title: Joint Effects of Structural Racism and Income Inequality on Small-for-Gestational-Age Birth.
abstract: OBJECTIVE
  We examined potential synergistic effects of racial and socioeconomic inequality associated with small-for-gestational-age (SGA) birth.
  
  
  METHODS
  Electronic medical records from singleton births to White and Black women in 10 US states and the District of Columbia (n = 121 758) were linked to state-level indicators of structural racism, including the ratios of Blacks to Whites who were employed, were incarcerated, and had a bachelor's or higher degree. We used state-level Gini coefficients to assess income inequality. Generalized estimating equations models were used to quantify the adjusted odds of SGA birth associated with each indicator and the joint effects of structural racism and income inequality.
  
  
  RESULTS
  Structural racism indicators were associated with higher odds of SGA birth, and similar effects were observed for both races. The joint effects of racial and income inequality were significantly associated with SGA birth only when levels of both were high; in areas with high inequality levels, adjusted odds ratios ranged from 1.81 to 2.11 for the 3 structural racism indicators.
  
  
  CONCLUSIONS
  High levels of racial inequality and socioeconomic inequality appear to increase the risk of SGA birth, particularly when they co-occur.
authors.affiliation: The authors are with the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD.
authors.forename: Maeve E
authors.initials: ME
authors.lastname: Wallace
authors.affiliation: The authors are with the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD.
authors.forename: Pauline
authors.initials: P
authors.lastname: Mendola
authors.affiliation: The authors are with the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD.
authors.forename: Danping
authors.initials: D
authors.lastname: Liu
authors.affiliation: The authors are with the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Grantz
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007182:Income; D007236:Infant, Small for Gestational Age; D063505:Racism; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult