Occurrence of fatal police violence during pregnancy and hazard of preterm birth in California.

Occurrence of fatal police violence during pregnancy and hazard of preterm birth in California.

Exposure to fatal police violence may play a role in population-level inequities in risk for preterm delivery. To evaluate whether exposure to fatal police violence during pregnancy affects the hazard of preterm delivery and whether associations differ by race/ethnicity and fetal sex. We leveraged temporal variation in incidents of fatal police violence within census tracts to assess whether occurrence of fatal police violence in a person’s tract during pregnancy was associated with increased hazard of extremely (20–27 weeks), early (28–31 weeks), moderate (32–33 weeks), and late (32–36 weeks) preterm delivery in California from 2007–2015. We used both death records and the Fatal Encounters database to identify incidents of fatal police violence. We estimated hazard ratios (HR) using time-varying Cox proportional hazard models stratified by census tract, controlling for age, race/ethnicity, educational attainment, health insurance type, parity, and the year and season of conception. We further stratified by race/ethnicity and infant sex to evaluate whether there were differential effects by these characteristics. Exposure to an incident of fatal police violence was associated with a small increase in the hazard of late preterm birth using both the death records (N=376,029; HR 1.05, 95% CI 1.00, 1.10) and the Fatal Encounters data (N=938,814; HR 1.03, 95% CI 1.00, 1.06). We also observed an association for moderate preterm birth in the Fatal Encounters data (HR 1.06, 95% CI 0.98, 1.15). We did not observe associations for early or extremely preterm birth in either data source. Larger relative hazards of moderate (HR 1.25, 95% CI 0.93, 1.68) and late preterm delivery (HR 1.18, 95% CI 1.05, 1.33) were observed among Black birth parents with female births in the Fatal Encounters data. Preventing police use of lethal force may reduce preterm delivery in communities where such violence occurs.

暴露于致命的警察暴力可能在早产风险的人群层面不平等中起作用。 为了评估孕期暴露于致命的警察暴力是否影响早产风险，以及这种关联是否因种族/族裔和胎儿性别而异。 我们利用人口普查区致命警察暴力事件的时间变化来评估孕期在某人所在的人口普查区发生致命警察暴力是否与2007 - 2015年加利福尼亚州极早产（20 - 27周）、早期早产（28 - 31周）、中度早产（32 - 33周）和晚期早产（32 - 36周）的风险增加有关。我们使用死亡记录和“致命遭遇”数据库来确定致命警察暴力事件。我们使用按人口普查区分层的时变考克斯比例风险模型估计风险比（HR），并控制年龄、种族/族裔、教育程度、医疗保险类型、产次以及受孕年份和季节。我们进一步按种族/族裔和婴儿性别分层，以评估这些特征是否存在不同影响。 使用死亡记录（N = 376,029；HR 1.05，95%置信区间1.00，1.10）和“致命遭遇”数据（N = 938,814；HR 1.03，95%置信区间1.00，1.06），暴露于致命警察暴力事件都与晚期早产风险小幅增加有关。我们还在“致命遭遇”数据中观察到中度早产的关联（HR 1.06，95%置信区间0.98，1.15）。在两种数据源中，我们都未观察到早期或极早产的关联。在“致命遭遇”数据中，生育女性婴儿的黑人父母中观察到中度（HR 1.25，95%置信区间0.93，1.68）和晚期早产（HR 1.18，95%置信区间1.05，1.33）的相对风险更大。 防止警察使用致命武力可能会减少发生此类暴力的社区的早产情况。