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Hill AV, Balascio P, Moore M, Blackmon B, Alston T, Anto-Ocrah M. Black Father's Influence on Adverse Pregnancy Outcomes in the United States: A Narrative Synthesis of Literature. Am J Mens Health 2024; 18:15579883241266466. [PMID: 39066606 PMCID: PMC11282517 DOI: 10.1177/15579883241266466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 07/28/2024] Open
Abstract
Few studies have investigated paternal characteristics in relationship with adverse pregnancy outcomes, and results are inconsistent. The purpose of this study was to review studies examining associations between characteristics of Black fathers and adverse pregnancy outcomes in the United States. A systematic narrative synthesis was conducted of research studies examining paternal characteristics of Black fathers in association with adverse pregnancy outcomes: preterm birth, hypertensive disorders of pregnancy, gestational diabetes, spontaneous abortion, and maternal mortality. Seven databases (Academic Search Premier, CINHAL, CENTRAL, ClinicalTrials.gov, Embase, PubMed, and Web of Science) were searched for original research articles from inception to February 2023. Articles were excluded if they (a) were in a language other than English, (b) did not describe original research, (c) included a geographic region outside of the United States, (d) did not include adverse maternal outcomes as a study outcome, (e) did not describe race of fathers in the study sample, and (f) did not describe a paternal characteristic of Black fathers. The search resulted in 210 articles. Six studies were included in the final review; five studies examined associations between paternal characteristics of Black fathers and preterm birth, finding significantly increased odds of preterm birth among births with Black fathers. Among births with non-Hispanic Black paternity, the odds of hypertensive disorders of pregnancy were reduced or not significantly associated. Researchers should continue to explore paternal factors that influence pregnancy outcomes in racial/ethnic-specific models to identify optimal intervention strategies to improve disparities in maternal and child health outcomes.
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Affiliation(s)
- Ashley V. Hill
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Phoebe Balascio
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mikaela Moore
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brandi Blackmon
- Department of Physician Assistant Studies, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tasha Alston
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Martina Anto-Ocrah
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Verschuuren AEH, Tankink JB, Postma IR, Bergman KA, Goodarzi B, Feijen-de Jong EI, Erwich JJHM. Suboptimal factors in maternal and newborn care for refugees: Lessons learned from perinatal audits in the Netherlands. PLoS One 2024; 19:e0305764. [PMID: 38935661 PMCID: PMC11210813 DOI: 10.1371/journal.pone.0305764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 06/04/2024] [Indexed: 06/29/2024] Open
Abstract
INTRODUCTION Refugees and their healthcare providers face numerous challenges in receiving and providing maternal and newborn care. Research exploring how these challenges are related to adverse perinatal and maternal outcomes is scarce. Therefore, this study aims to identify suboptimal factors in maternal and newborn care for asylum-seeking and refugee women and assess to what extent these factors may contribute to adverse pregnancy outcomes in the Netherlands. METHODS We conducted a retrospective analysis of national perinatal audit data from 2017 to 2019. Our analysis encompassed cases with adverse perinatal and maternal outcomes in women with a refugee background (n = 53). Suboptimal factors in care were identified and categorized according to Binder et al.'s Three Delays Model, and the extent to which they contributed to the adverse outcome was evaluated. RESULTS We identified 29 suboptimal factors, of which seven were related to care-seeking, six to the accessibility of services, and 16 to the quality of care. All 53 cases contained suboptimal factors, and in 67.9% of cases, at least one of these factors most likely or probably contributed to the adverse perinatal or maternal outcome. CONCLUSION The number of suboptimal factors identified in this study and the extent to which they contributed to adverse perinatal and maternal outcomes among refugee women is alarming. The wide range of suboptimal factors identified provides considerable scope for improvement of maternal and newborn care for refugee populations. These findings also highlight the importance of including refugee women in perinatal audits as it is essential for healthcare providers to better understand the factors associated with adverse outcomes to improve the quality of care. Adjustments to improve care for refugees could include culturally sensitive education for healthcare providers, increased workforce diversity, minimizing the relocation of asylum seekers, and permanent reimbursement of professional interpreter costs.
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Affiliation(s)
- A. E. H. Verschuuren
- Department of Health Sciences, Global Health Unit, University Medical Centre Groningen & University of Groningen, Groningen, the Netherlands
| | - J. B. Tankink
- Erasmus University Medical Centre, Department of Obstetrics and Gynecology, Rotterdam, The Netherlands
| | - I. R. Postma
- Department of Health Sciences, Global Health Unit, University Medical Centre Groningen & University of Groningen, Groningen, the Netherlands
- Department of Obstetrics and Gynecology, Isala Clinics, Zwolle, the Netherlands
| | - K. A. Bergman
- Department of Paediatrics Beatrix Children’s Hospital, University Medical Centre Groningen & University of Groningen, Groningen, the Netherlands
| | - B. Goodarzi
- Department of Midwifery Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Primary Care and Longterm Care, University Medical Center Groningen & University of Groningen, Groningen, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, The Netherlands
| | - E. I. Feijen-de Jong
- Department of Midwifery Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, The Netherlands
- Department of Primary Care and Longterm Care, University Medical Centre Groningen & University of Groningen, Groningen, the Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Groningen, the Netherlands
| | - J. J. H. M. Erwich
- Department of Obstetrics and Gynecology, University Medical Centre Groningen & University of Groningen, Groningen, the Netherlands
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Powell AM, Ali Khan FZ, Ravel J, Elovitz MA. Untangling Associations of Microbiomes of Pregnancy and Preterm Birth. Clin Perinatol 2024; 51:425-439. [PMID: 38705650 PMCID: PMC11070640 DOI: 10.1016/j.clp.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
This review illuminates the complex interplay between various maternal microbiomes and their influence on preterm birth (PTB), a driving and persistent contributor to neonatal morbidity and mortality. Here, we examine the dynamics of oral, gastrointestinal (gut), placental, and vaginal microbiomes, dissecting their roles in the pathogenesis of PTB. Importantly, focusing on the vaginal microbiome and PTB, the review highlights (1) a protective role of Lactobacillus species; (2) an increased risk with select anaerobes; and (3) the influence of social health determinants on the composition of vaginal microbial communities.
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Affiliation(s)
- Anna Maya Powell
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 249, Baltimore, MD 21287, USA
| | - Fouzia Zahid Ali Khan
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 249, Baltimore, MD 21287, USA
| | - Jacques Ravel
- Department of Microbiology and Immunology, Institute for Genome Sciences, 670 West Baltimore Street, 3rd Floor, Room 3173, Baltimore, MD 21201, USA
| | - Michal A Elovitz
- Department of Obstetrics and Gynecology, Women's Health Research, Icahn School of Medicine at Mount Sinai, Women's Biomedical Research Institute, 1468 Madison Avenue, New York, NY 10029, USA.
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Tang ID, Mallia D, Yan Q, Pe'er I, Raja A, Salleb-Aouissi A, Wapner R. A Scoping Review of Preterm Birth Risk Factors. Am J Perinatol 2024; 41:e2804-e2817. [PMID: 37748506 DOI: 10.1055/s-0043-1775564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Preterm birth is a major cause of neonatal morbidity and mortality, but its etiology and risk factors are poorly understood. We undertook a scoping review to illustrate the breadth of risk factors for preterm birth that have been reported in the literature. We conducted a search in the PubMed database for articles published in the previous 5 years. We determined eligibility for this scoping review by screening titles and abstracts, followed by full-text review. We extracted odds ratios and other measures of association for each identified risk factor in the articles. A total of 2,509 unique articles were identified from the search, of which 314 were eligible for inclusion in our final analyses. We summarized risk factors and their relative impacts in the following categories: Activity, Psychological, Medical History, Toxicology, Genetics, and Vaginal Microbiome. Many risk factors for preterm birth have been reported. It is challenging to synthesize findings given the multitude of isolated risk factors that have been studied, inconsistent definitions of risk factors and outcomes, and use of different covariates in analyses. Novel methods of analyzing large datasets may promote a more comprehensive understanding of the etiology of preterm birth and ability to predict the outcome. KEY POINTS: · Preterm birth is difficult to predict.. · Preterm birth has many diverse risk factors.. · Holistic approaches may yield new insights..
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Affiliation(s)
- Irene D Tang
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Daniel Mallia
- Department of Computer Science, Hunter College, New York, New York
| | - Qi Yan
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
| | - Itsik Pe'er
- Department of Computer Science, Columbia University, New York, New York
| | - Anita Raja
- Department of Computer Science, Hunter College, New York, New York
| | | | - Ronald Wapner
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
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Del Pozzo J, Kouba I, Alvarez A, O'Sullivan-Bakshi T, Krishnamoorthy K, Blitz MJ. Environmental Justice Index and adverse pregnancy outcomes. AJOG GLOBAL REPORTS 2024; 4:100330. [PMID: 38586614 PMCID: PMC10994970 DOI: 10.1016/j.xagr.2024.100330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND The Environmental Justice Index is a tool released by the Centers for Disease Control and Prevention that quantifies and ranks the environmental burden and social vulnerability of each census tract. Racial and ethnic disparities in adverse pregnancy outcomes are well established. The relative contributions of individual (person-level) and environmental (neighborhood-level) risk factors to disease prevalence remain poorly understood. OBJECTIVE This study aimed to determine whether the Environmental Justice Index is associated with adverse pregnancy outcomes after adjustment for individual clinical and sociodemographic risk factors. STUDY DESIGN This was a retrospective cross-sectional study of all patients who delivered a singleton newborn at ≥23 weeks of gestation between January 2019 and February 2022 at 7 hospitals within a large academic health system in New York. Patients were excluded if their home address was not available, if the address could not be geocoded to a census tract, or if the census tract did not have corresponding Environmental Justice Index data. Patients were also excluded if they had preexisting diabetes or hypertension. For patients who had multiple pregnancies during the study period, only the first pregnancy was included for analysis. Clinical and demographic data were obtained from the electronic medical record. Environmental Justice Index score, the primary independent variable, ranges from 0 to 1. Higher Environmental Justice Index scores indicate communities with increased cumulative environmental burden and increased social vulnerability. The primary outcome was adverse pregnancy outcome, defined as the presence of ≥1 of any of the following conditions: hypertensive disorders of pregnancy, gestational diabetes, preterm birth, fetal growth restriction, low birthweight, small for gestational age newborn, placental abruption, and stillbirth. Multivariable logistic regression was performed to investigate the relationship between Environmental Justice Index score and adverse pregnancy outcome, adjusting for potential confounding variables, including body mass index group, race and ethnicity group, advanced maternal age, nulliparity, public health insurance, and English as the preferred language. RESULTS A total of 65,273 pregnancies were included for analysis. Overall, adverse pregnancy outcomes occurred in 37.6% of pregnancies (n=24,545); hypertensive disorders of pregnancy (13.4%) and gestational diabetes (12.2%) were the most common adverse pregnancy outcome conditions. On unadjusted analysis, the strongest associations between Environmental Justice Index score and individual adverse pregnancy outcome conditions were observed for stillbirth (odds ratio, 1.079; 95% confidence interval, 1.025-1.135) and hypertensive disorders of pregnancy (odds ratio, 1.052; 95% confidence interval, 1.042-1.061). On multivariable logistic regression, every 0.1 increase in Environmental Justice Index score was associated with 1.4% higher odds of adverse pregnancy outcome (adjusted odds ratio, 1.014; 95% confidence interval, 1.007-1.021). The strongest associations with adverse pregnancy outcomes were observed with well-established clinical and social risk factors, including class 3 obesity (adjusted odds ratio, 1.710; 95% confidence interval, 1.580-1.849; reference: body mass index <25 kg/m2) and certain race and ethnicity groups (reference: non-Hispanic White), particularly Asian and Pacific Islander (adjusted odds ratio, 1.817; 95% confidence interval, 1.729-1.910), and non-Hispanic Black (adjusted odds ratio, 1.668; 95% confidence interval, 1.581-1.760) people. CONCLUSION Environmental Justice Index score is positively associated with adverse pregnancy outcomes, and most strongly associated with stillbirth and hypertensive disorders of pregnancy. Geospatial analysis with Environmental Justice Index may help to improve our understanding of health inequities by identifying neighborhood characteristics that increase the risk of pregnancy complications.
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Affiliation(s)
- Jaclyn Del Pozzo
- Northwell Health, New Hyde Park (Drs Del Pozzo and Kouba, Mr Alvarez, and Dr Blitz), NY
- Department of Obstetrics and Gynecology, South Shore University Hospital (Drs Del Pozzo, Kouba, and Blitz), Bay Shore, NY
- Zucker School of Medicine (Drs Del Pozzo, Kouba, and Blitz), Hempstead, NY
| | - Insaf Kouba
- Northwell Health, New Hyde Park (Drs Del Pozzo and Kouba, Mr Alvarez, and Dr Blitz), NY
- Department of Obstetrics and Gynecology, South Shore University Hospital (Drs Del Pozzo, Kouba, and Blitz), Bay Shore, NY
- Zucker School of Medicine (Drs Del Pozzo, Kouba, and Blitz), Hempstead, NY
| | - Alejandro Alvarez
- Northwell Health, New Hyde Park (Drs Del Pozzo and Kouba, Mr Alvarez, and Dr Blitz), NY
- Department of Biostatistics, Office of Academic Affairs, Northwell Health (Mr Alvarez), New Hyde Park, NY
| | - Tadhg O'Sullivan-Bakshi
- Feinstein Institutes for Medical Research, Northwell Health (Mr. O'Sullivan-Bakshi and Ms. Krishnamoorthy), Manhasset, NY
| | - Kaveri Krishnamoorthy
- Feinstein Institutes for Medical Research, Northwell Health (Mr. O'Sullivan-Bakshi and Ms. Krishnamoorthy), Manhasset, NY
| | - Matthew J. Blitz
- Northwell Health, New Hyde Park (Drs Del Pozzo and Kouba, Mr Alvarez, and Dr Blitz), NY
- Department of Obstetrics and Gynecology, South Shore University Hospital (Drs Del Pozzo, Kouba, and Blitz), Bay Shore, NY
- Zucker School of Medicine (Drs Del Pozzo, Kouba, and Blitz), Hempstead, NY
- Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health (Dr Blitz), Manhasset, NY
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McGaughey P, Howland RE, Dragan KL. Variation in Preterm Birth Rates Across Prenatal Care Sites in New York. J Obstet Gynecol Neonatal Nurs 2024; 53:46-56. [PMID: 37951580 DOI: 10.1016/j.jogn.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVE To investigate variation in preterm birth rates by the site at which prenatal care was received. DESIGN Cross-sectional cohort study. SETTING New York State. PARTICIPANTS Claims and encounter data on singleton live births that were covered by New York Medicaid (N = 154,377). METHODS We analyzed data from New York Medicaid and the American Community Survey. We established sites of prenatal care using geocoded billing addresses for prenatal visits. We calculated descriptive statistics and conducted logistic regression analyses to determine variation in crude and risk-adjusted preterm birth rates by prenatal care site. RESULTS The crude preterm birth rates averaged 7.8% (range = 2.0%-18.7%) by prenatal care site. The adjusted preterm birth rate was 8.0% (range = 2.8%-18.5%) by prenatal care site. Risk-adjusted preterm birth site-level rates at the 90th percentile were 2.7 times higher than those in the 10th percentile. The variation in risk-adjusted preterm birth site-level rates was not fully explained by birth volume, rural site location, or racial and ethnic composition of the patients who received prenatal care at the site. CONCLUSION Wide variation in risk-adjusted preterm birth rates across prenatal care sites exists, and factors beyond known individual demographics and medical factors contribute to the variation. Further research is warranted to identify why receiving care at some prenatal sites is associated with higher risk of preterm birth than receiving care at others.
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Khan SS, Vaughan AS, Harrington K, Seegmiller L, Huang X, Pool LR, Davis MM, Allen NB, Capewell S, O’Flaherty M, Miller GE, Mehran R, Vogel B, Kershaw KN, Lloyd-Jones DM, Grobman WA. US County-Level Variation in Preterm Birth Rates, 2007-2019. JAMA Netw Open 2023; 6:e2346864. [PMID: 38064212 PMCID: PMC10709777 DOI: 10.1001/jamanetworkopen.2023.46864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023] Open
Abstract
Importance Preterm birth is a leading cause of preventable neonatal morbidity and mortality. Preterm birth rates at the national level may mask important geographic variation in rates and trends at the county level. Objective To estimate age-standardized preterm birth rates by US county from 2007 to 2019. Design, Setting, and Participants This serial cross-sectional study used data from the National Center for Health Statistics composed of all live births in the US between 2007 and 2019. Data analyses were performed between March 22, 2022, and September 29, 2022. Main Outcomes and Measures Age-standardized preterm birth (<37 weeks' gestation) and secondarily early preterm birth (<34 weeks' gestation) rates by county and year calculated with a validated small area estimation model (hierarchical bayesian spatiotemporal model) and percent change in preterm birth rates using log-linear regression models. Results Between 2007 and 2019, there were 51 044 482 live births in 2383 counties. In 2007, the national age-standardized preterm birth rate was 12.6 (95% CI, 12.6-12.7) per 100 live births. Preterm birth rates varied significantly among counties, with an absolute difference between the 90th and 10th percentile counties of 6.4 (95% CI, 6.2-6.7). The gap between the highest and lowest counties for preterm births was 20.7 per 100 live births in 2007. Several counties in the Southeast consistently had the highest preterm birth rates compared with counties in California and New England, which had the lowest preterm birth rates. Although there was no statistically significant change in preterm birth rates between 2007 and 2019 at the national level (percent change, -5.0%; 95% CI, -10.7% to 0.9%), increases occurred in 15.4% (95% CI, 14.1%-16.9%) of counties. The absolute and relative geographic inequalities were similar across all maternal age groups. Higher quartile of the Social Vulnerability Index was associated with higher preterm birth rates (quartile 4 vs quartile 1 risk ratio, 1.34; 95% CI, 1.31-1.36), which persisted across the study period. Similar patterns were observed for early preterm birth rates. Conclusions and Relevance In this serial cross-sectional study of county-level preterm and early preterm birth rates, substantial geographic disparities were observed, which were associated with place-based social disadvantage. Stability in aggregated rates of preterm birth at the national level masked increases in nearly 1 in 6 counties between 2007 and 2019.
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Affiliation(s)
- Sadiya S. Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Adam S. Vaughan
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katharine Harrington
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Laura Seegmiller
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Xiaoning Huang
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lindsay R. Pool
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew M. Davis
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Norrina B. Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Simon Capewell
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Martin O’Flaherty
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Gregory E. Miller
- Institute for Policy Research, Northwestern University, Evanston, Illinois
- Department of Psychology, Northwestern University, Evanston, Illinois
| | - Roxana Mehran
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Associate Editor, JAMA Cardiology
| | - Birgit Vogel
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kiarri N. Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Donald M. Lloyd-Jones
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William A. Grobman
- Department of Obstetrics and Gynecology, The Ohio State University School of Medicine, Columbus
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Kuriloff M, Patel E, Mueller A, Dada T, Duncan C, Arnolds D, Rana S. COVID-19 and obstetric outcomes: a single-center retrospective experience in a predominantly Black population. J Matern Fetal Neonatal Med 2023; 36:2196364. [PMID: 37005011 DOI: 10.1080/14767058.2023.2196364] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Objective: This retrospective, single-center case series was designed to characterize the effects of perinatal COVID-19 diagnosis on obstetric and neonatal outcomes in a predominantly high-risk, urban Black population.Study Design: Data were collected via retrospective chart review on all COVID-19-positive obstetric patients and their neonates who presented to the University of Chicago Medical Center between March 2020 and November 2020, before the availability of the COVID-19 vaccine. Patient demographics, delivery outcomes, COVID-19 symptoms, treatment, and outcomes were analyzed.Results: A total of 56 COVID-19-positive obstetric patients were included in the study, of which four were lost to follow-up before delivery. The median age of patients was 27 years (IQR 23, 32), with 73.2% publicly insured and 66.1% Black. Patients had a median body mass index (BMI) of 31.6 kg/m2 (IQR 25.9, 35.5). 3.6% of patients had chronic hypertension, 12.5% had diabetes, and 16.1% had asthma. Perinatal complications were common. Twenty-six patients (50.0%) had a diagnosis of a hypertensive disorder of pregnancy (HDP). 28.8% had gestational hypertension, and 21.2% had preeclampsia (with and without severe features). The rate of maternal ICU admission was 3.6%. Furthermore, 23.5% of patients delivered preterm (<37 weeks gestation), and 50.9% of infants were admitted to the Neonatal Intensive Care Unit (NICU).Conclusion: In our study of a predominantly Black, publicly-insured, unvaccinated group of COVID-19-positive pregnant patients, we found high rates of hypertensive disorders of pregnancy, preterm delivery, and NICU admission compared to rates reported in existing literature before widespread vaccine availability. Our findings suggest that SARS-CoV-2 infection during pregnancy, irrespective of maternal disease severity, may exacerbate existing obstetric health disparities by disproportionately impacting Black, publicly insured patients. Larger comparative studies are needed to better characterize possible racial and socioeconomic disparities in obstetric outcomes in the setting of SARS-CoV-2 infection during pregnancy. These studies should examine the pathophysiology of SARS-CoV-2 infection during pregnancy, as well as potential associations between adverse perinatal outcomes and disparities in access to care, COVID-19 vaccination, and other social determinants of health amongst more vulnerable populations infected with SARS-CoV-2 during pregnancy.
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Affiliation(s)
- Melissa Kuriloff
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Easha Patel
- Division of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - Ariel Mueller
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Colleen Duncan
- Division of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - David Arnolds
- Department of Anaesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarosh Rana
- Division of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
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Spoer BR, Conderino SE, Lampe TM, Ofrane RH, De Leon E, Thorpe LE, Chang VW, Elbel B. Association between racial residential segregation and walkability in 745 U.S. cities. Health Place 2023; 84:103114. [PMID: 37774640 PMCID: PMC10842472 DOI: 10.1016/j.healthplace.2023.103114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/16/2023] [Accepted: 09/06/2023] [Indexed: 10/01/2023]
Abstract
Despite higher chronic disease prevalence, minoritized populations live in highly walkable neighborhoods in US cities more frequently than non-minoritized populations. We investigated whether city-level racial residential segregation (RRS) was associated with city-level walkability, stratified by population density, possibly explaining this counterintuitive association. RRS for Black-White and Latino-White segregation in large US cities was calculated using the Index of Dissimilarity (ID), and walkability was measured using WalkScore. Median walkability increased across increasing quartiles of population density, as expected. Higher ID was associated with higher walkability; associations varied in strength across strata of population density. RRS undergirds the observed association between walkability and minoritized populations, especially in higher population density cities.
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Affiliation(s)
- Ben R Spoer
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, USA.
| | - Sarah E Conderino
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, USA
| | - Taylor M Lampe
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, USA
| | - Rebecca H Ofrane
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, USA
| | - Elaine De Leon
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, USA
| | - Lorna E Thorpe
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, USA
| | - Virginia W Chang
- New York University College of Global Public Health, Department of Social and Behavioral Sciences, New York, NY, USA
| | - Brian Elbel
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, USA; NYU Wagner Graduate School of Public Service, New York, NY, USA
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10
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Hadley M, Oppong AY, Coleman J, Powell AM. Structural Racism and Adverse Pregnancy Outcomes Through the Lens of the Maternal Microbiome. Obstet Gynecol 2023; 142:911-919. [PMID: 37678901 PMCID: PMC10510805 DOI: 10.1097/aog.0000000000005345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/22/2023] [Accepted: 05/04/2023] [Indexed: 09/09/2023]
Abstract
Microbiome science offers a glimpse into personalized medicine by characterizing health and disease states according to an individual's microbial signatures. Without a critical examination of the use of race as a variable, microbiome studies may be susceptible to the same pitfalls as other areas of science grounded in racist biology. We will examine the use of race as a biological variable in pregnancy-related microbiome research. Emerging data from studies that investigate the intestinal microbiome in pregnancy suggest strong influence of a poor diet on adverse pregnancy outcomes. Differences in the vaginal microbiome implicated in adverse pregnancy outcomes are frequently attributed to race. We review evidence that links systemic racism to pregnancy health outcome differences with a focus on the vaginal and intestinal microbiomes as well as diet. We also review how structural racism ultimately contributes to inequitable access to healthy food and higher risk environmental exposures among pregnant people of lower socioeconomic status and exacerbates common pregnancy comorbidities.
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Affiliation(s)
- Megan Hadley
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; and the University of Chicago School of Medicine, Chicago, Illinois
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Meng Q, Liu J, Shen J, Del Rosario I, Lakey PS, Shiraiwa M, Su J, Weichenthal S, Zhu Y, Oroumiyeh F, Paulson SE, Jerrett M, Ritz B. Fine Particulate Matter Metal Composition, Oxidative Potential, and Adverse Birth Outcomes in Los Angeles. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:107012. [PMID: 37878796 PMCID: PMC10599636 DOI: 10.1289/ehp12196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 07/11/2023] [Accepted: 09/18/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Although many studies have linked prenatal exposure to PM 2.5 to adverse birth outcomes, little is known about the effects of exposure to specific constituents of PM 2.5 or mechanisms that contribute to these outcomes. OBJECTIVES Our objective was to investigate effects of oxidative potential and PM 2.5 metal components from non-exhaust traffic emissions, such as brake and tire wear, on the risk of preterm birth (PTB) and term low birth weight (TLBW). METHODS For a birth cohort of 285,614 singletons born in Los Angeles County, California, in the period 2017-2019, we estimated speciated PM 2.5 exposures modeled from land use regression with cokriging, including brake and tire wear related metals (barium and zinc), black carbon, and three markers of oxidative potential (OP), including modeled reactive oxygen species based on measured iron and copper (ROS), OH formation (OP OH ), and dithiothreitol (DTT) loss (OP DTT ). Using logistic regression, we estimated odds ratios (OR) and 95% confidence intervals (CI) for PTB and TLBW with speciated PM 2.5 exposures and PM 2.5 mass as continuous variables scaled by their interquartile range (IQR). RESULTS For both metals and oxidative potential metrics, we estimated increased risks for PTB (ORs ranging from 1.01 to 1.03) and TLBW (ORs ranging from 1.02 to 1.05) per IQR exposure increment that were robust to adjustment for PM 2.5 mass. Associations for PM 2.5 mass, black carbon, metal components, and oxidative potential (especially ROS and OP OH ) with adverse birth outcomes were stronger in Hispanic, Black, and mixed-race or Native American women. DISCUSSION Our results indicate that exposure to PM 2.5 metals from brake and tire wear and particle components that contribute to oxidative potential were associated with an increased risk of PTB and TLBW in Los Angeles County, particularly among Hispanic, Black, and mixed-race or Native American women. Thus, reduction of PM 2.5 mass only may not be sufficient to protect the most vulnerable pregnant women and children from adverse effects due to traffic source exposures. https://doi.org/10.1289/EHP12196.
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Affiliation(s)
- Qi Meng
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Jonathan Liu
- Department of Environmental Health Sciences, Fielding School of Public Health, UCLA, Los Angeles, California, USA
| | - Jiaqi Shen
- Department of Atmospheric & Oceanic Sciences, UCLA, Los Angeles, California, USA
| | - Irish Del Rosario
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Pascale S.J. Lakey
- Department of Chemistry, University of California, Irvine, Irvine, California, USA
| | - Manabu Shiraiwa
- Department of Chemistry, University of California, Irvine, Irvine, California, USA
| | - Jason Su
- Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Scott Weichenthal
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Yifang Zhu
- Department of Environmental Health Sciences, Fielding School of Public Health, UCLA, Los Angeles, California, USA
| | - Farzan Oroumiyeh
- Department of Environmental Health Sciences, Fielding School of Public Health, UCLA, Los Angeles, California, USA
| | - Suzanne E. Paulson
- Department of Atmospheric & Oceanic Sciences, UCLA, Los Angeles, California, USA
| | - Michael Jerrett
- Department of Environmental Health Sciences, Fielding School of Public Health, UCLA, Los Angeles, California, USA
| | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
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12
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Goulding AN, Fox KA, Reed CC, Salmanian B, Shamshirsaz AA, Aagaard KM. A Retrospective Review of Social Deprivation Index and Maternal Outcomes with Placenta Accreta Spectrum from a Single Referral Center. Am J Perinatol 2023; 40:1383-1389. [PMID: 37364598 PMCID: PMC11107423 DOI: 10.1055/s-0043-1770162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Little is known about how community characteristics influence placenta accreta spectrum (PAS) outcomes. Our objective was to evaluate whether adverse maternal outcomes among pregnant people (gravidae) with PAS delivering at a single referral center differ by community-level measures of social deprivation. STUDY DESIGN We conducted a retrospective cohort study of singleton gravidae with histopathology confirmed PAS delivering from January 2011 to June 2021 at a referral center. Data abstraction collected relevant patient information, including resident zip code, which was linked to Social Deprivation Index (SDI) score (a measure of area-level social deprivation). SDI scores were divided into quartiles for analysis. Primary outcome was a composite of maternal adverse outcomes. Bivariate analyses and multivariable logistic regression were performed. RESULTS Among our cohort (n = 264), those in the lowest (least deprived) SDI quartile were older, had lower body mass index, and were more likely to identify as non-Hispanic white. Composite maternal adverse outcome occurred in 81 (30.7%), and did not differ significantly by SDI quartile. Intraoperative transfusion of ≥4 red blood cell units occurred more often among those living in deprived areas (31.2% in the highest [most deprived] vs. 22.7% in the lowest [least deprived] SDI quartile, p = 0.04). No other outcomes differed by SDI quartile. In multivariable logistic regression, a quartile increase in SDI was associated with 32% increased odds of transfusion of ≥4 red blood cell units (adjusted odds ratio: 1.32, 95% confidence interval: 1.01-1.75). CONCLUSION Within a cohort of gravidae with PAS delivered at a single referral center, we found that those living in more socially deprived communities were more likely to receive transfusion of ≥4 red blood cell units, but other maternal adverse outcomes did not differ. Our findings highlight the importance of considering how characteristics of the surrounding community can impact PAS outcomes and may assist with risk stratification and resource deployment. KEY POINTS · Little is known about how community characteristics influence PAS outcomes.. · In a referral center, transfusion was more common in gravidae living in socially deprived areas.. · Future research should consider how community characteristics can impact PAS outcomes..
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Affiliation(s)
- Alison N. Goulding
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Karin A. Fox
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Christina C. Reed
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Bahram Salmanian
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | | | - Kjersti M. Aagaard
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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13
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Hwang SS, Bourque SL, Hannan KE, Passarella M, Radack J, Formanowski B, Lorch SA. Racial and Ethnic Disparities in Sudden Unexpected Infant Death Among US Infants Born Preterm. J Pediatr 2023; 260:113498. [PMID: 37211205 DOI: 10.1016/j.jpeds.2023.113498] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/03/2023] [Accepted: 05/14/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To investigate among US infants born at <37 weeks gestation (a) racial and ethnic disparities in sudden unexpected infant death (SUID) and (b) state variation in SUID rates and non-Hispanic Black (NHB)-non-Hispanic White (NHW) SUID disparity ratio. METHODS In this retrospective cohort analysis of linked birth and death certificates from 50 states from 2005 to 2014, SUID was defined by the following International Classification of Diseases, 9th or 10th edition, codes listed on death certificates: (7980, R95 or Recode 135; ASSB: E913, W75 or Recode 146; Unknown: 7999 R99 or Recode 134). Multivariable models were used to assess the independent association between maternal race and ethnicity and SUID, adjusting for several maternal and infant characteristics. The NHB-NHW SUID disparity ratios were calculated for each state. RESULTS Among 4 086 504 preterm infants born during the study period, 8096 infants (0.2% or 2.0 per 1000 live births) experienced SUID. State variation in SUID ranged from the lowest rate of 0.82 per 1000 live births in Vermont to the highest rate of 3.87 per 1000 live births in Mississippi. Unadjusted SUID rates across racial and ethnic groups varied from 0.69 (Asian/Pacific Islander) to 3.51 (NHB) per 1000 live births. In the adjusted analysis, compared with NHW infants, NHB and Alaska Native/American Indian preterm infants had greater odds of SUID (aOR, 1.5;[95% CI, 1.42-1.59] and aOR, 1.44 [95% CI, 1.21-1.72]) with varying magnitude of SUID rates and NHB-NHW disparities across states. CONCLUSIONS Significant racial and ethnic disparities in SUID among preterm infants exist with variation across US states. Additional research to identify the drivers of these disparities within and across states is needed.
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Affiliation(s)
- Sunah S Hwang
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
| | - Stephanie L Bourque
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Kathleen E Hannan
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Molly Passarella
- Division of Neonatology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joshua Radack
- Division of Neonatology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brielle Formanowski
- Division of Neonatology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Scott A Lorch
- Division of Neonatology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Romero R, Theis KR, Gomez-Lopez N, Winters AD, Panzer JJ, Lin H, Galaz J, Greenberg JM, Shaffer Z, Kracht DJ, Chaiworapongsa T, Jung E, Gotsch F, Ravel J, Peddada SD, Tarca AL. The Vaginal Microbiota of Pregnant Women Varies with Gestational Age, Maternal Age, and Parity. Microbiol Spectr 2023; 11:e0342922. [PMID: 37486223 PMCID: PMC10434204 DOI: 10.1128/spectrum.03429-22] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 06/25/2023] [Indexed: 07/25/2023] Open
Abstract
The composition of the vaginal microbiota is heavily influenced by pregnancy and may factor into pregnancy complications, including spontaneous preterm birth. However, results among studies have been inconsistent due, in part, to variation in sample sizes and ethnicity. Thus, an association between the vaginal microbiota and preterm labor continues to be debated. Yet, before assessing associations between the composition of the vaginal microbiota and preterm labor, a robust and in-depth characterization of the vaginal microbiota throughout pregnancy in the specific study population under investigation is required. Here, we report a large longitudinal study (n = 474 women, 1,862 vaginal samples) of a predominantly African-American cohort-a population that experiences a relatively high rate of pregnancy complications-evaluating associations between individual identity, gestational age, and other maternal characteristics with the composition of the vaginal microbiota throughout gestation resulting in term delivery. The principal factors influencing the composition of the vaginal microbiota in pregnancy are individual identity and gestational age at sampling. Other factors are maternal age, parity, obesity, and self-reported Cannabis use. The general pattern across gestation is for the vaginal microbiota to remain or transition to a state of Lactobacillus dominance. This pattern can be modified by maternal parity and obesity. Regardless, network analyses reveal dynamic associations among specific bacterial taxa within the vaginal ecosystem, which shift throughout the course of pregnancy. This study provides a robust foundational understanding of the vaginal microbiota in pregnancy and sets the stage for further investigation of this microbiota in obstetrical disease. IMPORTANCE There is debate regarding links between the vaginal microbiota and pregnancy complications, especially spontaneous preterm birth. Inconsistencies in results among studies are likely due to differences in sample sizes and cohort ethnicity. Ethnicity is a complicating factor because, although all bacterial taxa commonly inhabiting the vagina are present among all ethnicities, the frequencies of these taxa vary among ethnicities. Therefore, an in-depth characterization of the vaginal microbiota throughout pregnancy in the specific study population under investigation is required prior to evaluating associations between the vaginal microbiota and obstetrical disease. This initial investigation is a large longitudinal study of the vaginal microbiota throughout gestation resulting in a term delivery in a predominantly African-American cohort, a population that experiences disproportionally negative maternal-fetal health outcomes. It establishes the magnitude of associations between maternal characteristics, such as age, parity, body mass index, and self-reported Cannabis use, on the vaginal microbiota in pregnancy.
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Affiliation(s)
- Roberto Romero
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
| | - Kevin R. Theis
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Nardhy Gomez-Lopez
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Andrew D. Winters
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
- Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Jonathan J. Panzer
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
- Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Huang Lin
- Biostatistics and Bioinformatics Branch, National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Jose Galaz
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Division of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Jonathan M. Greenberg
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Zachary Shaffer
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - David J. Kracht
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Tinnakorn Chaiworapongsa
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Eunjung Jung
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Francesca Gotsch
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Jacques Ravel
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Shyamal D. Peddada
- Biostatistics and Bioinformatics Branch, National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Adi L. Tarca
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Computer Science, Wayne State University College of Engineering, Detroit, Michigan, USA
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15
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Woodall AM, Driscoll AK, Mirzazadeh A, Branum AM. Disparities in Mortality Trends for Infants of Teenagers: 1996 to 2019. Pediatrics 2023; 151:e2022060512. [PMID: 37035875 PMCID: PMC10178899 DOI: 10.1542/peds.2022-060512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Although mortality rates are highest for infants of teens aged 15 to 19, no studies have examined the long-term trends by race and ethnicity, urbanicity, or maternal age. The objectives of this study were to examine trends and differences in mortality for infants of teens by race and ethnicity and urbanicity from 1996 to 2019 and estimate the contribution of changes in the maternal age distribution and maternal age-specific (infant) mortality rates (ASMRs) to differences in infant deaths in 1996 and 2019. METHODS We used 1996 to 2019 period-linked birth and infant death data from the United States to assess biennial mortality rates per 1000 live births. Pairwise comparisons of rates were conducted using z test statistics and Joinpoint Regression was used to examine trends. Kitagawa decomposition analysis was used to estimate the proportion of change in infant deaths because of changes in the maternal age distribution and ASMRs. RESULTS From 1996 to 2019, the mortality rate for infants of teens declined 16.7%, from 10.30 deaths per 1000 live births to 8.58. The decline was significant across racial and ethnic and urbanization subgroups; however, within rural counties, mortality rates did not change significantly for infants of Black or Hispanic teens. Changes in ASMRs accounted for 93.3% of the difference between 1996 and 2019 infant mortality rates, whereas changes in the maternal age distribution accounted for 6.7%. CONCLUSIONS Additional research into the contextual factors in rural counties that are driving the lack of progress for infants of Black and Hispanic teens may help inform efforts to advance health equity.
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Affiliation(s)
- Ashley M. Woodall
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Anne K. Driscoll
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Ali Mirzazadeh
- Institute for Global Health Sciences, Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Amy M. Branum
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
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Sakali AK, Papagianni M, Bargiota A, Rasic-Markovic A, Macut D, Mastorakos G. Environmental factors affecting pregnancy outcomes. Endocrine 2023; 80:459-469. [PMID: 36729371 DOI: 10.1007/s12020-023-03307-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/10/2023] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Pregnancy represents a fragile period in the life of a woman, vulnerable to hazardous environmental substances which might affect maternal and fetal metabolism. The possible influence of environmental factors, including endocrine disrupting chemicals (EDCs), upon the mother and the fetus before and/or during pregnancy might be associated directly and/or indirectly to deleterious pregnancy outcomes. Because the existence of such associations would be, to our view, of major importance to the scientific community, their investigation is the scope of this critical review. METHODS This critical review includes in vivo animal and human studies regarding the role of environmental factors, including EDCs, on pregnancy outcomes complying with the SANRA (a scale for the quality assessment of narrative review articles) questions for narrative reviews. Studies were identified by searching the MEDLINE (PubMed and PubMed Central), the Cochrane library and the Google Scholar databases till October 2022 with the combinations of the appropriate key words (detailed environmental factors including EDCs AND detailed negative pregnancy outcomes) as well as by scanning references from already included articles and relevant reviews manually. Because environmental factors and EDCs have been associated to epigenetic alterations, special care has been given to EDC-induced transgenerational effects on pregnancy outcomes. RESULTS The existing evidence suggests positive associations between specific environmental factors and negative pregnancy outcomes such as ectopic pregnancies, pregnancy losses, gestational diabetes, hypertensive disorders of pregnancy, preterm births, birth defects, intrauterine growth restriction, and small or large for gestational age babies. CONCLUSION Environmental factors and EDCs may have a catalytic effect on the course and the outcomes of pregnancy.
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Affiliation(s)
- Anastasia-Konstantina Sakali
- Department of Endocrinology and Metabolic Diseases, Larissa University Hospital, University of Thessaly, Larissa, Greece
| | - Maria Papagianni
- Department of Nutrition and Dietetics, School of Physical Education and Sport Science and Dietetics, University of Thessaly, Trikala, Greece
- Endocrine Unit, 3rd Department of Pediatrics, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandra Bargiota
- Department of Endocrinology and Metabolic Diseases, Larissa University Hospital, University of Thessaly, Larissa, Greece
| | - Aleksandra Rasic-Markovic
- Institute of Medical Physiology, Faculty of Medicine, University of Belgrade, Visegradska 26, 11000, Belgrade, Serbia
| | - Djuro Macut
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - George Mastorakos
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, Aretaieion Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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McGovern M, Rokicki S, Von Jaglinsky A, Reichman NE. Neighborhood-level housing affordability and maternal depression. SSM - MENTAL HEALTH 2023. [DOI: 10.1016/j.ssmmh.2023.100192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Zhuang J, Goldbort J, Bogdan-Lovis E, Bresnahan M, Shareef S. Black mothers' birthing experiences: in search of birthing justice. ETHNICITY & HEALTH 2023; 28:46-60. [PMID: 35263206 DOI: 10.1080/13557858.2022.2027885] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Previous studies have suggested that often, Black mothers' birthing experiences are not what they expected because of how they were treated by healthcare providers during labor and birth. Our goal in this study was to ask Black mothers who had recently given birth about the quality of their birthing experiences as well as their level of respect from, trust in, and satisfaction with their maternity healthcare providers. DESIGN This study gathered data from Black mothers (N = 209) who had given birth within the past two years, using a cross-sectional online survey measuring several variables about the birthing experience including types of healthcare provider communication, provider respect for the mother, trust, birth satisfaction, and emotional responses to birth. RESULTS Provider-centered communication, although preferred by some mothers, was associated with lower birth satisfaction and stronger negative emotions whereas positive birth satisfaction was linked to patient-centered communication which resulted in positive emotions. While most mothers reported overall satisfaction with their birth experience, nearly half reported experiencing some degree of disrespect from their healthcare providers during labor and birth. Moreover, trust and respect mediated the relationship for patient-centered communication with positive emotion and birth satisfaction. Over one-third of participants gave birth with a certified nurse midwife attending. There were no differences in perception of being respected or the quality of birth given the professional identity of the provider as an Obstetrician/Gynecologist or as a midwife. The advice suggested by Black mothers for their healthcare providers was instructive in identifying ways those providers could better serve their patients during birth. CONCLUSION This study showed that there is still additional work that needs to be done for racial equity and respect during birth. Practical implications for addressing health inequities are discussed.
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Affiliation(s)
- Jie Zhuang
- Department of Communication Studies, Texas Christian University, Fort Worth, TX, USA
| | - Joanne Goldbort
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | | | - Mary Bresnahan
- Department of Communication, Michigan State University, East Lansing, MI, USA
| | - Sameerah Shareef
- Sexual Assault Healthcare Program, Michigan State University, East Lansing, MI, USA
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Balascio P, Moore M, Gongalla M, Regan A, Ha S, Taylor BD, Hill AV. Measures of Racism and Discrimination in Preterm Birth Studies. Obstet Gynecol 2023; 141:69-83. [PMID: 36701611 PMCID: PMC9886318 DOI: 10.1097/aog.0000000000005023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/29/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Preterm birth (any birth at less than 37 weeks of gestation) disproportionally affects Black birthing people and is associated with adverse perinatal and fetal health outcomes. Racism increases the risk of preterm birth, but standardized measurement metrics are elusive. This narrative synthesis examines literature on measures of racial discrimination used in preterm birth research. DATA SOURCES Six databases (CINAHL, Cochrane, EMBASE, PubMed [MEDLINE], Scopus, Web of Science) and ClinicalTrials.gov were searched. Search terms were categorized into three groups (racism terms, measurement terms, preterm birth terms) to identify original research articles that explored associations between racism and preterm birth. English-language, original research articles with U.S. populations were included. METHODS OF STUDY SELECTION Studies were excluded if conducted in only White populations, if only paternal factors were included, or if only racial differences in preterm birth were described. Articles were independently reviewed by two blinded researchers for inclusion at every stage of screening and data extraction; a third reviewer resolved discrepancies. TABULATION, INTEGRATION, AND RESULTS Sixty studies were included in the final analysis. Articles primarily included measures examining interpersonal forms of racism (n=17) through the Experiences of Discrimination and Everyday Discrimination scales, neighborhood composition (n=22) with the Neighborhood Deprivation Index and the Index of Concentration at the Extremes, policy-level racism (n=12) through institutions such as residential racial segregation or policy inequities, or multiple forms (n=9). CONCLUSION Among studies, assessment methods and application of constructs varied. This heterogeneity poses significant challenges to understanding associations between racial discrimination and preterm birth and to describing potential etiologic pathways of preterm birth, which ultimately hinders development of effective intervention. Strategies to capture multilevel exposures to racism require the development and expansion of metrics that are culturally inclusive, empirically valid, and reliable among Black pregnant populations. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022327484.
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Affiliation(s)
- Phoebe Balascio
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, and the Department of Sociology, College of Liberal Arts, Temple University, Philadelphia, Pennsylvania; the Division of Basic Science and Translational Research, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, Texas; and the School of Nursing and Health Professions, University of San Francisco, San Francisco, and the Department of Public Health, Health Science Research Institute, University of California, Merced, Merced, California
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Headen IE, Elovitz MA, Battarbee AN, Lo JO, Debbink MP. Racism and perinatal health inequities research: where we have been and where we should go. Am J Obstet Gynecol 2022; 227:560-570. [PMID: 35597277 PMCID: PMC9529822 DOI: 10.1016/j.ajog.2022.05.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 05/16/2022] [Accepted: 05/16/2022] [Indexed: 11/18/2022]
Abstract
For more than a century, substantial racial and ethnic inequities in perinatal health outcomes have persisted despite technical clinical advances and changes in public health practice that lowered the overall incidence of morbidity. Race is a social construct and not an inherent biologic or genetic reality; therefore, racial differences in health outcomes represent the consequences of structural racism or the inequitable distribution of opportunities for health along racialized lines. Clinicians and scientists in obstetrics and gynecology have a responsibility to work to eliminate health inequities for Black, Brown, and Indigenous birthing people, and fulfilling this responsibility requires actionable evidence from high-quality research. To generate this actionable evidence, the research community must realign paradigms, praxis, and infrastructure with an eye directed toward reproductive justice and antiracism. This special report offers a set of key recommendations as a roadmap to transform perinatal health research to achieve health equity. The recommendations are based on expert opinion and evidence presented at the State of the Science Research Symposium at the 41st Annual Pregnancy Meeting of the Society for Maternal-Fetal Medicine in 2021. Recommendations fall into 3 broad categories-changing research paradigms, reforming research praxis, and transforming research infrastructure-and are grounded in a historic foundation of the advances and shortcomings of clinical, public health, and sociologic scholarship in health equity. Changing the research paradigm requires leveraging a multidisciplinary perspective on structural racism; promoting mechanistic research that identifies the biologic pathways perturbed by structural racism; and utilizing conceptual models that account for racism as a factor in adverse perinatal outcomes. Changing praxis approaches to promote and engage multidisciplinary teams and to develop standardized guidelines for data collection will ensure that paradigm shifts center the historically marginalized voices of Black, Brown, and Indigenous birthing people. Finally, infrastructure changes that embed community-centered approaches are required to make shifts in paradigm and praxis possible. Institutional policies that break down silos and support true community partnership, and also the alignment of institutional, funding, and academic publishing objectives with strategic priorities for perinatal health equity, are paramount. Achieving health equity requires shifting the structures that support the ecosystem of racism that Black, Brown, and Indigenous birthing people must navigate before, during, and after childbearing. These structures extend beyond the healthcare system in which clinicians operate day-to-day, but they cannot be excluded from research endeavors to create the actionable evidence needed to achieve perinatal health equity.
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Affiliation(s)
- Irene E Headen
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Michal A Elovitz
- Center for Research in Reproduction and Women's health, Department of Obstetrics and Gynecology and Microbiology, University of Pennsylvania, Philadelphia, PA
| | - Ashley N Battarbee
- Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL
| | - Jamie O Lo
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | - Michelle P Debbink
- Department of Obstetrics and Gynecology, The University of Utah Health, Salt Lake City, UT.
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Barriers and Promotors to Health Service Utilization for Pelvic Floor Disorders in the United States: Systematic Review and Meta-analysis of Qualitative and Quantitative Studies. Female Pelvic Med Reconstr Surg 2022; 28:574-581. [PMID: 35649239 DOI: 10.1097/spv.0000000000001215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE We need a systematic approach to understanding health service utilization behavior in women with pelvic floor symptoms in the United States. OBJECTIVES The aim of this study was to determine the prevalence of pelvic floor care utilization and identify its barriers and promotors using Andersen's model, which theorizes care-seeking behavior with individual care needs, resources, predispositions, and macrostructures. DESIGN This was a systematic search of studies on care-seeking patterns in women with symptomatic pelvic floor disorders, which included pelvic organ prolapse, lower urinary tract symptoms, and anal incontinence. We then performed meta-analyses with random-effects models and descriptive analysis to determine utilization rate and the impact of each identified determinant. RESULTS The pooled utilization rate was 37% (95% confidence interval [CI], 30%-45%). Determinants were identified across all domains except at the macrostructure level. For individual care needs, increased symptom severity or duration and a history of depression (odds ratio [OR], 1.27; 95% CI, 1.07-1.51) were associated with higher utilization. In the resources domain, having social support and established primary/secondary care were promotors, whereas higher income and employed status trended as barriers. Under predispositions, age ≥50 years (OR, 1.29; 95% CI, 1.05-1.60), and pelvic floor awareness were associated with utilization, whereas Asian (OR, 0.60; 95% CI, 0.51-0.72) and Black (OR, 0.77; 95% CI, 0.55-1.08) women as well as women experiencing fear, misinformation, or normalization of pelvic floor disorders had decreased utilization. CONCLUSIONS This review identified a low utilization rate for pelvic floor care and revealed multilayered, actionable items affecting care-seeking behavior. It highlights the need for more inclusive and multifaceted approaches in future pelvic floor disparity research and equity interventions.
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Schwartz GL, Wang G, Kershaw KN, McGowan C, Kim MH, Hamad R. The long shadow of residential racial segregation: Associations between childhood residential segregation trajectories and young adult health among Black US Americans. Health Place 2022; 77:102904. [PMID: 36063651 PMCID: PMC10166594 DOI: 10.1016/j.healthplace.2022.102904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 01/10/2023]
Abstract
Residential racial segregation is a key manifestation of anti-Black structural racism, thought to be a fundamental cause of poor health; evidence has shown that it yields neighborhood disinvestment, institutional discrimination, and targeting of unhealthy products like tobacco and alcohol. Yet research on the long-term impacts of childhood exposure to residential racial segregation is limited. Here, we analyzed data on 1823 Black participants in the Panel Study of Income Dynamics, estimating associations between childhood segregation trajectories and young adult health. Black young adults who consistently lived in high-segregation neighborhoods throughout childhood experienced unhealthier smoking and drinking behaviors and higher odds of obesity compared to other trajectory groups, including children who moved into or out of high-segregation neighborhoods. Results were robust to controls for neighborhood and family poverty. Findings underscore that for Black children who grow up in segregated neighborhoods, the roots of structurally-determined health inequities are established early in life.
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Affiliation(s)
- Gabriel L Schwartz
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States.
| | - Guangyi Wang
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
| | - Kiarri N Kershaw
- Northwestern Feinberg School of Medicine, Suite 1400, 680 N Lake Shore Drive, Chicago, IL, 60611, United States
| | - Cyanna McGowan
- Northwestern Feinberg School of Medicine, Suite 1400, 680 N Lake Shore Drive, Chicago, IL, 60611, United States
| | - Min Hee Kim
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
| | - Rita Hamad
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
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Wang G, Schwartz GL, Kershaw KN, McGowan C, Kim MH, Hamad R. The association of residential racial segregation with health among U.S. children: A nationwide longitudinal study. SSM Popul Health 2022; 19:101250. [PMID: 36238814 PMCID: PMC9550534 DOI: 10.1016/j.ssmph.2022.101250] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/02/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Residential racial segregation in the U.S. has been hypothesized as a fundamental cause driving health disparities across racial groups. Potential mechanisms include economic and social marginalization, subsequent constrained opportunities, and high stress. Yet evidence on residential segregation's association with health among Black and White children-particularly longitudinally-is sparse. This study aims to address this gap. We used data from the Panel Study of Income Dynamics (PSID), a national longitudinal study of U.S. households, analyzing information on 1,251 Black and 1,427 White children who participated in the Child Development Supplement (CDS) at least twice (survey waves 1997, 2002, 2007, 2014). We fit individual fixed-effects models to estimate the within-person association of neighborhood-level residential segregation, measured with local Getis-Ord G* statistics, with three outcomes (general health, weight status, and behavioral problems). We examined heterogeneous effects by age and sex. We also examined associations between health and childhood segregation trajectories, i.e., the pattern of children's residential segregation exposures from birth through when their health outcomes were measured, providing additional insight on dynamic experiences of segregation. In fixed effects models, among Black children, higher segregation was associated with worse self-rated health, especially for Black children who were older (aged 11-17 years). In trajectory models, among White children, moving out of highly segregated neighborhoods was associated with a lower probability of poor self-rated health, while moving into those neighborhoods or back and forth between neighborhood types were both associated with increased behavioral problems. Our findings highlight the importance of early-life residential segregation in shaping persistent racial health disparities, as well as the costs of segregation for all children living in highly segregated neighborhoods.
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Affiliation(s)
- Guangyi Wang
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
| | - Gabriel L. Schwartz
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
| | - Kiarri N. Kershaw
- Northwestern University Feinberg School of Medicine, Suite 1400, 680 N Lake Shore Drive, Chicago, IL, 60611, United States
| | - Cyanna McGowan
- Northwestern University Feinberg School of Medicine, Suite 1400, 680 N Lake Shore Drive, Chicago, IL, 60611, United States
| | - Min Hee Kim
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
| | - Rita Hamad
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
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Venkatesh KK, Germann K, Joseph J, Kiefer M, Buschur E, Thung S, Costantine MM, Gabbe S, Grobman WA, Fareed N. Association Between Social Vulnerability and Achieving Glycemic Control Among Pregnant Individuals With Pregestational Diabetes. Obstet Gynecol 2022; 139:1051-1060. [PMID: 35675602 PMCID: PMC10953616 DOI: 10.1097/aog.0000000000004727] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/13/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the association between community-level social vulnerability and achieving glycemic control (defined as hemoglobin A1c [Hb A1c] less than 6.0% or less than 6.5%) among individuals with pregestational diabetes. METHODS We conducted a retrospective cohort of individuals with pregestational diabetes with singleton gestations from 2012 to 2016 at a tertiary care center. Addresses were geocoded using ArcGIS and then linked at the census tract to the Centers for Disease Control and Prevention's 2018 SVI (Social Vulnerability Index), which incorporates 15 Census variables to produce a composite score and four scores across thematic domains (socioeconomic status, household composition and disability, minority status and language, and housing type and transportation). Scores range from 0 to 1, with higher values indicating greater community-level social vulnerability. The primary outcome was Hb A1c less than 6.0%, and, secondarily, Hb A1c less than 6.5%, in the second or third trimesters. Multivariable Poisson regression with robust error variance was used to evaluate the association between SVI score as a continuous measure and target Hb A1c. RESULTS Among 418 assessed pregnant individuals (33.0% type 1; 67.0% type 2 diabetes), 41.4% (173/418) achieved Hb A1c less than 6.0%, and 56.7% (237/418) Hb A1c less than 6.5% at a mean gestational age of 29.5 weeks (SD 5.78). Pregnant individuals with a higher SVI score were less likely to achieve Hb A1c less than 6.0% compared with those with a lower SVI score. For each 0.1-unit increase in SVI score, the risk of achieving Hb A1c less than 6.0% decreased by nearly 50% (adjusted risk ratio [aRR] 0.53; 95% CI 0.36-0.77), and by more than 30% for Hb A1c less than 6.5% (adjusted odds ratio 0.67; 95% CI 0.51-0.88). With regard to specific SVI domains, those who scored higher on socioeconomic status (aRR 0.50; 95% CI 0.35-0.71) as well as on household composition and disability (aRR 0.55; 95% CI 0.38-0.79) were less likely to achieve Hb A1c less than 6.0%. CONCLUSION Pregnant individuals with pregestational diabetes living in an area with higher social vulnerability were less likely to achieve glycemic control, as measured by HgbA1c levels. Interventions are needed to assess whether addressing social determinants of health can improve glycemic control in pregnancy.
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Affiliation(s)
- Kartik K Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, the College of Medicine, the Division of Endocrinology, Department of Medicine, and the Department of Bioinformatics, The Ohio State University, Columbus, Ohio
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25
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Wang G, Schwartz GL, Kim MH, White JS, Glymour MM, Reardon S, Kershaw KN, Gomez SL, Inamdar PP, Hamad R. School Racial Segregation and the Health of Black Children. Pediatrics 2022; 149:186781. [PMID: 35434734 PMCID: PMC9173588 DOI: 10.1542/peds.2021-055952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Few researchers have evaluated whether school racial segregation, a key manifestation of structural racism, affects child health, despite its potential impacts on school quality, social networks, and stress from discrimination. We investigated whether school racial segregation affects Black children's health and health behaviors. METHODS We estimated the association of school segregation with child health, leveraging a natural experiment in which school districts in recent years experienced increased school segregation. School segregation was operationalized as the Black-White dissimilarity index. We used ordinary least squares models as well as quasi-experimental instrumental variables analysis, which can reduce bias from unobserved confounders. Data from the Child Development Supplement of the Panel Study of Income Dynamics (1997-2014, n = 1248 Black children) were linked with district-level school segregation measures. Multivariable regressions were adjusted for individual-, neighborhood-, and district-level covariates. We also performed subgroup analyses by child sex and age. RESULTS In instrumental variables models, a one standard deviation increase in school segregation was associated with increased behavioral problems (2.53 points on a 27-point scale; 95% CI, 0.26 to 4.80), probability of having ever drunk alcohol (0.23; 95% CI, 0.049 to 0.42), and drinking at least monthly (0.20; 95% CI, 0.053 to 0.35). School segregation was more strongly associated with drinking behaviors among girls. CONCLUSIONS School segregation was associated with worse outcomes on several measures of well-being among Black children, which may contribute to health inequities across the life span. These results highlight the need to promote school racial integration and support Black youth attending segregated schools.
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Affiliation(s)
- Guangyi Wang
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
| | - Gabriel L Schwartz
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
| | - Min Hee Kim
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
| | - Justin S White
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Sean Reardon
- Graduate School of Education, Stanford University, Palo Alto, California
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Pushkar P Inamdar
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California,Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
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Greenberg MB, Gandhi M, Davidson C, Carter EB. Society for Maternal-Fetal Medicine Consult Series #62: Best practices in equitable care delivery-Addressing systemic racism and other social determinants of health as causes of obstetrical disparities. Am J Obstet Gynecol 2022; 227:B44-B59. [PMID: 35378098 DOI: 10.1016/j.ajog.2022.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The Centers for Disease Control and Prevention define social determinants of health as "the conditions in the places where people live, learn, work, and play" that can affect health outcomes. Systemic racism is a root cause of the power and wealth imbalances that affect social determinants of health, creating disproportionate rates of comorbidities and adverse outcomes in the communities of racial and ethnic minority groups. Focusing primarily on disparities between Black and White individuals born in the United States, this document reviews the effects of social determinants of health and systemic racism on reproductive health outcomes and recommends multilevel approaches to mitigate disparities in obstetrical outcomes.
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Ndukwe T, Cole E, Scanzera AC, Chervinko MA, Chiang MF, Campbell JP, Chan RVP. Health Equity and Disparities in ROP Care: A Need for Systematic Evaluation. Front Pediatr 2022; 10:806691. [PMID: 35433564 PMCID: PMC9010777 DOI: 10.3389/fped.2022.806691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/03/2022] [Indexed: 12/04/2022] Open
Abstract
Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder that can have devastating visual sequelae if not managed appropriately. From an ophthalmology standpoint, ROP care is complex, since it spans multiple care settings and providers, including those in the neonatal intensive care unit (NICU), step down nurseries, and the outpatient clinic setting. This requires coordination and communication between providers, ancillary staff, and most importantly, effective communication with the patient's family members and caregivers. Often, factors related to the social determinants of health play a significant role in effective communication and care coordination with the family, and it is important for ophthalmologists to recognize these risk factors. The aim of this article is to (1) review the literature related to disparities in preterm birth outcomes and infants at risk for ROP; (2) identify barriers to ROP care and appropriate follow up, and (3) describe patient-oriented solutions and future directions for improving ROP care through a health equity lens.
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Affiliation(s)
- Tochukwu Ndukwe
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Emily Cole
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Angelica C. Scanzera
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Margaret A. Chervinko
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Michael F. Chiang
- National Institutes of Health, National Eye Institute, Bethesda, MD, United States
| | - John Peter Campbell
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR, United States
| | - Robison Vernon Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
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Johnson JD, Louis JM. Does race or ethnicity play a role in the origin, pathophysiology, and outcomes of preeclampsia? An expert review of the literature. Am J Obstet Gynecol 2022; 226:S876-S885. [PMID: 32717255 DOI: 10.1016/j.ajog.2020.07.038] [Citation(s) in RCA: 92] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/17/2020] [Accepted: 07/22/2020] [Indexed: 12/15/2022]
Abstract
The burden of preeclampsia, a substantial contributor to perinatal morbidity and mortality, is not born equally across the population. Although the prevalence of preeclampsia has been reported to be 3% to 5%, racial and ethnic minority groups such as non-Hispanic Black women and American Indian or Alaskan Native women are widely reported to be disproportionately affected by preeclampsia. However, studies that add clarity to the causes of the racial and ethnic differences in preeclampsia are limited. Race is a social construct, is often self-assigned, is variable across settings, and fails to account for subgroups. Studies of the genetic structure of human populations continue to find more variations within racial groups than among them. Efforts to examine the role of race and ethnicity in biomedical research should consider these limitations and not use it as a biological construct. Furthermore, the use of race in decision making in clinical settings may worsen the disparity in health outcomes. Most of the existing data on disparities examine the differences between White and non-Hispanic Black women. Fewer studies have enough sample size to evaluate the outcomes in the Asian, American Indian or Alaskan Native, or mixed-race women. Racial differences are noted in the occurrence, presentation, and short-term and long-term outcomes of preeclampsia. Well-established clinical risk factors for preeclampsia such as obesity, diabetes, and chronic hypertension disproportionately affect non-Hispanic Black, American Indian or Alaskan Native, and Hispanic populations. However, with comparable clinical risk factors for preeclampsia among women of different race or ethnic groups, addressing modifiable risk factors has not been found to have the same protective effect for all women. Abnormalities of placental formation and development, immunologic factors, vascular changes, and inflammation have all been identified as contributing to the pathophysiology of preeclampsia. Few studies have examined race and the pathophysiology of preeclampsia. Despite attempts, a genetic basis for the disease has not been identified. A number of genetic variants, including apolipoprotein L1, have been identified as possible risk modifiers. Few studies have examined race and prevention of preeclampsia. Although low-dose aspirin for the prevention of preeclampsia is recommended by the US Preventive Service Task Force, a population-based study found racial and ethnic differences in preeclampsia recurrence after the implementation of low-dose aspirin supplementation. After implementation, recurrent preeclampsia reduced among Hispanic women (76.4% vs 49.6%; P<.001), but there was no difference in the recurrent preeclampsia in non-Hispanic Black women (13.7 vs 18.1; P=.252). Future research incorporating the National Institute on Minority Health and Health Disparities multilevel framework, specifically examining the role of racism on the burden of the disease, may help in the quest for effective strategies to reduce the disproportionate burden of preeclampsia on a minority population. In this model, a multilevel framework provides a more comprehensive approach and takes into account the influence of behavioral factors, environmental factors, and healthcare systems, not just on the individual.
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Affiliation(s)
- Jasmine D Johnson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC
| | - Judette M Louis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL.
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Cameron NA, Everitt I, Seegmiller LE, Yee LM, Grobman WA, Khan SS. Trends in the Incidence of New-Onset Hypertensive Disorders of Pregnancy Among Rural and Urban Areas in the United States, 2007 to 2019. J Am Heart Assoc 2022; 11:e023791. [PMID: 35014858 PMCID: PMC9238536 DOI: 10.1161/jaha.121.023791] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Hypertensive disorders of pregnancy are growing public health problems that contribute to maternal morbidity, mortality, and future risk of cardiovascular disease. Given established rural‐urban differences in maternal cardiovascular health, we described contemporary trends in new‐onset hypertensive disorders of pregnancy in the United States. Methods and Results We conducted a serial, cross‐sectional analysis of 51 685 525 live births to individuals aged 15 to 44 years from 2007 to 2019 using the Centers for Disease Control and Prevention Natality Database. We included gestational hypertension and preeclampsia/eclampsia in individuals without chronic hypertension and calculated the age‐adjusted incidence (95% CI) per 1000 live births overall and by urbanization status (rural or urban). We used Joinpoint software to identify inflection points and calculate rate of change. We quantified rate ratios to compare the relative incidence in rural compared with urban areas. Incidence (95% CI) of new‐onset hypertensive disorders of pregnancy increased from 2007 to 2019 in both rural (48.6 [48.0–49.2] to 83.9 [83.1–84.7]) and urban (37.0 [36.8–37.2] to 77.2 [76.8–77.6]) areas. The rate of annual increase in new‐onset hypertensive disorders of pregnancy was more rapid after 2014 with greater acceleration in urban compared with rural areas. Rate ratios (95% CI) comparing incidence of new‐onset hypertensive disorders of pregnancy in rural and urban areas decreased from 1.31 (1.30–1.33) in 2007 to 1.09 (1.08–1.10) in 2019. Conclusions Incidence of new‐onset hypertensive disorders of pregnancy doubled from 2007 to 2019 with persistent rural‐urban differences highlighting the need for targeted interventions to improve the health of pregnant individuals and their offspring.
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Affiliation(s)
- Natalie A Cameron
- Department of Internal Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Ian Everitt
- Department of Internal Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Laura E Seegmiller
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Lynn M Yee
- Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - William A Grobman
- Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Sadiya S Khan
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL.,Division of Cardiology Northwestern University Feinberg School of Medicine Chicago IL
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Montoya-Williams D, Fraiman YS, Peña MM, Burris HH, Pursley DM. Antiracism in the Field of Neonatology: A Foundation and Concrete Approaches. Neoreviews 2022; 23:e1-e12. [PMID: 34970665 PMCID: PMC8796312 DOI: 10.1542/neo.23-1-e1] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Neonatal patients and families from historically marginalized and discriminated communities have long been documented to have differential access to health care, disparate health care, and as a result, inequitable health outcomes. Fundamental to these processes is an understanding of what race and ethnicity represent for patients and how different levels of racism act as social determinants of health. The NICU presents a unique opportunity to intervene with regard to the detrimental ways in which structural, institutional, interpersonal, and internalized racism affect the health of newborn infants. The aim of this article is to provide neonatal clinicians with a foundational understanding of race, racism, and antiracism within medicine, as well as concrete ways in which health care professionals in the field of neonatology can contribute to antiracism and health equity in their professional careers.
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Affiliation(s)
| | - Yarden S Fraiman
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Michelle-Marie Peña
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Heather H Burris
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - DeWayne M Pursley
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA
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Evenosky S, Lewis E, DiSantis KI. A Mixed Methods Case Study of Food Shopping in a Community with High Infant Mortality. Nutrients 2021; 13:3845. [PMID: 34836108 PMCID: PMC8623881 DOI: 10.3390/nu13113845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 11/29/2022] Open
Abstract
In the U.S., preterm birth disproportionately impacts certain racial/ethnic groups, with Black women experiencing preterm birth at a rate 50% higher than other groups. Among the numerous factors that likely contribute to these increased rates are neighborhood characteristics, such as food environment. In this mixed-methods case study, we evaluated how pregnant women living in a predominately minority, lower income community with high preterm birth rates navigate and perceive their food environment. Qualitative interviews were performed to assess perceptions of food environment (n = 7) along with geographic and observational assessments of their food environment. Participants traveled an average of 2.10 miles (SD = 1.16) and shopped at an average of 3 stores. They emphasized the importance of pricing and convenience when considering where to shop and asserted that they sought out healthier foods they thought would enhance their pregnancy health. Observational assessments of stores' nutrition environment showed that stores with lower nutritional scores were in neighborhoods with greater poverty and a higher percent Black population. Future policies and programmatic efforts should focus on improving nutrition during pregnancy for women living in communities with high rates of poor birth outcomes. Availability, affordability, and accessibility are key aspects of the food environment to consider when attempting to achieve birth equity.
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Affiliation(s)
- Sarah Evenosky
- College of Health Sciences, Arcadia University, Glenside, PA 19038, USA
| | - Eleanor Lewis
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA;
| | - Katherine I. DiSantis
- College of Population Health, Thomas Jefferson University, Philadelphia, PA 19107, USA;
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Wang MC, Freaney PM, Perak AM, Greenland P, Lloyd-Jones DM, Grobman WA, Khan SS. Trends in Prepregnancy Obesity and Association With Adverse Pregnancy Outcomes in the United States, 2013 to 2018. J Am Heart Assoc 2021; 10:e020717. [PMID: 34431359 PMCID: PMC8649260 DOI: 10.1161/jaha.120.020717] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background The prevalence of obesity in the population has increased in parallel with increasing rates of adverse pregnancy outcomes (APOs). Quantifying contemporary trends in prepregnancy obesity and associations with interrelated APOs (preterm birth, low birth weight, and pregnancy‐associated hypertension) together and individually can inform prevention strategies to optimize cardiometabolic health in women and offspring. Methods and Results We performed a serial, cross‐sectional study using National Center for Health Statistics birth certificate data including women aged 15 to 44 years with live singleton births between 2013 and 2018, stratified by race/ethnicity (non‐Hispanic White, non‐Hispanic Black, Hispanic, and non‐Hispanic Asian). We quantified the annual prevalence of prepregnancy obesity (body mass index ≥30.0 kg/m2; body mass index ≥27.5 kg/m2 if non‐Hispanic Asian). We then estimated adjusted associations using multivariable logistic regression (odds ratios and population attributable fractions) for obesity‐related APOs compared with normal body mass index (18.5–24.9 kg/m2; 18.5–22.9 kg/m2 if non‐Hispanic Asian). Among 20 139 891 women, the prevalence of prepregnancy obesity increased between 2013 and 2018: non‐Hispanic White (21.6%–24.8%), non‐Hispanic Black (32.5%–36.2%), Hispanic (26.0%–30.5%), and non‐Hispanic Asian (15.3%–18.6%) women (P‐trend < 0.001 for all). Adjusted odds ratios (95% CI) for APOs associated with obesity increased between 2013 and 2018, and by 2018, ranged from 1.27 (1.25–1.29) in non‐Hispanic Black to 1.94 (1.92–1.96) in non‐Hispanic White women. Obesity was most strongly associated with pregnancy‐associated hypertension and inconsistently associated with preterm birth and low birth weight. Population attributable fractions of obesity‐related APOs increased over the study period: non‐Hispanic White (10.6%–14.7%), non‐Hispanic Black (3.7%–6.9%), Hispanic (7.0%–10.4%), and non‐Hispanic Asian (7.4%–9.7%) women (P‐trend < 0.01 for all). Conclusions The prevalence of prepregnancy obesity and burden of obesity‐related APOs have increased, driven primarily by pregnancy‐associated hypertension, and vary across racial/ethnic subgroups.
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Affiliation(s)
- Michael C Wang
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Priya M Freaney
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL.,Division of Cardiology Northwestern University Feinberg School of Medicine Chicago IL
| | - Amanda M Perak
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL.,Ann & Robert H. Lurie Children's Hospital of Chicago Chicago IL
| | - Philip Greenland
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL.,Division of Cardiology Northwestern University Feinberg School of Medicine Chicago IL
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL.,Division of Cardiology Northwestern University Feinberg School of Medicine Chicago IL
| | - William A Grobman
- Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine Chicago IL
| | - Sadiya S Khan
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL.,Division of Cardiology Northwestern University Feinberg School of Medicine Chicago IL
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Banner GC, Weaver KN, Rushovich T, York SL, Yee LM. Association between Food Deserts and Gestational Diabetes Mellitus in a Large Metropolitan Area. Am J Perinatol 2021; 38:e39-e45. [PMID: 32120416 DOI: 10.1055/s-0040-1702991] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study is to determine the relationship between urban food deserts and frequency and obstetric outcomes related to gestational diabetes. STUDY DESIGN We conducted a retrospective cohort study of singleton births in Chicago from 2010 to 2014. Birth certificate data were analyzed and geomapped by census tract. Census tracts were categorized as "food deserts" according to the USDA Food Access Research Atlas. The primary outcome was frequency of gestational diabetes. Secondary outcomes were assessed among women with gestational diabetes and their neonates. RESULTS Of the 191,947 eligible women, 8,709 (4.5%) were diagnosed with gestational diabetes. Those in food deserts were more likely to be younger, obese, minority race/ethnicity, and multiparous. Women in food deserts were less likely to develop gestational diabetes (3.8 vs. 4.8%, p < 0.01; adjusted odds ratio 0.91, 95% confidence interval 0.86-0.96). Women with gestational diabetes did not experience worse maternal and neonatal outcomes after controlling for potential confounders. CONCLUSION In contrast to prior work, women in Chicago living within food deserts were less likely to develop gestational diabetes and did not experience poorer outcomes, suggesting environmental factors other than food access contribute to perinatal outcomes.
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Affiliation(s)
- Grace C Banner
- Department of Obstetrics and Gynecology, Rush University Medical Center, Chicago, Illinois
| | - Kingsley N Weaver
- Chicago Department of Public Health, Office of Epidemiology, Chicago, Illinois
| | - Tamara Rushovich
- Chicago Department of Public Health, Office of Epidemiology, Chicago, Illinois
| | - Sloane L York
- Department of Obstetrics and Gynecology, Rush University Medical Center, Chicago, Illinois
| | - Lynn M Yee
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Holliday CN, Bevilacqua K, Grace KT, Denhard L, Kaur A, Miller J, Decker MR. Examining the Neighborhood Attributes of Recently Housed Partner Violence Survivors in Rapid Rehousing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084177. [PMID: 33920892 PMCID: PMC8071223 DOI: 10.3390/ijerph18084177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/01/2021] [Accepted: 04/07/2021] [Indexed: 11/25/2022]
Abstract
Survivors’ considerations for re-housing following intimate partner violence (IPV) are understudied despite likely neighborhood-level influences on women’s safety. We assess housing priorities and predictors of re-housing location among recent IPV survivors (n = 54) in Rapid Re-housing (RRH) in the Baltimore-Washington Metropolitan Area. Choropleth maps depict residential location relative to census tract characteristics (neighborhood deprivation index (NDI) and residential segregation) derived from American Community Survey data (2013–2017). Linear regression measured associations between women’s individual, economic, and social factors and NDI and segregation. In-depth interviews (n = 16) contextualize quantitative findings. Overall, survivors re-housed in significantly more deprived and racially segregated census tracts within their respective regions. In adjusted models, trouble securing housing (B = 0.74, 95% CI: 0.13, 1.34), comfortability with proximity to loved ones (B = 0.75, 95% CI: 0.02, 1.48), and being unsure (vs unlikely) about IPV risk (B = −0.76, 95% CI: −1.39, −0.14) were significantly associated with NDI. Economic dependence on an abusive partner (B = −0.31, 95% CI: −0.56, −0.06) predicted re-housing in segregated census tracts; occasional stress about housing affordability (B = 0.39, 95% CI: 0.04, 0.75) predicted re-housing in less segregated census tracts. Qualitative results contextualize economic (affordability), safety, and social (familiarity) re-housing considerations and process impacts (inspection delays). Structural racism, including discriminatory housing practices, intersect with gender, exacerbating challenges among survivors of severe IPV. This mixed-methods study further highlights the significant economic tradeoffs for safety and stability, where the prioritization of safety may exacerbate economic devastation for IPV survivors. Findings will inform programmatic policies for RRH practices among survivors.
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Affiliation(s)
- Charvonne N. Holliday
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (K.B.); (K.T.G.); (A.K.); (M.R.D.)
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Correspondence:
| | - Kristin Bevilacqua
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (K.B.); (K.T.G.); (A.K.); (M.R.D.)
| | - Karen Trister Grace
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (K.B.); (K.T.G.); (A.K.); (M.R.D.)
- Department of Advanced Nursing Practice, School of Nursing & Health Studies, Georgetown University, Washington, DC 20057, USA
| | - Langan Denhard
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Arshdeep Kaur
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (K.B.); (K.T.G.); (A.K.); (M.R.D.)
| | | | - Michele R. Decker
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (K.B.); (K.T.G.); (A.K.); (M.R.D.)
- Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
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Wilkinson K, Sheets L, Fitch D, Popejoy L. Systematic review of approaches to use of neighborhood-level risk factors with clinical data to predict clinical risk and recommend interventions. J Biomed Inform 2021; 116:103713. [PMID: 33610880 DOI: 10.1016/j.jbi.2021.103713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 02/06/2021] [Accepted: 02/10/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite a large body of literature investigating how the environment influences health outcomes, most published work to date includes only a limited subset of the rich clinical and environmental data that is available and does not address how these data might best be used to predict clinical risk or expected impact of clinical interventions. OBJECTIVE Identify existing approaches to inclusion of a broad set of neighborhood-level risk factors with clinical data to predict clinical risk and recommend interventions. METHODS A systematic review of scientific literature published and indexed in PubMed, Web of Science, Association of Computing Machinery (ACM) and SCOPUS from 2010 through October 2020 was performed. To be included, articles had to include search terms related to Electronic Health Record (EHR) data Neighborhood-Level Risk Factors (NLRFs), and Machine Learning (ML) Methods. Citations of relevant articles were also reviewed for additional articles for inclusion. Articles were reviewed and coded by two independent reviewers to capture key information including data sources, linkage of EHR to NRLFs, methods, and results. Articles were assessed for quality using a modified Quality Assessment Tool for Systematic Reviews of Observational Studies (QATSO). RESULTS A total of 334 articles were identified for abstract review. 36 articles were identified for full review with 19 articles included in the final analysis. All but two of the articles included socio-demographic data derived from the U.S. Census and we found great variability in sources of NLRFs beyond the Census. The majority or the articles (14 of 19) included broader clinical (e.g. medications, labs and co-morbidities) and demographic information about the individual from the EHR in addition to the clinical outcome variable. Half of the articles (10) had a stated goal to predict the outcome(s) of interest. While results of the studies reinforced the correlative association of NLRFs to clinical outcomes, only one article found that adding NLRFs into a model with other data added predictive power with the remainder concluding either that NLRFs were of mixed value depending on the model and outcome or that NLRFs added no predictive power over other data in the model. Only one article scored high on the quality assessment with 13 scoring moderate and 4 scoring low. CONCLUSIONS In spite of growing interest in combining NLRFs with EHR data for clinical prediction, we found limited evidence that NLRFs improve predictive power in clinical risk models. We found these data and methods are being used in four ways. First, early approaches to include broad NLRFs to predict clinical risk primarily focused on dimension reduction for feature selection or as a data preparation step to input into regression analysis. Second, more recent work incorporates NLRFs into more advanced predictive models, such as Neural Networks, Random Forest, and Penalized Lasso to predict clinical outcomes or predict value of interventions. Third, studies that test how inclusion of NLRFs predict clinical risk have shown mixed results regarding the value of these data over EHR or claims data alone and this review surfaced evidence of potential quality challenges and biases inherent to this approach. Finally, NLRFs were used with unsupervised learning to identify underlying patterns in patient populations to recommend targeted interventions. Further access to computable, high quality data is needed along with careful study design, including sub-group analysis, to better determine how these data and methods can be used to support decision making in a clinical setting.
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Affiliation(s)
- Katie Wilkinson
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO 65212, United States; School of Medicine, University of Missouri, Columbia, MO 65212, United States.
| | - Lincoln Sheets
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO 65212, United States; School of Medicine, University of Missouri, Columbia, MO 65212, United States
| | - Dale Fitch
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO 65212, United States; School of Social Work, University of Missouri, Columbia, MO 65212, United States
| | - Lori Popejoy
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO 65212, United States; School of Nursing, University of Missouri, Columbia, MO 65212, United States
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Wang X, Whittaker J, Kellom K, Garcia S, Marshall D, Dechert T, Matone M. Integrating the Built and Social Environment into Health Assessments for Maternal and Child Health: Creating a Planning-Friendly Index. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9224. [PMID: 33321736 PMCID: PMC7763863 DOI: 10.3390/ijerph17249224] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/17/2022]
Abstract
Environmental and community context earliest in the life course have a profound effect on life-long health outcomes. Yet, standard needs assessments for maternal and child health (MCH) programs often overlook the full range of influences affecting health in-utero and early childhood. To address this, we developed a methodology for assessing community risk in MCH based on six domains integrating 66 indicators across community, environment, socioeconomic indicators, and MCH outcomes. We pilot this methodology in Pennsylvania, and share examples of how local governments, planners, and public health officials across the geographic spectrum can integrate this data into community planning for improved maternal and child health.
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Affiliation(s)
| | | | | | | | | | | | - Meredith Matone
- PolicyLab at Children’s Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146, USA; (X.W.); (J.W.); (K.K.); (S.G.); (D.M.); (T.D.)
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Blosnich JR, Montgomery AE, Taylor LD, Dichter ME. Adverse social factors and all-cause mortality among male and female patients receiving care in the Veterans Health Administration. Prev Med 2020; 141:106272. [PMID: 33022319 DOI: 10.1016/j.ypmed.2020.106272] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/23/2020] [Accepted: 09/27/2020] [Indexed: 10/23/2022]
Abstract
Social factors account more for health outcomes than medical care, yet health services research in this area is limited due to the lack of social factors data contained within electronic health records (EHR) systems. Few investigations have examined how cumulative burdens of co-occurring adverse social factors impact health outcomes. From 293,872 patients in one region of the Veterans Health Administration (VHA), we examined how increasing numbers of adverse social factors extracted from the EHR were associated with mortality across a one-year period for male and female patients. Adverse social factors were identified using four sources in the EHR: responses to universal VHA screens, International Classification of Disease (ICD) diagnostic codes that indicate social factors, receipt of VHA services related to social factors, and templated social work referrals. Seven types of adverse social factors were coded: violence, housing instability, employment or financial problems, legal issues, social or familial problems, lack of access to care or transportation, and nonspecific psychosocial needs. Overall, each increase in an adverse social factor was associated with 27% increased odds of mortality, after accounting for demographics, medical comorbidity, and military service-related disability. Non-specific psychosocial factors were most strongly associated with mortality, followed by social or familial problems. Although women were more likely than men to have multiple adverse social factors, social factors were not associated with mortality among women as they were among men. By incorporating social factors data, health care systems can better understand patient all-cause mortality and identify potential prevention efforts built around social determinants.
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Affiliation(s)
- John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States of America; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America.
| | - Ann Elizabeth Montgomery
- U.S. Department of Veterans Affairs (VA), National Center on Homelessness Among Veterans, Tampa, FL, United States of America; Birmingham VA Medical Center, Birmingham, AL, United States of America; Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Laura D Taylor
- U.S. Department of Veterans Affairs (VA), National Social Work Program Office, Washington, DC, United States of America
| | - Melissa E Dichter
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States of America; School of Social Work, College of Public Health, Temple University, Philadelphia, PA, United States of America
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Abstract
OBJECTIVE To evaluate whether women living in areas deemed food deserts had higher rates of pregnancy morbidity, specifically preeclampsia, gestational hypertension, gestational diabetes, prelabor rupture of membranes, preterm labor, than women who did not live in food deserts at the time of their pregnancy and delivery. METHODS This was a retrospective observational study in which we reviewed electronic medical records of all patients who delivered at Loyola University Medical Center in Maywood, Illinois in 2014. The Economic Research Service of the U.S. Department of Agriculture publishes the Food Access Research Atlas, which presents a spatial overview of food access indicators for low-income and other Census tracts using different measures of supermarket accessibility. A spatial join between the Food Access Research Atlas and patient coordinates was performed to identify patient point locations and determine whether each patient was located within or outside of a food desert. RESULTS Data for 1,003 deliveries at Loyola University Medical Center in 2014 were provided by the Loyola University Chicago Clinical Research Database. Two deliveries were excluded owing to inability to map address coordinates; thus 1,001 deliveries were analyzed. Of the 1,001 patients, 195 (19.5%) women were designated to food deserts. Multivariable analysis was done by adjusting for age, race, and medical insurance class. Having at least one morbid condition was the only variable that demonstrated a significant association with the food desert in multivariable analyses (47.2% vs 35.6%) (odds ratio [OR] 1.62, 95% CI 1.18-2.22) (adjusted OR 1.64, 95% CI 1.18-2.29). CONCLUSION The odds of having at least one of the studied morbid conditions in pregnancy were greater for patients living in a food desert. As there is an association of morbidity in pregnancy with living in a food desert, intervention trials to improve the built food environment or mitigate the effect otherwise are needed.
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Scott KA, Chambers BD, Baer RJ, Ryckman KK, McLemore MR, Jelliffe-Pawlowski LL. Preterm birth and nativity among Black women with gestational diabetes in California, 2013-2017: a population-based retrospective cohort study. BMC Pregnancy Childbirth 2020; 20:593. [PMID: 33023524 PMCID: PMC7541301 DOI: 10.1186/s12884-020-03290-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/27/2020] [Indexed: 02/08/2023] Open
Abstract
Background Despite the disproportionate prevalence of gestational diabetes (GDM) and preterm birth (PTB) and their associated adverse perinatal outcomes among Black women, little is known about PTB among Black women with GDM. Specifically, the relationship between PTB by subtype (defined as indicated PTB and spontaneous PT labor) and severity, GDM, and nativity has not been well characterized. Here we examine the risk of PTB by severity (early < 34 weeks, late 34 to 36 weeks) and early term birth (37 to 38 weeks) by nativity among Black women with GDM in California. Methods This retrospective cohort study used linked birth certificate and hospital discharge data for 8609 of the 100,691 self-identifying non-Hispanic Black women with GDM who had a singleton live birth between 20 and 44 weeks gestation in California in 2013–2017. Adjusted odds ratios (aOR) and 95% confidence intervals (CIs) were examine risks for PTB, by severity and subtype, and early term birth using multivariate regression modeling. Results Approximately, 83.9% of Black women with GDM were US-born and 16.1% were foreign-born. The overall prevalence of early PTB, late PTB, and early term birth was 3.8, 9.5, and 29.9%, respectively. Excluding history of prior PTB, preeclampsia was the greatest overall risk factor for early PTB (cOR = 6.7, 95%, CI 5.3 to 8.3), late PTB (cOR = 4.3, 95%, CI 3.8 to 5.0), and early term birth (cOR = 1.8, 95%, CI 1.6 to 2.0). There was no significant difference in the prevalence of PTB by subtypes and nativity (p = 0.5963). Overall, 14.2% of US- compared to 8.9% of foreign-born women had a PTB (early PTB: aOR = 0.56, 95%, CI 0.38 to 0.82; late PTB: aOR = 0.57, 95%, CI 0.45 to 0.73; early term birth: aOR = 0.67, 95%, CI 0.58 to 0.77). Conclusions Foreign-born status remained protective of PTB, irrespective of severity and subtype. Preeclampsia, PTB, and GDM share pathophysiologic mechanisms suggesting a need to better understand differences in perinatal stress, chronic disease, and vascular dysfunction based on nativity in future epidemiologic studies and health services research.
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Affiliation(s)
- Karen A Scott
- Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California San Francisco, 2356 Sutter Street, J-140, San Francisco, CA, 94143, USA.
| | - Brittany D Chambers
- California Preterm Birth Initiative, University of California San Francisco, 3333 California Street, Suite 285, San Francisco, CA, 94118, USA.,Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, 560 16th Street, Second Floor, San Francisco, CA, 94158, USA
| | - Rebecca J Baer
- Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California San Francisco, 2356 Sutter Street, J-140, San Francisco, CA, 94143, USA.,California Preterm Birth Initiative, University of California San Francisco, 3333 California Street, Suite 285, San Francisco, CA, 94118, USA.,Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, Building 3, La Jolla, CA, 92161, USA
| | - Kelli K Ryckman
- Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Drive, Office S435 CPHB, Iowa City, IA, 52242, USA
| | - Monica R McLemore
- Family Health Care Nursing Department, School of Nursing, University of California, 2 Koret Way, N431H, San Francisco, San Francisco, CA, 94143, USA
| | - Laura L Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California San Francisco, 3333 California Street, Suite 285, San Francisco, CA, 94118, USA.,Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, 560 16th Street, Second Floor, San Francisco, CA, 94158, USA
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Nardone AL, Casey JA, Rudolph KE, Karasek D, Mujahid M, Morello-Frosch R. Associations between historical redlining and birth outcomes from 2006 through 2015 in California. PLoS One 2020; 15:e0237241. [PMID: 32764800 PMCID: PMC7413562 DOI: 10.1371/journal.pone.0237241] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/22/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Despite being one of the wealthiest nations, disparities in adverse birth outcomes persist across racial and ethnic lines in the United States. We studied the association between historical redlining and preterm birth, low birth weight (LBW), small-for-gestational age (SGA), and perinatal mortality over a ten-year period (2006-2015) in Los Angeles, Oakland, and San Francisco, California. METHODS We used birth outcomes data from the California Office of Statewide Health Planning and Development between January 1, 2006 and December 31, 2015. Home Owners' Loan Corporation (HOLC) Security Maps developed in the 1930s assigned neighborhoods one of four grades that pertained to perceived investment risk of borrowers from that neighborhood: green (grade A) were considered "Best", blue (grade B) "Still Desirable", yellow (grade C) "Definitely Declining", and red (grade D, hence the term "redlining") "Hazardous". Geocoded residential addresses at the time of birth were superimposed on HOLC Security Maps to assign each birth a HOLC grade. We adjusted for potential confounders present at the time of Security Map creation by assigning HOLC polygons areal-weighted 1940s Census measures. We then employed propensity score matching methods to estimate the association of historical HOLC grades on current birth outcomes. Because tracts graded A had almost no propensity of receiving grade C or D and because grade B tracts had low propensity of receiving grade D, we examined birth outcomes in the three following comparisons: B vs. A, C vs. B, and D vs. C. RESULTS The prevalence of preterm birth, SGA and mortality tended to be higher in worse HOLC grades, while the prevalence of LBW varied across grades. Overall odds of mortality and preterm birth increased as HOLC grade worsened. Propensity score matching balanced 1940s census measures across contrasting groups. Logistic regression models revealed significantly elevated odds of preterm birth (odds ratio (OR): 1.02, 95% confidence interval (CI): 1.00-1.05), and SGA (OR: 1.03, 95% CI: 1.00-1.05) in the C vs. B comparison and significantly reduced odds of preterm birth (OR: 0.93, 95% CI: 0.91-0.95), LBW (OR: 0.94-95% CI: 0.92-0.97), and SGA (OR: 0.94, 95% CI: 0.92-0.96) in the D vs. C comparison. Results differed by metropolitan area and maternal race. CONCLUSION Similar to prior studies on redlining, we found that worsening HOLC grade was associated with adverse birth outcomes, although this relationship was less clear after propensity score matching and stratifying by metropolitan area. Higher odds of preterm birth and SGA in grade C versus grade B neighborhoods may be caused by higher-stress environments, racial segregation, and lack of access to resources, while lower odds of preterm birth, SGA, and LBW in grade D versus grade C neighborhoods may due to population shifts in those neighborhoods related to gentrification.
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Affiliation(s)
- Anthony L. Nardone
- University of California, Berkeley-University of California San Francisco Joint Medical Program, Berkeley, California, United States of America
| | - Joan A. Casey
- Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Kara E. Rudolph
- Department of Epidemiology, Columbia University, New York, New York, United States of America
| | - Deborah Karasek
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Mahasin Mujahid
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Rachel Morello-Frosch
- School of Public Health, University of California, Berkeley, California, United States of America
- Department of Environmental Science, Policy and Management, University of California, Berkeley, California, United States of America
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Julian Z, Robles D, Whetstone S, Perritt JB, Jackson AV, Hardeman RR, Scott KA. Community-informed models of perinatal and reproductive health services provision: A justice-centered paradigm toward equity among Black birthing communities. Semin Perinatol 2020; 44:151267. [PMID: 32684310 DOI: 10.1016/j.semperi.2020.151267] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Perinatal health outcomes in the United States continue to worsen, with the greatest burden of inequity falling on Black birthing communities. Despite transdisciplinary literature citing structural racism as a root cause of inequity, interventions continue to be mostly physician-centered models of perinatal and reproductive healthcare (PRH). These models prioritize individual, biomedical risk identification and stratification as solutions to achieving equity, without adequately addressing the social and structural determinants of health. The objective of this review is to: (1) examine the association between the impact of structural and obstetric racism and patient-centered access to PRH, (2) define and apply reproductive justice (RJ) as a framework to combat structural and obstetric racism in PRH, and (3) describe and demonstrate how to use an RJ lens to critically analyze physician-led and community-informed PRH models. We conclude with recommendations for building a PRH workforce whose capacity is aligned with racial equity. Institutional alignment with a RJ praxis creates opportunities for advancing PRH workforce diversification and development and improving PRH experiences and outcomes for our patients, communities, and workforce.
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Affiliation(s)
- Zoë Julian
- Department of Obstetrics and Gynecology and Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
| | - Diana Robles
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco School of Medicine, San Francisco, CA
| | - Sara Whetstone
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco School of Medicine, San Francisco, CA
| | - Jamila B Perritt
- Independent Reproductive Health and Family Planning Specialist, Washington, DC, United States
| | - Andrea V Jackson
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco School of Medicine, San Francisco, CA
| | - Rachel R Hardeman
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN
| | - Karen A Scott
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco School of Medicine, San Francisco, CA
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Yang TC, Park K, Matthews SA. Racial/ethnic segregation and health disparities: Future directions and opportunities. SOCIOLOGY COMPASS 2020; 14:e12794. [PMID: 32655686 PMCID: PMC7351362 DOI: 10.1111/soc4.12794] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/08/2020] [Indexed: 05/10/2023]
Abstract
Health researchers have investigated the association between racial segregation and racial health disparities with multilevel approaches. This study systematically reviews these multilevel studies and identifies broad trends and potential directions for future research on racial segregation and health disparities in the US. After searching databases including CINAHL and MEDLINE, we identified and systematically reviewed 66 articles published between 2003 and 2019 and found four major gaps in racial/ethnic segregation and health disparities: (a) the concept of segregation was rarely operationalized at the neighborhood level, (b) except for the evenness and exposure dimension, other dimensions of segregation are overlooked, (c) little attention was paid to the segregation between whites and non-black minorities, particularly Hispanics and Asians, and (d) mental health outcomes were largely absent. Future directions and opportunities include: First, other segregation dimensions should be explored. Second, the spatial scales for segregation measures should be clarified. Third, the theoretical frameworks for black and non-black minorities should be tested. Fourth, mental health, substance use, and the use of mental health care should be examined. Fifth, the long-term health effect of segregation has to be investigated, and finally, other competing explanations for why segregation matters at the neighborhood level should be answered.
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Affiliation(s)
- Tse-Chuan Yang
- Department of Sociology, University at Albany, State University of New York, 315 AS, 1400 Washington Avenue, Albany, NY 12222
| | - Kiwoong Park
- Department of Sociology & Criminology, University of Arkansas, 211 Old Main, University of Arkansas Fayetteville, AR 72701
| | - Stephen A Matthews
- Department of Sociology & Criminology, Pennsylvania State University, 211 Oswald Tower, University Park, PA 16802
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Johnson JD, Green CA, Vladutiu CJ, Manuck TA. Racial Disparities in Prematurity Persist among Women of High Socioeconomic Status. Am J Obstet Gynecol MFM 2020; 2:100104. [PMID: 33179010 DOI: 10.1016/j.ajogmf.2020.100104] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives Despite persistent racial disparities in preterm birth (PTB) in the US among non-Hispanic (NH) black women compared to NH white women, it remains controversial whether sociodemographic factors can explain these differences. We sought to evaluate whether disparities in PTB persist among NH black women with high socioeconomic status (SES). Study Design We conducted a population-based cohort study of all live births in the US from 2015-2017 using birth certificate data from the National Vital Statistics System. We included singleton, non-anomalous live births among women who were of high SES (defined as having ≥ 16 years of education, private insurance, and not receiving Women, Infants and Children [WIC] benefits) and who identified as NH white, NH black, or 'mixed' NH black and white race. The primary outcome was PTB <37 weeks; secondary outcomes included PTB <34 and <28 weeks. In addition, analyses were repeated considering birthweight <2500g as a surrogate for preterm birth <37 weeks, birthweight <1500g as a surrogate for preterm birth <34 weeks, and birthweight <750g as a surrogate for preterm birth <28 weeks' gestation. Data were analyzed with chi-square, t-test, and logistic regression. Results 2,170,686 live births met inclusion criteria, with 92.9% NH white, 6.7% NH black, and 0.4% both NH white and black race. Overall, 5.9% delivered <37, 1.3% <34, and 0.3 % <28 weeks. In unadjusted analyses of women with high SES, the PTB rate at each gestational age cutoff was higher for women of 'mixed' NH white and black race, and highest for women who were NH black only compared to women who were NH white only. In regression models we further adjusted for women with insurance and prenatal care their entire pregnancy, maternal race was associated with higher odds of PTB at each GA cutoff, with the highest odds observed at <28 weeks. Finally, in further adjustement analysis including only the 1,934,912 women who received prenatal care in the first trimester, findings were similar. Rates of preterm birth at each gestational age cutoff remained highest for women who identified as non-Hispanic black, intermediate for women identifying as both non-Hispanic black and white race, and lowest for non-Hispanic white women at <37 weeks (9.9% vs. 6.1% vs. 5.5%, respectively; p<0.001), <34 weeks (3.5% vs. 1.5% vs. 1.1%, respectively; p<0.001), and <28 weeks' gestation (1.2% vs. 0.4% vs. 0.2%, respectively, p<0.001). Conclusions Even among college-educated women with private insurance who are not receiving WIC, racial disparities in prematurity persist. These national findings are consistent with prior studies that suggest factors other than socio-demographics are important in the underlying pathogenesis of PTB.
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Affiliation(s)
- Jasmine D Johnson
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC
| | - Celeste A Green
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC
| | - Catherine J Vladutiu
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC
| | - Tracy A Manuck
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC
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Battarbee AN, Yee LM. Association of Fast Food and Supermarket Density with Neonatal Outcomes of Pregnancies Affected by Gestational Diabetes. Am J Perinatol 2019; 36:1405-1411. [PMID: 30646419 PMCID: PMC7190214 DOI: 10.1055/s-0038-1677478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To measure the association of fast food density (FFD) and supermarket density (SD) with adverse neonatal outcomes in pregnancies with gestational diabetes mellitus (GDM). STUDY DESIGN This was a retrospective cohort study of women with GDM who delivered at a tertiary care center in a large metropolitan area (1/2010-2/2016). ZIP codes were used to link women with surrounding food environment. FFD and SD were calculated as the number of establishments per 100,000 residents for each ZIP code and classified into quartiles. Quartile 1 represented lowest FFD or SD. Four neonatal outcomes were assessed: large for gestational age (LGA) neonate, shoulder dystocia, neonatal hypoglycemia, and neonatal intensive care unit admission > 3 days. Bivariable and multivariable analyses estimated associations of FFD and SD with outcomes. RESULTS A total of 2,373 women met eligibility criteria. Insurance, race/ethnicity, language, and body mass index differed between quartiles, although GDM type did not. High FFD was associated with lower odds of LGA but not with other outcomes. Low SD and FFD:SD ratios were not associated with any outcomes. CONCLUSION Among women with GDM, high FFD was associated with some neonatal outcomes, but low SD and FFD:SD ratio was not. Food environment may not be the only social determinant of neonatal outcomes in pregnancies with GDM.
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Affiliation(s)
- Ashley N. Battarbee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Lynn M. Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern Feinberg School of Medicine, Chicago, Illinois
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Golembiewski E, Allen KS, Blackmon AM, Hinrichs RJ, Vest JR. Combining Nonclinical Determinants of Health and Clinical Data for Research and Evaluation: Rapid Review. JMIR Public Health Surveill 2019; 5:e12846. [PMID: 31593550 PMCID: PMC6803891 DOI: 10.2196/12846] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/23/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
Background Nonclinical determinants of health are of increasing importance to health care delivery and health policy. Concurrent with growing interest in better addressing patients’ nonmedical issues is the exponential growth in availability of data sources that provide insight into these nonclinical determinants of health. Objective This review aimed to characterize the state of the existing literature on the use of nonclinical health indicators in conjunction with clinical data sources. Methods We conducted a rapid review of articles and relevant agency publications published in English. Eligible studies described the effect of, the methods for, or the need for combining nonclinical data with clinical data and were published in the United States between January 2010 and April 2018. Additional reports were obtained by manual searching. Records were screened for inclusion in 2 rounds by 4 trained reviewers with interrater reliability checks. From each article, we abstracted the measures, data sources, and level of measurement (individual or aggregate) for each nonclinical determinant of health reported. Results A total of 178 articles were included in the review. The articles collectively reported on 744 different nonclinical determinants of health measures. Measures related to socioeconomic status and material conditions were most prevalent (included in 90% of articles), followed by the closely related domain of social circumstances (included in 25% of articles), reflecting the widespread availability and use of standard demographic measures such as household income, marital status, education, race, and ethnicity in public health surveillance. Measures related to health-related behaviors (eg, smoking, diet, tobacco, and substance abuse), the built environment (eg, transportation, sidewalks, and buildings), natural environment (eg, air quality and pollution), and health services and conditions (eg, provider of care supply, utilization, and disease prevalence) were less common, whereas measures related to public policies were rare. When combining nonclinical and clinical data, a majority of studies associated aggregate, area-level nonclinical measures with individual-level clinical data by matching geographical location. Conclusions A variety of nonclinical determinants of health measures have been widely but unevenly used in conjunction with clinical data to support population health research.
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Affiliation(s)
| | - Katie S Allen
- IUPUI Richard M Fairbanks School of Public Health, Indianapolis, IN, United States.,Regenstrief Institute, Inc, Indianapolis, IN, United States
| | - Amber M Blackmon
- IUPUI Richard M Fairbanks School of Public Health, Indianapolis, IN, United States
| | | | - Joshua R Vest
- IUPUI Richard M Fairbanks School of Public Health, Indianapolis, IN, United States.,Regenstrief Institute, Inc, Indianapolis, IN, United States
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Mayne SL, Yellayi D, Pool LR, Grobman WA, Kershaw KN. Racial Residential Segregation and Hypertensive Disorder of Pregnancy Among Women in Chicago: Analysis of Electronic Health Record Data. Am J Hypertens 2018; 31:1221-1227. [PMID: 30010764 DOI: 10.1093/ajh/hpy112] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/11/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Racial residential segregation is associated with higher rates of chronic hypertension, as well as greater risk of preterm birth and low birthweight. However, few studies have examined associations between segregation and hypertensive disorder of pregnancy (HDP). METHODS Electronic health records from 4,748 singleton births among non-Hispanic black women at Prentice Women's Hospital in Chicago, IL (2009-2013) were geocoded to the census tract level. Residential segregation was measured using the Gi* statistic, a z-score measuring the extent to which each individual's neighborhood composition deviates from the composition of the larger surrounding area. Segregation was categorized as low (z < 0), medium (z = 0-1.96) or high (z > 1.96). We estimated cross-sectional associations of segregation with HDP using multilevel logistic regression models with census tract random intercepts. Models adjusted for neighborhood poverty and maternal characteristics. We also examined effect modification by neighborhood poverty. RESULTS Overall, 27.2% of women lived in high segregation, high-poverty neighborhoods. Racial residential segregation was not associated as a main effect with HDP in models adjusting for neighborhood poverty and maternal characteristics. However, at higher levels of neighborhood poverty (>20%), women living in high- and medium-segregated neighborhoods had greater odds of HDP relative to those in low-segregation neighborhoods (P interaction: 0.002). CONCLUSIONS In this sample of non-Hispanic black women in Chicago, racial residential segregation was associated with greater prevalence of HDP among those living in higher poverty neighborhoods. Understanding sources of heterogeneity in the relationship between segregation and health will help refine targeted intervention efforts to reduce disparities.
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Affiliation(s)
- Stephanie L Mayne
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Disha Yellayi
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lindsay R Pool
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - William A Grobman
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kiarri N Kershaw
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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