Structural Racism and Preterm Birth in the United States Open Access

Abstract

Preterm birth is a leading cause of morbidity and mortality among infants in the United States. Non-Hispanic Black women are almost twice as likely to have a preterm birth than are White women. A growing body of research suggests that racism plays a key role in health outcome disparities. While many studies have analyzed interpersonal racism, in this cross-sectional study we examined racism at an institutional level across 43 states in the U.S. We used a novel technique, calculating Black-White disparities across 3 state-level indicators 1) educational attainment, 2) occupational level, and 3) incarceration to determine a structural racism "score," ranging from 0 to 3 for each state. Data on preterm birth and maternal state residency were obtained from 2013 birth certificates compiled by the National Center for Health Statistics (N=2,297,257). We used logistic regression models controlled for individual level factors to calculate prevalence odds ratios by race, using women in states with a score of 0 as the referent group. Contrary to our hypothesis, Black women living in states with the highest structural racism score of 3 had statistically significant lower odds of preterm birth (OR=0.88 95% CI= [0.83, 0.94]). Consistent with our hypothesis, White women living in states with structural racism scores of 1, 2, and 3 had progressively lower odds of preterm birth (OR= 0.98 95% CI= [0.88, 1.09], OR= 0.91 95% CI= [0.79, 1.05], OR=0.83 95% CI= [0.77, 0.88], respectively). These results for White women support emerging theories that racism at an institutional level benefits those who claim superiority. The results for Black women are not consistent with theory that institutional racism harms the health of the subordinate group, nor is there any empirical evidence supporting our finding, raising questions of whether our analysis may be affected by unmeasured confounding.

Table of Contents

Chapter 1- Background

Preterm Birth ....... 1-5

Structural Racism in the United States ....... 5-8

Incarceration ....... 8-10

Education ....... 10-12

Occupational Status ....... 12-13

Purpose of this Research ....... 14

Chapter 2 - Manuscript

Abstract ....... 15-16

Introduction ....... 16-17

Methods ....... 17-21

Results ....... 21-23

Discussion ....... 23-27

Sources ....... 28-31

Tables .......32-25

Chapter 3 - Summary, Public Health Implications, Possible Future Directions ....... 36-38

Appendix ....... 39-40

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Keyword	Preterm birth Structural Racism
Committee Chair / Thesis Advisor	Kramer, Michael R, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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