title: The effects of racial density and income incongruity on pregnancy outcomes.
abstract: This study shows that living in a better area reduces the risk of adverse pregnancy outcomes but, among African-American women, living in an area in which they are in a racial minority may increase the risk. Using the 1991 cohort of single infants born to African-American women in Chicago, we measured census tract socioeconomic status and defined women as having "positive income incongruity" if they lived in wealthier tracts than the average African-American woman of comparable education and marital status. We examined whether or not the effect of positive income incongruity differed according to whether or not African-American women lived in predominantly black, or mixed tracts. Among the women living in predominantly black census tracts, positive income incongruity was associated with a lower risk of low birth weight (odds ratio (OR)=0.91) and preterm delivery (OR=0.83). These effects were modest, but statistically significant for gestation (p-value=0.01). In contrast, among the women living in mixed tracts positive income incongruity was not associated with low birth weight (OR=1.04) or preterm delivery (OR=1.11). In mixed areas the expected benefits of positive income incongruity are completely offset by the racial density effect, suggesting that the positive effects of a better socioeconomic context may be countered for minority women by the adverse effects of racism or racial stigma.
authors.affiliation: Department of Health Sciences, University of York, Seebohm Rowntree Building, Room A/TB/220, Heslington, York YO10 5DD, UK. kp6@york.ac.uk
authors.forename: Kate E
authors.initials: KE
authors.lastname: Pickett
authors.forename: James W
authors.initials: JW
authors.lastname: Collins
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Masi
authors.forename: Richard G
authors.initials: RG
authors.lastname: Wilkinson
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D002641:Chicago / Q000453:epidemiology; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D011156:Population Density; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000191:economics* / Q000208:ethnology*; D047928:Premature Birth / Q000191:economics / Q000208:ethnology; D012111:Residence Characteristics / Q000145:classification*; D012307:Risk Factors; D012923:Social Class; D012959:Socioeconomic Factors