Evidence map›Paper›PMID 40147332›Full record

ArticleSocial science & medicine (1982)2025

A multidimensional tool for quantifying structural racism: Application to adverse pregnancy outcomes in Chicago, Illinois.

Alexa A Freedman, Lauren S Keenan-Devlin, Britney P Smart, Renee M Odom-Konja, Shanti U Gallivan, Andrew D Franklin, Amy H Crockett, Linda M Ernst, Ann Borders, Gregory E Miller

Abstract read
In one paragraph

Article in Social science & medicine (1982), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Alexa A FreedmanDepartment of Preventive Medicine, Northwestern University Feinberg School of Medicine, United States. Electronic address: alexa.freedman@northwestern.edu.
Lauren S Keenan-DevlinDepartment of Obstetrics and Gynecology, Endeavor Health, University of Chicago, Pritzker School of Medicine, United States.
Britney P SmartDepartment of Obstetrics and Gynecology, Endeavor Health, United States.
Renee M Odom-KonjaDepartment of Obstetrics and Gynecology, Endeavor Health, United States.
Shanti U GallivanInstitute for Policy Research, Northwestern University, United States.
Andrew D FranklinDepartment of Pediatrics, Endeavor Health, University of Chicago, Pritzker School of Medicine, United States; Department of Pediatrics, Advocate Aurora Health, United States.
Amy H CrockettDepartment of Obstetrics and Gynecology, Prisma Health, University of South Carolina School of Medicine, United States.
Linda M ErnstDepartment of Pathology and Laboratory Medicine, Endeavor Health, University of Chicago, Pritzker School of Medicine, United States.
Ann BordersDepartment of Obstetrics and Gynecology, Endeavor Health, University of Chicago, Pritzker School of Medicine, United States; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, United States; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, United States.
Gregory E MillerInstitute for Policy Research, Northwestern University, United States; Department of Psychology, Northwestern University, United States.

Funding

The impact of structural racism and discrimination on perinatal health during the COVID-19 pandemicR01HD092446 · NICHD · ENDEAVOR HEALTH CLINICAL OPERATIONS · PI BORDERS, ANN E.B., CROCKETT, AMY HAIRSTON · 2018 to 2022
$3.9M
Placental contributions to disparities in offspring cardiovascular health across the life courseK01HL165038 · NHLBI · NORTHWESTERN UNIVERSITY AT CHICAGO · PI Alexa Freedman · 2023 to 2026
$524k
NHLBI NIH HHS K01 HL165038NICHD NIH HHS R01 HD092446
6 · The paper itself

Abstract

Understanding the relationship between structural racism and health is essential for identifying practice- and policy-based interventions to reduce health inequities. We developed neighborhood-based measures of structural racism and tested their associations with adverse pregnancy outcomes, health outcomes characterized by some of the most pronounced racial inequities. We leveraged electronic health records from 89,410 pregnant patients at six Chicago-area hospitals. Patients were linked with neighborhood exposure to 22 experiences reflective of structural racism based on home address, geocoded to the census tract. Measures were summarized into six domains identified as salient to Black women in the literature: law enforcement, housing, medical, employment, education, and community infrastructure. The primary outcome was preterm birth and models were stratified by race and ethnicity. After adjustment for neighborhood socioeconomic status, Black patients in neighborhoods with unfavorable law enforcement practices and school characteristics were more likely to deliver preterm (law RR: 1.07; 95 % CI: 1.02, 1.12; education RR: 1.08; 95 % CI: 1.03, 1.14). This study developed an approach for quantifying multiple domains of structural racism and illustrated its value in the context of preterm birth risk among Black patients.

Indexed as

Pregnancy OutcomePremature BirthRacial GroupsRacismAdultBlack or African AmericanChicagoFemaleHumansNeighborhood CharacteristicsPregnancyResidence CharacteristicsPreterm birthStructural racism

Identifiers

PMID40147332
PMCPMC12011194

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.