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Inequity in US Racial/Ethnic Infant Health and Birth Outcomes: The Role of the Adult Sex Ratio as a Potential Indicator of Structural Anti-Black Racism

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Abstract

Background

Structural racism accounts for inequity in health outcomes in ways that are difficult to measure. To conduct more actionable research and measure the impact of intervention programs, there is a need to develop indicator measures of structural racism. One potential candidate is the Adult Sex Ratio (ASR), which was identified by Du Bois as an important indicator of social life functioning over 100 years ago and has remained significant up to the present day. This study investigated the utility of this measure.

Methods

We compared birth/infant health outcomes using the US 2000 Linked Birth/Infant Death Cohort Data Set matched with 2000 Census data on adult sex ratios in multilevel logistic regression models, stratified by the racial/ethnic category of the mothers.

Results

In an adjusted model, the odds of infant death was 21% higher among non-Hispanic Black (NHB) women living in counties in the lowest ASR tertile category when compared to their counterparts in counties in the highest ASR tertile. Similarly, the odds of giving birth to a preterm or a low birth weight infant were each 20% higher among NHB women living in counties in the lowest ASR tertile compared to their counterparts in counties in the highest ASR tertile.

Conclusion

ASRs may serve as a useful indicator of anti-Black structural racism at the local level. More research is needed to determine the circumstances under which this factor may serve to improve assessment of structural racism and facilitate health equity research.

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Availability of Data and Material

The outcome data are publicly available here: https://www.cdc.gov/nchs/nvss/linked-birth.htm. The Census data are publicly available here: https://www.census.gov/.

Code Availability

The authors will make the code used for the analyses available upon request.

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Funding

This study was made possible, in part, by support from a Distinguished CUNY Scholar Award to E.R.P. to conduct research at The Graduate School and CUNY University Center at the Advanced Research Collaborative. The authors declare that no other funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Health and Nutrition Sciences, Brooklyn College, The City University of New York, 2900 Bedford Avenue, Brooklyn, NY, 11210, USA

    Enrique R. Pouget, Garumma T. Feyissa & Tracy Wong

Authors
  1. Enrique R. Pouget
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  2. Garumma T. Feyissa
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  3. Tracy Wong
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Contributions

E.R.P. performed the analyses and authored the first draft of the manuscript. E.R.P., G.T.F. and T.W. each contributed substantively to multiple drafts in order to develop the final manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Enrique R. Pouget.

Ethics declarations

Ethics Approval

This study used only publicly available deidentified administrative data. Therefore, this research is not considered human subjects research and, as such, approval from an Institutional Review Board was not sought. The study adhered to the Data Release Policy for Vital Statistics Micro-data Files policy of the National Vital Statistics System for data released prior to 2005.

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Not applicable.

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Not applicable.

Conflicts of Interest/Competing Interests

The authors have no relevant financial or non-financial interests to disclose.

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Pouget, E.R., Feyissa, G.T. & Wong, T. Inequity in US Racial/Ethnic Infant Health and Birth Outcomes: The Role of the Adult Sex Ratio as a Potential Indicator of Structural Anti-Black Racism. J. Racial and Ethnic Health Disparities (2024). https://doi.org/10.1007/s40615-024-01984-4

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  • DOI: https://doi.org/10.1007/s40615-024-01984-4

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