ArticleJournal of epidemiology and community health2024
Dynamic changes in place-based measures of structural racism and preterm birth in the USA.
Article in Journal of epidemiology and community health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Allostatic Load, Neighborhood Disadvantage, and Birth Outcomes.Journal of racial and ethnic health disparities · 2026Article
- Economic connectedness and fetal and infant death: a population-based cross-sectional study of California.Journal of epidemiology and community health · 2026Article
- Stillbirths and the race-specific gap in neonatal death among extremely preterm births.Scientific reports · 2025Article
- Economic connectivity and clustering: The influence of social connections on maternal and infant health.SSM - population health · 2025Article
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8 authors.
Funding
Abstract
backgroundStructurally racist systems, ideologies and processes generate and reinforce inequities among minoritised racial/ethnic groups. Prior cross-sectional literature finds that place-based structural racism, such as the Index of Concentration at the Extremes (ICE), correlates with higher infant morbidity and mortality. We move beyond cross-sectional approaches and examine whether a decline in place-based structural racism over time coincides with a reduced risk of preterm birth across the USA.
methodsWe used as the outcome count of preterm births overall and among non-Hispanic (NH) black and NH white populations across three epochs (1998-2002, 2006-2010, 2014-2018) in 1160 US counties. For our measure of structural racism, we used ICE race/income county measures from the US Census Bureau. County-level fixed effects Poisson models include a population offset (number of live births) and adjust for epoch indicators, per cent poverty and mean maternal age within counties.
resultsAn SD increase in ICE (0.11) over time corresponds with a 0.6% reduced risk of preterm birth overall (incidence rate ratio (IRR): 0.994, 95% CI 0.990, 0.998), a 0.6% decrease in preterm risk among NH black births (IRR: 0.994, 95% CI 0.989, 0.999) and a 0.4% decrease among NH white births (IRR: 0.996, 95% CI 0.992, 0.999).
conclusionsMovement away from county-level concentrated NH black poverty preceded reductions in preterm risk, especially among NH black populations. Our longitudinal design strengthens inference that place-based reductions in structural racism may improve perinatal health. These improvements, however, do not appear sufficient to redress large disparities.
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