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.

项目概要/摘要 相对于白人，黑人母亲早产（PTB）和小于胎龄儿的几率更高 （SGA），导致婴儿死亡率的种族差异。存在种族歧视和令人信服的证据 居住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因素和母亲调解的作用 途径。我们将通过测试两个特定目标来阐明黑人 PTB 和 SGA 风险的结构预测因素。 目标 1：系统地测试早产和小于妊娠风险不平等的结构预测因素 黑人母亲的出生年龄，以及母亲和地区层面调解者的作用。结构性因素将是 使用不同的公共数据源在县或大都市统计区 (MSA) 进行评估，包括：1) 从基于网络的偏见和种族主义汇总测量中得出反黑人偏见； 2）黑人住宅 隔离作为隔离指标； 3）多维综合的黑人社会经济劣势； 4）黑人居民的社区暴力犯罪暴露和监禁风险； 5）结构性障碍 医疗保健，衡量标准为：a) 获得初级保健的空间，b) 黑人医生的可用性，c-d) 无保险 黑人母亲的产前护理率不足，以及 e) 公共卫生和避孕药具的可用性 服务。结构因素中的黑白（B-W）差异也将被检查。使用国家出生记录 (2014-2017)，样本将包括非西班牙裔美国出生的黑人和白人母亲的单胎出生 拥有至少 10,000 名黑人居民的 MSA。多级模型将允许预测 PTB 和 SGA 风险 黑人母亲、地区风险差异以及地区特定的黑白风险差异。结构性因素的调节 将按孕产妇和地区一级的社会人口统计和健康变量进行测试。曾患有 PTB 的母亲也 将被视为结构性因素可能限制该人群获得所需的健康干预措施。 目标 2：估计种族社会压力源对黑人早产风险的影响。时间上的变化 以及可能被视为不公正或出于种族动机的高曝光黑人杀戮地点 被用来创建一个自然实验。高调宣传后黑人早产风险预计会增加 黑人杀戮，特别是在妊娠前四个月内曝光的、最广为人知的杀戮，以及 在靠近杀戮的地区。由于媒体可能会进行大量报道，对黑人的杀戮将 来自警察实施和极端分子实施的杀戮的数据集。内媒体报道数量 60 天的杀戮将用于识别高知名度的杀戮（前十分之一；约 35 起杀戮）。 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 PTB 和 SGA 风险不平等的预测因素。通过检查调解路径和障碍 医疗保健的获取，该项目可以为健康预防工作提供信息，以改善黑人的出生结果。