Abstract
Objectives
Social and contextual factors underlying the continually disproportionate and burdensome risk of adverse health outcomes experienced by Black women in the US are underexplored in the literature. The aim of this study was to use an index based on area-level population distributions of race and income to predict risk of death during pregnancy and up to 1 year postpartum among women in Louisiana.
Methods
Using vital records data provided by the Louisiana Department of Health 2016–2017 (n = 125,537), a modified Poisson model was fit with generalized estimating equations to examine the risk of pregnancy-associated death associated with census tract-level values of the Index of Concentration at the Extremes (ICE)—grouped by tertile—while adjusting for both individual and tract-level confounders.
Results
Analyses resulted in an estimated 1.73 (95% CI 1.02–2.93) times increased risk for pregnancy-associated death for those in areas which were characterized by concentrated deprivation (high proportions of Black and low-income residents) relative to those in areas of concentrated privilege (high proportions of white and high-income residents), independent of other factors.
Conclusions for Practice
In addition to continuing to consider the deeply entrenched racism and economic inequality that shape the experience of pregnancy-associated death, we must also consider their synergistic effect on access to resources, maternal population health, and health inequities.
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Funding
This work was supported by the National Institute of Child Health and Human Development Grant Numbers R01HD092653 and R01HD096070. The funding source had no involvement in the conduct of the research or preparation of the article. Its contents are solely the responsibility of the authors and do not necessarily represent the official position of the National Institutes of Health or the Louisiana Department of Health.
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LD conceived the study. LD and MW conducted and interpreted the analysis. BC, JP, and KT interpreted the analysis and were major contributors in writing the manuscript. All authors read, contributed to, and agreed to the final version of the manuscript prior to submission. The authors would also like to acknowledge Dr. Kate Babineau for her assistance with data visualization for Fig. 1.
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As all data were deidentified, this study was deemed exempt the Tulane University Institutional Review Board.
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Dyer, L., Chambers, B.D., Crear-Perry, J. et al. The Index of Concentration at the Extremes (ICE) and Pregnancy-Associated Mortality in Louisiana, 2016–2017. Matern Child Health J 26, 814–822 (2022). https://doi.org/10.1007/s10995-021-03189-1
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DOI: https://doi.org/10.1007/s10995-021-03189-1