Metropolitan isolation segregation and Black-White disparities in very preterm birth: a test of mediating pathways and variance explained.
Residential isolation segregation (a measure of residential inter-racial exposure) has been associated with rates of preterm birth (<37 weeks gestation) experienced by Black women. Epidemiologic differences between very preterm (<32 weeks gestation) and moderately preterm births (32-36 weeks) raise questions about whether this association is similar across gestational ages, and through what pathways it might be mediated. Hierarchical Bayesian models were fit to answer three questions: is the isolation-prematurity association similar for very and moderately preterm birth; is this association mediated by maternal chronic disease, socioeconomic status, or metropolitan area crime and poverty rates; and how much of the geographic variation in Black-White very preterm birth disparities is explained by isolation segregation? Singleton births to Black and White women in 231 U.S. metropolitan statistical areas in 2000-2002 were analyzed and isolation segregation was calculated for each. We found that among Black women, isolation is associated with very preterm birth and moderately preterm birth. The association may be partially mediated by individual level socioeconomic characteristics and metropolitan level violent crime rates. There is no association between segregation and prematurity among White women. Isolation segregation explains 28% of the geographic variation in Black-White very preterm birth disparities. Our findings highlight the importance of isolation segregation for the high-burden outcome of very preterm birth, but unexplained excess risk for prematurity among Black women is substantial.
Emory University, Epidemiology, Atlanta, GA 30322, USA. mkram02@emory.edu
Michael R
MR
Kramer
Hannah L
HL
Cooper
Carolyn D
CD
Drews-Botsch
Lance A
LA
Waller
Carol R
CR
Hogue
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D001499:Bayes Theorem; D005260:Female; D005865:Gestational Age; D054624:Health Status Disparities; D006801:Humans; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology*; D012111:Residence Characteristics; D012307:Risk Factors; D012931:Social Environment; D012934:Social Isolation; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult