Neighborhood disadvantage and the racial disparity in postpartum hypertension

Lemon, Lara; Hauspurg, Alisse; Garrard, William T.; Quinn, Beth; Simhan, Hyagriv N.

doi:10.1016/j.ajogmf.2022.100773

Cited by 10 publications

(5 citation statements)

References 16 publications

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“…Our study makes a contribution to previous studies by highlighting neighborhood conditions in HV interventions and addressing the challenge of increasing HV utilization among birthing people of color in disadvantaged communities. [8][9][10] Compared with previous CHW-informed HV studies focusing on individual risk factors and birth outcomes, 20,21 we expanded the analyses to neighborhood segregation and examined program engagement, an important step to achieve program effectiveness on birth outcomes. Compared with previous literature on neighborhood determinants of HV program engagement, [13][14][15] we took a step further by evaluating how CHW-delivered HV programs can facilitate program outreach to segregated neighborhoods and provided operational a Neighborhood segregation was measured with year-specific ICE using both income and race/ethnicity at the census tract level, which was averaged across years and divided into quintiles representing from the most segregated neighborhoods with concentrated deprivation (most deprived, Q1) to the most segregated neighborhoods with concentrated privilege (least deprived, Q5).…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…6,7 Recent literature has paid greater attention to place-based disadvantage and neighborhood conditions as drivers of racial health inequities beyond individual risk factors. [8][9][10] Neighborhood segregation is a manifestation of structural racism and perpetuates differences in neighborhood quality and safety. 11,12 Resource deprivation, community violence, and psychological distress related to neighborhood segregation may impose constraints on reaching and retaining eligible individuals in HV.…”

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confidence: 99%

“…Despite these benefits, most eligible individuals do not enroll or stay after enrollment, especially among people of color 6,7. Recent literature has paid greater attention to place-based disadvantage and neighborhood conditions as drivers of racial health inequities beyond individual risk factors 8-10. Neighborhood segregation is a manifestation of structural racism and perpetuates differences in neighborhood quality and safety 11,12.…”

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confidence: 99%

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Community Health Workers: Improving Home Visiting Engagement of High-Risk Birthing People in Segregated Neighborhoods

Yu,

Meghea,

Raffo

et al. 2024

Journal of Public Health Management &Amp; Practice

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Context: Racial and ethnic disparities in perinatal health remain a public health crisis. Despite improved outcomes from home visiting (HV) participation during pregnancy, most eligible individuals of color do not engage. Neighborhood segregation, a manifestation of structural racism, may impose constraints on engaging eligible individuals in HV. Objective: To examine whether race, ethnicity, and/or language-concordant community health workers (CHWs) increased HV engagement for birthing people in segregated neighborhoods. Design: Program evaluation using administrative linked data from birth records, Medicaid claims, and HV program participation. Strong Beginnings (SB), a program with HV provided by CHWs working with nurses and social workers, was compared with the Maternal Infant Health Program (MIHP), a state Medicaid-sponsored HV program without CHW involvement. Data were analyzed using χ2 tests and Poisson regressions. Participants: A total of 4560 individuals with a Medicaid-eligible birth between 2016 and 2019, including 1172 from SB and 3388 from the MIHP. Main Outcome Measures: Penetration (percentage of participants in HV among all Medicaid-eligible individuals across quintiles of neighborhood segregation) and dosage (the total number of home visits from both CHWs and nurses/social workers, and then restricted to those from nurses/social workers). Results: SB penetrated more segregated neighborhoods than the MIHP (58.4% vs 48.3%; P < .001). SB participants received a higher dosage of home visits (mean [SD]: 11.9 [6.1]) than MIHP participants (mean [SD]: 4.4 [2.8], P < .001). Importantly, CHWs did not replace but moderately increased home visits from nurses and social workers (51.1% vs 35.2% with ≥5 intervention visits, P < .001), especially in more segregated neighborhoods. Policy Implication: Community-informed HV models intentionally designed for people facing disparities may help facilitate program outreach to segregated neighborhoods with concentrated deprivation and reduce racial and ethnic disparities. Conclusions: An HV program provided by CHWs working with nurses and social workers was associated with an increase in penetration and dosage in segregated neighborhoods, compared with HV without CHW involvement. This underscores the value of CHWs partnering with licensed professional workers in improving HV engagement in disadvantaged communities.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Community Health Workers: Improving Home Visiting Engagement of High-Risk Birthing People in Segregated Neighborhoods

Yu,

Meghea,

Raffo

et al. 2024

Journal of Public Health Management &Amp; Practice

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“…The Area Deprivation Index (ADI) is one measure used in other pregnancy studies that has been associated with APOs and severe maternal morbidity. [26][27][28] The ADI uses the Neighborhood Atlas to include theoretical domains of income, education, employment, and housing quality in the index. 29 However, the ADI does not include health domains as the COI does.…”

Section: Discussionmentioning

confidence: 99%

The Childhood Opportunity Index's Association with Adverse Pregnancy and Newborn Outcomes in Nulliparous Persons

Abraham,

Jampa,

Quinney

et al. 2023

Am J Perinatol

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Objective: The objective of the study was to determine if using a novel measure of social determinants of health, the Childhood Opportunity Index (COI), at the time of delivery was associated with development of adverse pregnancy outcomes (APO) in nulliparous pregnant persons. Study Design: Data were extracted from the 779 participants from a single nuMoM2b study site, a prospective cohort study designed to identify contributors to APOs. Residential address information at delivery was linked to the location’s COI. The overall composite and component scores in education, health and environmental, and socioeconomic indices were recorded. APOs of interest included preterm birth, hypertensive disorders of pregnancy, small for gestational age at birth, stillbirth, and gestational diabetes. Participant characteristics were compared by COI category and the association of COI with APOs was analyzed by logistic regression, controlling for age and self-reported race/ethnicity. Results: The overall COI distribution was: very low (45%); low (17%), moderate (10%), high (15%), and very high (13%). 329 (43.5%) participants experienced at least one APO. Overall COI was associated with developing an APO (p=0.02). Each component score was also associated with developing APOs and with race/ethnicity (p<0.05). Compared to higher COI categories, an overall low or very low categorized location was independently associated with developing an APO (odds ratio 1.636, 95% confidence interval 1.16-2.31). Adjusting for gestational age at birth, those in lower COI areas had newborns with lower birthweight, birth length, and head circumference (estimate (95% confidence interval)- birthweight: -0.0005g (-0.0008 to -0.0001); length: -0.065cm (-0.124 to -0.0091); head circumference: -0.123cm (-0.208 to -0.045). COI was not associated with other newborn outcomes. Conclusion: COI, a marker for social determinants of health, is independently associated with APOs. The COI may be a tool for risk stratification for pregnant people to help with APO-reducing strategies.

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