Revealing the Variations in Impact of Economic Segregation on Preterm Birth Among Disaggregated Asian Ethnicities across MSAs in the United States: 2015-2017 Public
Quan, Nathan (Spring 2020)
Published
Abstract
Background: Preterm birth (PTB) accounts for the majority of perinatal morbidity and mortality in developed nations, accounting for 9.63% of all births in the U.S. in 2016. Prior research has been conducted to evaluate the effects of residential segregation, specifically economic segregation, on the risk for preterm birth. Prior research has also evaluated disparities in PTB risk between Black and non-Hispanic White mothers, but no research has been conducted examining the fastest growing population in the U.S., Asian- Americans. This analysis examines how economic segregation modifies risk for PTB among various Asian ethnic groups.
Methods: U.S. natality data were used to identify 134 Metropolitan Statistical Areas (MSA) with greater than 500 Asian births from 2015-2017 (n=766,711). Economic segregation was calculated for each MSA using 2017 income data with the Rank-Order Information Theory Index (H Index). Generalized Estimating Equations were used to assess the association between economic segregation and PTB, allowing for modification by ethnicity and controlling for individual-level risk factors.
Results: This study suggests that there is clear heterogeneity of outcomes by ethnicity and that the effect of economic segregation is non-linear. The risk for PTB follows an upwards opening parabolic relationship as standardized H Index increases for Chinese, Filipino, Japanese, Korean, Vietnamese, and Other Pacific Islander mothers. The risk for PTB follows a downwards opening parabolic relationship as standardized H Index increases for Indian, Hawaiian, Guamanian, and Samoan mothers. Out of the ethnic groups evaluated, Filipino, Hawaiian, Guamanian, and Other Pacific Islander mothers had the highest predicted risk for PTB at mean levels of economic segregation while Chinese mothers had the lowest.
Conclusion: These findings may be explained by different histories of immigration to the U.S. caused by a combination of European colonialism, U.S. imperialism, and globalization. Importantly, the results suggest that current practices of aggregating Asian health data mask disparities in health and how socially stratifying processes like economic segregation may differ by ethnic group.
Table of Contents
CHAPTER I: BACKGROUND.................................................................................................... 1
PRETERM BIRTH ............................................................................................................................. 1
POWER AND STRUCTURAL RACISM .............................................................................................. 2
RACE, ETHNICITY, & NATIVITY STATUS ...................................................................................... 3
RISK FACTOR 1: PREVIOUS PRETERM DELIVERY ........................................................................ 4
RISK FACTOR 2: MATERNAL SMOKING........................................................................................ 4
RISK FACTOR 3: GESTATIONAL DIABETES AND PREECLAMPSIA ............................................... 5
RISK FACTOR 4: MATERNAL AGE................................................................................................. 5
RISK FACTOR 5: EDUCATIONAL ATTAINMENT ............................................................................ 5
SEGREGATION................................................................................................................................. 5
INCOME SEGREGATION .................................................................................................................. 6
ASIANS, PRETERM BIRTH, AND INCOME SEGREGATION ............................................................. 9
CHAPTER II: MANUSCRIPT .................................................................................................. 11
INTRODUCTION ............................................................................................................................. 11
METHODS ...................................................................................................................................... 15
RESULTS ........................................................................................................................................ 17
DISCUSSION ................................................................................................................................... 20
REFERENCES ................................................................................................................................. 27
TABLES .......................................................................................................................................... 34
FIGURES......................................................................................................................................... 61
CHAPTER III: SUMMARY, PUBLIC HEALTH IMPLICATIONS, & FUTURE DIRECTIONS .............................................................................................................................. 64
APPENDICES .............................................................................................................................. 66
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