A Comparison of MSA/Rural Residence and Rural Racial Segregation in the Risk of Preterm Birth in Georgia Público

Abstract

Preterm birth (PTB) is currently on the rise in the United States and is estimated to occur in
twice as many black births as white births. Individual maternal characteristics and neighborhood
level characteristics have been shown to alter the effect of race on preterm birth. Comparisons of
urban and rural residence with preterm birth are not prominent in the literature, and no existing
literature analyzes the patterns of racial segregation in the association of preterm birth and race. The
purpose of this study was to evaluate the risk of preterm birth for rural mothers compared to
mothers in Metropolitan and Micropolitan Statistical Areas (MSA). A secondary goal was to evaluate
the association of preterm birth with two measures of segregation, dissimilarity and isolation, among
rural residents. Individual-level birth records for births to non-Hispanic white women and non-
Hispanic black women in Georgia from 1998 to 2002 were merged with MSA and county level
segregation measures that were derived from census data. A logistic regression model of preterm
birth with MSA/Rural Residence that included the maternal characteristics, neighborhood level
characteristics, as well as interaction terms of the covariates with MSA/Rural Residence was analyzed
to address the primary study question. For the secondary purpose, a logistic model of preterm birth
with isolation, dissimilarity, the maternal characteristics, neighborhood level characteristics, and
interaction terms for isolation and dissimilarity with race was analyzed using a restricted cohort of
rural mothers. For aim 1, black women in the rural counties were at a higher risk of preterm birth
than their white neighbors and black women in MSAs. The opposite effect was true for white
women with the risk of preterm birth higher among women in MSAs. For aim 2, as isolation
increases and dissimilarity is held constant, there is an increase in the risk of preterm birth for black
women in the rural cohort. For white women, the risk of preterm birth actually decreases when
controlling for dissimilarity and increasing isolation. Birth outcomes are not well studied among rural
women and further studies are needed to better understand the effects of rural residence on birth
outcomes.

Table of Contents

Table of Contents

I.Introduction
II.Background
III.Methods
IV.Results
V.Discussion
VI.Strengths and Weaknesses
VII.Future Directions
VIII. References
IX.Tables
1. Table 1. Descriptive statistics for categorical variables stratified by residence in a
MSA or rural county
2. Table 2. Descriptive statistics for MSA residents stratified by race
3. Table 3. Descriptive statistics for rural county residents stratified by race
4. Table 4. Descriptive statistics for continuous variables stratified by residence in a
MSA or rural county
5. Table 5. Descriptive statistics for continuous variables restricted to preterm births
and stratified by residence in a MSA or rural county
6. Table 6. Descriptive statistics for continuous variables stratified by residence in a
MSA or rural county and race
7. Table 7. Descriptive statistics for continuous variables restricted to preterm births
stratified by residence in a MSA or rural county and race
8. Table 8. Logistic regression results for Crude Model 1 and Model 1
9. Table 9. Odds ratio estimates for Model 1
10. Table 10. Logistic regression results for Crude Model 2 and Model 2
11. Table 11. Odds ratio estimates comparing changes in isolation and dissimilarity for
black and white women in rural Georgia counties (Model 2).
12. Table 12. Odds ratio estimates for comparing black and white mothers in rural
Georgia counties (Model 2).

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Palabra Clave	Birth Outcomes Racial Segregation Urban/Rural
Committee Chair / Thesis Advisor	Kramer, Michael R, Emory University
Partnering Agencies	Georgia state or local health department

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