Beyond access, proximity to care, and healthcare use: sustained racial disparities in perinatal outcomes due to marginalization-related diminished returns and racism

Ethno-racial inequalities on adverse birth and neonatal outcomes: a nationwide, retrospective cohort study of 21 million Brazilian newborns

Background

Ethno-racial inequalities are critical determinants of health outcomes. We quantified ethnic-racial inequalities on adverse birth outcomes and early neonatal mortality in Brazil.

Methods

We conducted a cohort study in Brazil using administrative linked data between 2012 and 2019. Estimated the attributable fractions for the entire population (PAF) and specific groups (AF), as the proportion of each adverse outcome that would have been avoided if all women had the same baseline conditions as White women, both unadjusted and adjusted for socioeconomics and maternal risk factors. AF was also calculated by comparing women from each maternal race/skin colour group in different groups of mothers' schooling, with White women with 8 or more years of education as the reference group and by year.

Findings

21,261,936 newborns were studied. If all women experienced the same rate as White women, 1.7% of preterm births, 7.2% of low birth weight (LBW), 10.8% of small for gestational age (SGA) and 11.8% of early neonatal deaths would have been prevented. Percentages preventable were higher among Indigenous (22.2% of preterm births, 17.9% of LBW, 20.5% of SGA and 19.6% of early neonatal deaths) and Black women (6% of preterm births, 21.4% of LBW, 22.8% of SGA births and 20.1% of early neonatal deaths). AF was higher in groups with fewer years of education among Indigenous, Black and Parda for all outcomes. AF increased over time, especially among Indigenous populations.

Interpretation

A considerable portion of adverse birth outcomes and neonatal deaths could be avoided if ethnic-racial inequalities were non-existent in Brazil. Acting on the causes of these inequalities must be central in maternal and child health policies.

Funding

Bill & Melinda Gates Foundation and Wellcome Trust.

Black Americans' Diminished Health Returns of Professional Occupations: A Thirty-Year Follow-Up Study of Middle-Aged and Older Adults

INTRODUCTION

Occupational classes exert substantial effects on both subjective and objective health outcomes. However, it remains unclear whether the health impact of similar occupational classes varies across racial groups among middle-aged and older adults in the United States.

AIM

Grounded in the theory of Minorities' Diminished Returns (MDRs), which posits that health benefits from resources such as employment are systematically weaker for racial minority populations, particularly Non-Latino Black individuals, this study tested Black-White disparities in the effects of similar occupational classes on health outcomes in middle-aged and older adults.

METHODS

Utilizing data from the Health and Retirement Study (HRS), we employed a 30-year longitudinal design with a nationally representative sample of middle-aged and older adults in the United States. Six occupational classes-operator, managerial, professional specialty, sales, clerical/admin, and service-served as the key predictor variables (independent variables), with race as the moderator. Various health outcomes, including self-rated health, chronic disease, body mass index (BMI), activities of daily living (ADL), and cognitive function, were measured longitudinally from wave 1 to wave 15 (from baseline to 30 years later). Statistical analyses, incorporating logistic regression models, were conducted to assess associations between occupational class and health outcomes overall and based on race.

RESULTS

Our analysis included 7538 Non-Latino White or Non-Latino Black participants followed for up to 30 years. Initial findings revealed positive health effects of professional occupations on cognitive function and self-rated health over 30 years of follow-uWe also identified significant interactions between race and professional occupational class on all health outcomes, indicating notable racial differences in the effects of professional occupations on health outcomes across domains. The effects of professional occupational class were weaker for Non-Latino Black individuals than for Non-Latino White individuals.

CONCLUSION

Consistent with the Minorities' Diminished Returns theory, our findings indicated less pronounced positive effects of professional occupations on a wide range of health outcomes for Non-Latino Black individuals compared to Non-Latino Whites. These disparities emphasize the critical need to address structural factors that contribute to the diminished returns of prestigious occupations for Non-Latino Black populations.

Immigration Status, Socioeconomic Status, and Self-Rated Health in Europe

The literature has established a protective effect of socioeconomic status (SES) indicators on health. However, at least in the US, these SES indicators tend to generate fewer health gains for marginalized groups including immigrants. As this literature mainly originated in the US, it is necessary to study whether these indicators similarly correlate with the health of foreign-born and native-born individuals in Europe. The current study was based on the Marginalization-related Diminished Returns (MDRs) theory and compared the effects of three SES indicators, namely parental education, own education and income, on self-rated health (SRH) of immigrant and native-born individuals. We used data from the European Social Survey 2020 (ESS 2020). Participants included 14,213 individuals who identified as either native-born (n = 9052) or foreign-born (n = 508). Education, income, and parental education were the independent variables. Self-rated health (SRH) was the outcome. Age and sex were covariates. Linear regression and logistic regression were used for data analysis. Overall, high education, income, and parental education were associated with lower odds of poor SRH. We documented a statistical interaction between immigration status and parental education, indicating a weaker inverse association between parental education and poor SRH for foreign-born than native-born individuals. The links between some but not all SES indicators vary across foreign-born and native-born individuals in Europe. Host countries seem to undervalue the parental educational attainment of foreign-born families. Future research should explore the role of time, period, cohort and country of origin as well as host country and associated policies in equalizing returns of SES indicators on the health of population subgroups. The results are important given that most studies on MDRs are developed in the US, and less is known about Europe. The results are also very important given the growing anti-immigrant sentiment and nationalist movements in Europe and the rest of the world.