Across Two Generations Within Marginalized Communities

“…Work in this field should also recognize and acknowledge the historical legacies of oppression that have intergenerational impacts on health and wellness, even before a child is born (Owens & Fett, 2019). Both policies and practices are needed to address these health disparities in birth outcomes that appear to be growing in our current sociopolitical context (e.g., Thoma et al, 2019), especially during this time of increased police brutality targeting African Americans (Edwards, Lee, & Esposito, 2019) and during the COVID‐19 pandemic, which affects African Americans disproportionately, largely because of our history and current practices of systemic racism (Devakumar, Shannon, Bhopal, & Abubakar., 2020). In this article, we sought to shed light on a major gap in our understanding of the biological embedding of chronic stress that is unique to people of color in efforts to reduce the major health disparities in marginalized communities.…”

Outcomes of truncus arteriosus repair and predictors of mortality

“…Socioeconomic and ethnic‐racial disparities are a major risk for prematurity 12 . Studies have shown that non‐Hispanic Black women are 2.5 times more likely to have preterm birth vs White women 13 . The dynamics and interplay between these three risk factors (preterm birth, non‐White race, and government insurance) are challenging, and the coexistence of these factors is not uncommon.…”