The Racial Social Structure and Unequal Risk of Adverse Birth Outcomes among Black Infants

黑人婴儿的种族社会结构和不良出生结果的不平等风险

• 批准号: 9977648
• 负责人: David Stuart Curtis
• 金额: $ 24.13万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-05 至 2022-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9977648
• 关键词: Address; African American; American; Area; Birth; Birth Records; Birth Weight; Categories; Code; Collection; Community Surveys; Complex; Contraceptive Agents; County; Data Set; Data Sources; Development; Dimensions; Disadvantaged; Discrimination; Economically Deprived Population; Economics; Ensure; Event; Exposure to; Fetal Growth; Health; Health Policy; Health Services Accessibility; High birth weight infant; Imprisonment; Infant; Infant Mortality; Intervention; Length; Location; Logistic Regressions; Measurement; Measures; Mediating; Mediation; Mediator of activation protein; Mental Health; Methods; Modeling; Mothers; Natural experiment; Neighborhoods; Not Hispanic or Latino; Online Systems; Outcome; Pathway interactions; Perinatal; Persons; Physicians; Police; Population; Population Intervention; Pregnancy; Pregnant Women; Prejudice; Premature Birth; Prenatal care; Prevention; Primary Health Care; Process; Public Health; Publishing; Recurrence; Research; Research Design; Research Personnel; Research Project Grants; Risk; Role; Sampling; Services; Small for Gestational Age Infant; Stress; Structure; Techniques; Testing; Variant; Woman; adverse birth outcomes; barrier to care; black/white disparity; experience; health care availability; high risk; high risk population; improved; indexing; killings; maternal risk; metropolitan; multilevel analysis; novel; postpartum contraception; racial difference; racial discrimination; racism; segregation; social structure; sociodemographics; socioeconomic disadvantage; stressor; violent crime

PROJECT SUMMARY/ABSTRACT Relative to Whites, Black mothers have higher odds of preterm birth (PTB) and small-for-gestational-age birth (SGA), leading to racial differences in infant mortality. Compelling evidence exists for racial discrimination and residential segregation as determinants of such adverse birth outcomes. Yet, more complete assessments of the racial social structure are needed to identify the role of additional structural factors and maternal mediating pathways. We will elucidate structural predictors of Black PTB and SGA risk by testing two Specific Aims. Aim 1: Systematically test structural predictors of unequal risk of preterm and small-for-gestational- age birth for Black mothers, and the role of maternal- and area-level mediators. Structural factors will be assessed at the county or metropolitan statistical area (MSA) using diverse public data sources and include: 1) area anti-Black prejudice from aggregated web-based measurements of bias and racism; 2) Black residential segregation as the isolation index; 3) Black socioeconomic disadvantage from a multidimensional composite; 4) neighborhood violent crime exposure and incarceration risk for Black residents; and 5) structural barriers to healthcare, measured as a) spatial access to primary care, b) availability of Black physicians, c-d) uninsurance and inadequate prenatal care rates for Black mothers, and e) availability of public health and contraceptive services. Black-White (B-W) differences in structural factors also will be examined. Using national birth records (2014-2017), the sample will include singleton births to non-Hispanic US born Black and White mothers in MSAs with at least 10,000 Black residents. Multilevel models will allow for prediction of PTB and SGA risk for Black mothers, area variance in risk, and area-specific B-W differences in risk. Mediation of structural factors by maternal- and area-level sociodemographic and health variables will be tested. Mothers with prior PTB also will be considered as structural factors may restrict access to needed health interventions for this population. Aim 2: Estimate the effect of racial societal stressors on Black preterm birth risk. Variation in timing and location of high publicity killings of Black persons, likely to be viewed as unjust or racially motivated, will be exploited to create a natural experiment. Black preterm birth risk is expected to increase after high publicity Black killings, particularly for exposure in the first four gestational months, for the most publicized killings, and in areas proximate to the killing. Due to their potential for intense media coverage, killings of Black persons will come from datasets of police-perpetrated and extremist-perpetrated killings. Number of media stories within 60-days of the killing will be used to identify high publicity killings (top decile; ~35 killings). The project will provide novel and rigorous tests of the racial social structure and racial societal stressors as predictors of unequal risk of PTB and SGA for Black mothers. By examining mediating paths and barriers to healthcare access, the project can inform health prevention efforts to improve Black birth outcomes.

项目摘要/摘要 相对于白人，黑人母亲的早产几率更高（PTB）和小胎龄出生 （SGA），导致婴儿死亡率的种族差异。有令人信服的证据存在种族歧视和 住宅隔离是这种不良出生结果的决定因素。然而，更完整的评估 需要种族社会结构来确定其他结构性因素和孕产妇调解的作用 途径。我们将通过测试两个具体目标来阐明黑色PTB和SGA风险的结构预测指标。 AIM 1：系统地测试结构性预测指标 黑人母亲的年龄出生以及孕产妇和地区级调解人的作用。结构因素将是 使用不同的公共数据来源在县或大都会统计区（MSA）进行评估，其中包括：1） 基于偏见和种族主义的总体测量结果来自区域反黑的偏见； 2）黑色住宅 隔离为隔离指数； 3）来自多维复合材料的黑人社会经济劣势； 4）黑人居民的邻里暴力犯罪暴露和监禁风险； 5）结构性障碍 医疗保健，以a）为空间获得初级保健，b）黑人医生的可用性，c-d）不保险 黑人母亲的产前护理率不足，e）公共卫生和避孕 服务。还将检查结构因素的黑白（B-W）差异。使用国家出生记录 （2014-2017），样本将包括非西班牙裔美国人黑人和白人母亲的单身人士的出生 MSA至少有10,000名黑人居民。多级模型将允许PTB和SGA风险预测 黑人母亲，风险区域差异以及风险特定地区的B-W差异。结构因素的调解 将测试由孕产妇和地区级的社会人口统计学和健康变量。患有PTB的母亲也 将被视为结构性因素可能会限制该人群所需的健康干预措施的机会。 目标2：估计种族社会压力源对黑色早产风险的影响。定时的变化 大量宣传杀害黑人的位置可能被视为不公正或出于种族动机的地点 被利用以创建自然实验。宣传后，黑人早产风险预计将增加 黑人杀人，特别是在前四个月中暴露于最广泛宣传的杀戮，以及 在接近杀戮的地区。由于其潜力强烈的媒体报道，黑人的杀戮将 来自警察遭受重视和极端主义遭受重复的杀戮数据集。媒体故事的数量 60天的杀戮将用于识别高宣传杀戮（最高十分命中； 〜35杀人）。 该项目将为种族社会结构和种族社会压力源提供新颖而严格的测试 黑人母亲的PTB和SGA风险不平等的预测因素。通过检查中介道路和障碍 医疗保健访问，该项目可以为预防健康的努力提供帮助，以改善黑人的出生结果。