Skip to main content

Advertisement

SpringerLink
Log in

Testing the Association Between Traditional and Novel Indicators of County-Level Structural Racism and Birth Outcomes among Black and White Women

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Despite decreases in infants born premature and at low birth weight in the United States (U.S.), racial disparities between Black and White women continue. In response, the purpose of this analysis was to examine associations between both traditional and novel indicators of county-level structural racism and birth outcomes among Black and White women. We merged individual-level data from the California Birth Statistical Master Files 2009–2013 with county-level data from the United States (U.S.) Census American Community Survey. We used hierarchical linear modeling to examine Black-White differences among 531,170 primiparous women across 33 California counties. Traditional (e.g., dissimilarity index) and novel indicators (e.g., Black to White ratio in elected office) were associated with earlier gestational age and lower birth weight among Black and White women. A traditional indicator was more strongly associated with earlier gestational age for Black women than for White women. This was the first study to empirically demonstrate that structural racism, measured by both traditional and novel indicators, is associated with poor health and wellbeing of infants born to Black and White women. However, findings indicate traditional indicators of structural racism, rather than novel indicators, better explain racial disparities in birth outcomes. Results also suggest the need to develop more innovative approaches to: (1) measure structural racism at the county-level and (2) reform public policies to increase integration and access to resources.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Preterm Birth United States | PeriStats | March of Dimes. http://www.marchofdimes.org/Peristats/ViewTopic.aspx?reg=99&top=3&lev=0&slev=1. Accessed June 29, 2017.

  2. Nuru-Jeter A, Dominguez TP, Hammond WP, et al. It’s the skin you’re in: African-American women talk about their experiences of racism. An exploratory study to develop measures of racism for birth outcome studies. Matern Child Health J. 2009;13(1):29. https://doi.org/10.1007/s10995-008-0357-x.

    Article  PubMed  Google Scholar 

  3. Infant Mortality | Maternal and Infant Health | Reproductive Health | CDC. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm. Accessed August 3, 2017.

  4. Braveman PA, Heck K, Egerter S, et al. The role of socioeconomic factors in black–white disparities in preterm birth. Am J Public Health. 2015;105(4):694–702.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Colen CG, Geronimus AT, Bound J, James SA. Maternal upward socioeconomic mobility and Black–White disparities in infant birthweight. Am J Public Health. 2006;96(11):2032–9.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Beck LF, Morrow B, Lipscomb LE, et al. Prevalence of selected maternal behaviors and experiences, Pregnancy Risk Assessment Monitoring System (PRAMS). Morb Mortal Wkly Rep CDC Surveill Summ. 1999, 2002;51(2) http://www.cdc.gov/mmWr/preview/mmwrhtml/ss5102a1.htm. Accessed March 5, 2017

  7. Ebrahim SH, Floyd RL, Merritt RK II, Decoufle P, Holtzman D. Trends in pregnancy-related smoking rates in the United States, 1987-1996. JAMA. 2000;283(3):361–6.

    Article  CAS  PubMed  Google Scholar 

  8. Giscombé CL, Lobel M. Explaining disproportionately high rates of adverse birth outcomes among African Americans: the impact of stress, racism, and related factors in pregnancy. Psychol Bull. 2005;131(5):662–83. https://doi.org/10.1037/0033-2909.131.5.662.

    Article  PubMed  Google Scholar 

  9. Wadhwa PD, Entringer S, Buss C, Lu MC. The contribution of maternal stress to preterm birth: issues and considerations. Clin Perinatol. 2011;38(3):351–84. https://doi.org/10.1016/j.clp.2011.06.007.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Heslehurst N, Simpson H, Ells LJ, et al. The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis. Obes Rev. 2008;9(6):635–83.

    Article  CAS  Google Scholar 

  11. Premkumar A, Henry DE, Moghadassi M, Nakagawa S, Norton ME. The interaction between maternal race/ethnicity and chronic hypertension on preterm birth. Am J Obstet Gynecol. 2016;215(6):787–e1.

    Article  PubMed  Google Scholar 

  12. Partridge S, Balayla J, Holcroft CA, Abenhaim HA. Inadequate prenatal care utilization and risks of infant mortality and poor birth outcome: a retrospective analysis of 28,729,765 U.S. deliveries over 8 years. Am J Perinatol. 2012;29(10):787–94. https://doi.org/10.1055/s-0032-1316439.

    Article  PubMed  Google Scholar 

  13. Xaverius P, Alman C, Holtz L, Yarber L. Risk factors associated with very low birth weight in a large urban area, stratified by adequacy of prenatal care. Matern Child Health J. 2016;20(3):623–9. https://doi.org/10.1007/s10995-015-1861-4.

    Article  PubMed  Google Scholar 

  14. Bell JF, Zimmerman FJ, Almgren GR, Mayer JD, Huebner CE. Birth outcomes among urban African-American women: a multilevel analysis of the role of racial residential segregation. Soc Sci Med. 2006;63(12):3030–45.

    Article  PubMed  Google Scholar 

  15. Grady SC. Racial disparities in low birthweight and the contribution of residential segregation: a multilevel analysis. Soc Sci Med. 2006;63(12):3013–29.

    Article  PubMed  Google Scholar 

  16. Grady SC. Racial residential segregation impacts on low birth weight using improved neighborhood boundary definitions. Spat Spatio-Temporal Epidemiol. 2010;1(4):239–49.

    Article  Google Scholar 

  17. Grady SC, Ramírez IJ. Mediating medical risk factors in the residential segregation and low birthweight relationship by race in New York City. Health Place. 2008;14(4):661–77. https://doi.org/10.1016/j.healthplace.2007.10.011.

    Article  PubMed  Google Scholar 

  18. Kramer MR, Cooper HL, Drews-Botsch CD, Waller LA, Hogue CR. Metropolitan isolation segregation and Black–White disparities in very preterm birth: a test of mediating pathways and variance explained. Soc Sci Med. 2010;71(12):2108–16. https://doi.org/10.1016/j.socscimed.2010.09.011.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mason SM, Messer LC, Laraia BA, Mendola P. Segregation and preterm birth: the effects of neighborhood racial composition in North Carolina. Health Place. 2009;15(1):1–9. https://doi.org/10.1016/j.healthplace.2008.01.007.

    Article  PubMed  Google Scholar 

  20. Messer LC, Kaufman JS, Dole N, Savitz DA, Laraia BA. Neighborhood crime, deprivation, and preterm birth. Ann Epidemiol. 2006;16(6):455–62.

    Article  Google Scholar 

  21. Wallace ME, Mendola P, Liu D, Grantz KL. Joint effects of structural racism and income inequality on small-for-gestational-age birth. J Inf. 2015;105(8) https://doi.org/10.2105/AJPH.2015.302613. Accessed March 7, 2017

    Article  PubMed  PubMed Central  Google Scholar 

  22. Britton ML, Shin H. Metropolitan residential segregation and very preterm birth among African American and Mexican-origin women. Soc Sci Med. 2013;98:37–45.

    Article  PubMed  Google Scholar 

  23. Messer LC, Oakes JM, Mason S. Effects of socioeconomic and racial residential segregation on preterm birth: a cautionary tale of structural confounding. Am J Epidemiol. 2010;171(6):664–73.

    Article  Google Scholar 

  24. Massey DS, Denton NA. The dimensions of residential segregation. Soc Forces. 1988;67(2):281–315. https://doi.org/10.1093/sf/67.2.281.

    Article  Google Scholar 

  25. Massey DS, Denton NA. Hypersegregation in U.S. metropolitan areas: black and Hispanic segregation along five dimensions. Demography. 1989;26(3):373–91. https://doi.org/10.2307/2061599.

    Article  CAS  PubMed  Google Scholar 

  26. Riley AR. Neighborhood disadvantage, residential segregation, and beyond—lessons for studying structural racism and health. J Racial Ethn Health Disparities. 2017:1–9. https://doi.org/10.1007/s40615-017-0378-5.

    Article  PubMed  Google Scholar 

  27. Kramer MR, Hogue CR. Is segregation bad for your health? Epidemiol Rev. 2009;31(1):178–94. https://doi.org/10.1093/epirev/mxp001.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Krieger N. Epidemiology and the web of causation: has anyone seen the spider? Soc Sci Med. 1994;39(7):887–903.

    Article  CAS  Google Scholar 

  29. Krieger N. Theories for social epidemiology in the 21st century: an ecosocial perspective. Int J Epidemiol. 2001;30(4):668–77.

    Article  CAS  PubMed  Google Scholar 

  30. Krieger N. 11 the science and epidemiology of racism and health: racial/ethnic categories, biological expressions of racism, and the embodiment of inequality—an ecosocial perspective. Whats Use Race Mod Gov Biol Differ. 2010;225

  31. Krieger N. Epidemiology and the people’s health: theory and context. Oxford University Press; 2011. https://books.google.com/books?hl=en&lr=&id=Z59ciXRRaPsC&oi=fnd&pg=PP2&dq=Epidemiology+and+the+people%27s+health:+theory+and+context.+&ots=KyQ3wgbgey&sig=Fs7IftamyNjcOGlrjxd7dAd30HI. Accessed March 5, 2017.

  32. Krieger N. Methods for the scientific study of discrimination and health: an ecosocial approach. Am J Public Health. 2012;102(5):936–44.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Elo IT, Culhane JF, Kohler IV, et al. Neighbourhood deprivation and small-for-gestational-age term births in the United States. Paediatr Perinat Epidemiol. 2009;23(1):87–96.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Janevic T, Stein CR, Savitz DA, Kaufman JS, Mason SM, Herring AH. Neighborhood deprivation and adverse birth outcomes among diverse ethnic groups. Ann Epidemiol. 2010;20(6):445–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. O’Campo P, Burke JG, Culhane J, et al. Neighborhood deprivation and preterm birth among non-Hispanic Black and White women in eight geographic areas in the United States. Am J Epidemiol. 2008;167(2):155–63. https://doi.org/10.1093/aje/kwm277.

    Article  PubMed  Google Scholar 

  36. Dominguez TP. Adverse birth outcomes in African American women: the social context of persistent reproductive disadvantage. Soc Work Public Health. 2010;26(1):3–16.

    Article  Google Scholar 

  37. Lukachko A, Hatzenbuehler ML, Keyes KM. Structural racism and myocardial infarction in the United States. Soc Sci Med. 2014;103:42–50. https://doi.org/10.1016/j.socscimed.2013.07.021.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Jones CP. Invited commentary:“race,” racism, and the practice of epidemiology. Am J Epidemiol. 2001;154(4):299–304.

    Article  CAS  Google Scholar 

  39. Smedley A, Smedley BD. Race as biology is fiction, racism as a social problem is real: anthropological and historical perspectives on the social construction of race. Am Psychol. 2005;60(1):16.

    Article  Google Scholar 

  40. West C. A Genealogy of Modern Racism. na; 2002. http://www.geraldbivens.com/rd/west-genealogy-of-modern-racism.pdf. Accessed March 8, 2017.

  41. Bird ST. Separate black and white infant mortality models: differences in the importance of structural variables. Soc Sci Med. 1995;41(11):1507–12.

    Article  CAS  PubMed  Google Scholar 

  42. Massey DS, Rothwell J, Domina T. The changing bases of segregation in the United States. Ann Am Acad Pol Soc Sci. 2009;626(1):74–90.

    Article  Google Scholar 

  43. Bambhroliya AB, Burau KD, Sexton K. Spatial analysis of county-level breast cancer mortality in Texas. J Environ Public Health. 2012;2012 https://www.hindawi.com/journals/jeph/2012/959343/abs/. Accessed March 5, 2017

  44. Gutnik LA, Castro MC. Does spatial access to mammography have an effect on early stage of breast cancer diagnosis? A county-level analysis for New York state. Breast J. 2016;22(1):127–30. https://doi.org/10.1111/tbj.12530.

    Article  PubMed  Google Scholar 

  45. Hipp JA. Spatial analysis and correlates of county-level diabetes prevalence, 2009–2010. Prev Chronic Dis. 2015;12 https://doi.org/10.5888/pcd12.140404.

  46. Jia H, Moriarty DG, Kanarek N. County-level social environment determinants of health-related quality of life among US adults: a multilevel analysis. J Community Health. 2009;34(5):430–9. https://doi.org/10.1007/s10900-009-9173-5.

    Article  PubMed  Google Scholar 

  47. Sommers BD, Chua K-P, Kenney GM, Long SK, McMorrow S. California’s early coverage expansion under the affordable care act: a county-level analysis. Health Serv Res. 2015; https://doi.org/10.1111/1475-6773.12397/pdf. Accessed March 7, 2017

  48. California State Association of Counties. County Structure & Powers. California State Association of Counties. http://www.counties.org/general-information/county-structure-0. Accessed March 6, 2017.

  49. Nyarko KA, Wehby GL. Residential segregation and the health of African-American infants: does the effect vary by prevalence? Matern Child Health J. 2012;16(7):1491–9. https://doi.org/10.1007/s10995-011-0915-5.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Kotelchuck M. An evaluation of the Kessner adequacy of prenatal care index and a proposed adequacy of prenatal care utilization index. Am J Public Health. 1994;84(9):1414–20. https://doi.org/10.2105/AJPH.84.9.1414.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Brumberg HL, Shah SI. Born early and born poor: an eco-bio-developmental model for poverty and preterm birth. J Neonatal-Perinat Med. 2015;8(3):179–87.

    Article  CAS  Google Scholar 

  52. Wallace M, Harville E, Theall K, Webber L, Chen W, Berenson G. Neighborhood poverty, allostatic load, and birth outcomes in African American and white women: findings from the Bogalusa Heart Study. Health Place. 2013;24:260–6.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Debbink MP, Bader MD. Racial residential segregation and low birth weight in Michigan’s metropolitan areas. Am J Public Health. 2011;101(9):1714–20.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Halfon N, Hochstein M. Life course health development: an integrated framework for developing health, policy, and research. Milbank Q. 2002;80(3):433–79.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Kotelchuck M. Editorial: building on a life-course perspective in maternal and child health. Matern Child Health J. 2003;7(1):5–11.

    Article  PubMed  Google Scholar 

  56. Lu MC, Kotelchuck M, Hogan V, Jones L, Wright K, Halfon N. Closing the black-white gap in birth outcomes: a life-course approach. Ethn Dis. 2010;20(1 0 2):S2.

    PubMed  PubMed Central  Google Scholar 

  57. Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective. Matern Child Health J. 2003;7(1):13–30.

    Article  Google Scholar 

  58. Dominguez TP. Race, racism, and racial disparities in adverse birth outcomes. Clin Obstet Gynecol. 2008;51(2):360–70.

    Article  PubMed  Google Scholar 

  59. Earnshaw VA, Rosenthal L, Lewis JB, et al. Maternal experiences with everyday discrimination and infant birth weight: a test of mediators and moderators among young, urban women of color. Ann Behav Med Publ Soc Behav Med. 2013;45(1):13–23. https://doi.org/10.1007/s12160-012-9404-3.

    Article  Google Scholar 

  60. Slaughter-Acey JC, Sealy-Jefferson S, Helmkamp L, et al. Racism in the form of micro aggressions and the risk of preterm birth among black women. Ann Epidemiol. 2016;26(1):7–13.

    Article  Google Scholar 

  61. Acevedo-Garcia D, Lochner KA, Osypuk TL, Subramanian SV. Future directions in residential segregation and health research: a multilevel approach. Am J Public Health. 2003;93(2):215–21.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Charles CZ. The dynamics of racial residential segregation. Annu Rev Sociol. 2003;29(1):167–207.

    Article  Google Scholar 

  63. Jargowsky PA. Poverty and place: ghettos, barrios, and the American city. Russell Sage Foundation; 1997.

    Google Scholar 

  64. Massey DS, Denton NA. American Apartheid: Segregation and the Making of the Underclass: Harvard University Press; 1993.

Download references

Author information

Authors and Affiliations

  1. UCSF Preterm Birth Initiative- California, University of California, San Francisco, San Francisco, CA, USA

    Brittany D. Chambers

  2. Department of Public Health Education, University of North Carolina, Greensboro, Greensboro, NC, USA

    Jennifer Toller Erausquin, Amanda E. Tanner & Tracy R. Nichols

  3. Department of Sociology, University of North Carolina, Greensboro, Greensboro, NC, USA

    Shelly Brown-Jeffy

Authors
  1. Brittany D. Chambers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer Toller Erausquin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amanda E. Tanner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tracy R. Nichols
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shelly Brown-Jeffy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brittany D. Chambers.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chambers, B.D., Erausquin, J.T., Tanner, A.E. et al. Testing the Association Between Traditional and Novel Indicators of County-Level Structural Racism and Birth Outcomes among Black and White Women. J. Racial and Ethnic Health Disparities 5, 966–977 (2018). https://doi.org/10.1007/s40615-017-0444-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-017-0444-z

Keywords

Search

Navigation