A new study suggests that neighborhoods with fewer educational, health, environmental, and socioeconomic resources may increase the risk of preterm birth and contribute to the racial gap in preterm birth in the Commonwealth.
Preterm birth, defined as the birth of a live baby before 37 weeks of pregnancy, is the second-leading cause of infant mortality in the United States and disproportionately affects Black and Hispanic women. While individual factors such as poverty, age and health status may contribute to racial or ethnic disparities in preterm birth, researchers believe there are broader structural challenges that may be driving the racial gap in this common birth complication.
A new study led by the Boston University School of Public Health (BUSPH) examined preterm births in Massachusetts, where 1 in 11 live births are premature, and found that social characteristics of a birthing parent’s neighborhood are associated with their risk of experiencing a preterm birth.
Posted in JAMA Network OpenThe study found that more than half of black and Hispanic babies were born in neighborhoods with very low opportunities and that babies born in these neighborhoods had a 16 percent higher risk of being born preterm. Researchers assessed neighborhood opportunity level based on a variety of educational, health, environmental, and socioeconomic characteristics identified in the Childhood Opportunity Index (COI), a widely used composite measure that currently includes 44 indicators per census tract.
The study sheds new light on the health consequences of structural racism and historically discriminatory practices (such as residential segregation and disproportionate exposure to pollutants) that continue to shape the conditions and circumstances of today’s neighborhoods. Because social opportunities in neighborhoods are unequally distributed by race and ethnicity, the COI serves as a valuable measure of historical and current structural racism, the researchers say.
“Our findings suggest that the context of social opportunity impacts children’s health even before they are born, and may be partly a driver of persistent racial and ethnic disparities in preterm birth,” said study leader and corresponding author Dr. Candice Belanoff, clinical assistant professor of community health sciences at BUSPH. “The effect persisted after controlling for factors such as maternal and parental health at birth and individual social position.”
Dr. Belanoff and colleagues at BUSPH, Simmons SSW, the University of Illinois, Chicago (UIC), and Brandeis University (Brandeis) used Massachusetts birth certificate data by census tract for more than 260,000 singleton infants born in the Boston, Springfield, and Worcester metropolitan areas from February 2011 to December 2015 to explore possible links between neighborhood opportunity levels and preterm births.
Premature birth was highest among black infants at 8.4 percent, followed by Hispanic infants at 7.3 percent, Asian or Pacific Islander infants at 5.8 percent, and white infants at 5.8 percent. Compared with white and Asian or Pacific Islander infants, black and Hispanic infants were about 54 percent more likely to be born in neighborhoods with very low opportunities for children, compared with white infants (11.8 percent) and Asian or Pacific Islander infants (19.6 percent). Similarly, black and Hispanic infants were also less likely to be born in neighborhoods with very high opportunities for children, at 6 percent and 6.7 percent, respectively.
“While many low-opportunity neighborhoods are rich cultural centers and places of incredible activism and community power, they still suffer from the effects of economic exclusion, are still more exposed to toxic environments, and overall still have fewer resources that help people thrive throughout their lives,” says Dr. Belanoff.
“That’s why it’s important to look beyond the individual if we want to reduce or eliminate the racial/ethnic gap in birth outcomes,” said senior study author Dr. Joanna Almeida, professor and Eva Whiting White Chair at Simmons SSW. “We need to address the unequal distribution of resources and access to opportunities in neighborhoods to make progress in combating racial and ethnic disparities in preterm birth.”