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MacCallum-Bridges CL, Gartner DR, Hettinger K, Zamani-Hank Y, Margerison CE. Did the Affordable Care Act Promote Racial Equity in Pregnancy-Related Health? A Scoping Review. Popul Health Manag 2024. [PMID: 38574270 DOI: 10.1089/pop.2023.0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
In the United States, there are profound and persistent racial and ethnic disparities in pregnancy-related health, emphasizing the need to promote racial health equity through public policy. There is evidence that the Affordable Care Act (ACA) increased health insurance coverage, access to health care, and health care utilization, and may have affected some pregnancy-related health outcomes (eg, preterm delivery). It is unclear, however, whether these impacts on pregnancy-related outcomes were equitably distributed across race and ethnicity. Thus, the objective of this study was to fill that gap by summarizing the peer-reviewed evidence regarding the impact of the ACA on racial and ethnic disparities in pregnancy-related health outcomes. The authors conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR), using broad search terms to identify relevant peer-reviewed literature in PubMed, Web of Science, and EconLit. The authors identified and reviewed n = 21 studies and found that the current literature suggests that the ACA and its components were differentially associated with contraception-related and fertility-related outcomes by race/ethnicity. Literature regarding pregnancy health, birth outcomes, and postpartum health, however, was sparse and mixed, making it difficult to draw conclusions regarding the impact on racial/ethnic disparities in these outcomes. To inform future health policy that reduces racial disparities, additional work is needed to clarify the impacts of contemporary health policy, like the ACA, on racial disparities in pregnancy health, birth outcomes, and postpartum health.
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Affiliation(s)
| | - Danielle R Gartner
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
| | - Katlyn Hettinger
- Department of Economics, Western Kentucky University, Bowling Green, Kentucky, USA
| | - Yasamean Zamani-Hank
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
- Department of Family Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Claire E Margerison
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
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Siddika N, Song S, Margerison CE, Kramer MR, Luo Z. The impact of place-based contextual social and environmental determinants on preterm birth: A systematic review of the empirical evidence. Health Place 2023; 83:103082. [PMID: 37473634 DOI: 10.1016/j.healthplace.2023.103082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/22/2023]
Abstract
The objective of this study was to systematically review the available empirical evidence examining associations between preterm birth (PTB) and five domains of place-based contextual social and environmental determinants, including (1) physical environment, (2) residential greenness, (3) neighborhood violence/crime, (4) food accessibility and availability, and (5) health services accessibility, among adult mothers in high-income countries. The evidence in this review suggests an adverse association between damaged physical environment, neighborhood violence/crime, lack of health services accessibility, and PTB. The existing evidence also suggests a beneficial effect of residential greenness on PTB. Further studies are needed to investigate these associations for more understanding of the direction and magnitude of these association and for potential heterogeneity by factors such as race/ethnicity, urban vs rural residence, immigration status, and social class.
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Affiliation(s)
- Nazeeba Siddika
- Department of Epidemiology and Biostatistics, Michigan State University, Fee Hall West Wing; 909 Wilson Rd, East Lansing, MI, 48824, USA
| | - Shengfang Song
- Department of Epidemiology and Biostatistics, Michigan State University, Fee Hall West Wing; 909 Wilson Rd, East Lansing, MI, 48824, USA
| | - Claire E Margerison
- Department of Epidemiology and Biostatistics, Michigan State University, Fee Hall West Wing; 909 Wilson Rd, East Lansing, MI, 48824, USA
| | - Michael R Kramer
- Department of Epidemiology, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
| | - Zhehui Luo
- Department of Epidemiology and Biostatistics, Michigan State University, Fee Hall West Wing; 909 Wilson Rd, East Lansing, MI, 48824, USA.
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Margerison CE, Zamani-Hank Y, Catalano R, Hettinger K, Michling TR, Bruckner TA. Association of the 2021 Child Tax Credit Advance Payments With Low Birth Weight in the US. JAMA Netw Open 2023; 6:e2327493. [PMID: 37556140 PMCID: PMC10413172 DOI: 10.1001/jamanetworkopen.2023.27493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/26/2023] [Indexed: 08/10/2023] Open
Abstract
IMPORTANCE Infants and pregnant people in the US fare worse on almost all health measures compared with those in peer nations. Families in the US are more likely to live in poverty and have a less generous social safety net, which has generated debate over the contribution of economic conditions to this disparity. OBJECTIVE To assess the association between temporary increases in income during pregnancy through the 2021 expanded Child Tax Credit (CTC) and birth outcomes. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study applied a comparison-population, interrupted time series design to data from US birth certificates (January 1, 2014, through December 31, 2021) to test whether the log odds of low birth weight (LBW) among monthly cohorts of births exposed to the CTC would coincide with a decreased incidence of LBW. All singleton live births to US residents aged 15 to 49 years with available data were included. EXPOSURE Monthly birth cohorts exposed to the CTC were defined as those born to parous people during the CTC advance payment period from July through December 2021. MAIN OUTCOMES AND MEASURES The main outcome was the natural logarithm of the odds of LBW (<2500 g) among monthly birth cohorts. RESULTS Among included births (n = 28 866 466), 61.2% were to parous people, the majority were to people aged 20 to 39 years (91.7%), and 6.5% were born LBW. The odds of LBW increased above expected values in 5 of the 6 months of the CTC payments (range of increases, 3.3%-5.4% across the 5 months). The outlier-adjusted odds of LBW increased, on average, by 4.2% (95% CI, 2.7%-5.7%) among the monthly birth cohorts exposed to the CTC. CONCLUSIONS AND RELEVANCE This study found that the odds of LBW among birth cohorts exposed to the CTC increased above expected values in 5 of the 6 months of the CTC advance payments. Additional research is needed to evaluate rival explanations for this increase in LBW among births exposed to the CTC payments.
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Affiliation(s)
- Claire E. Margerison
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing
| | - Yasamean Zamani-Hank
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing
- Now with Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing
| | - Ralph Catalano
- School of Public Health, University of California, Berkeley
| | - Katlyn Hettinger
- Department of Economics, Michigan State University, East Lansing
| | - Timothy R. Michling
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing
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Gartner DR, Islam JY, Margerison CE. Medicaid expansions and differences in guideline-adherent cervical cancer screening between American Indian and White women. Cancer Med 2023; 12:8700-8709. [PMID: 36629351 PMCID: PMC10134301 DOI: 10.1002/cam4.5593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Although preventable through screening, cervical cancer incidence and mortality are higher among American Indian and Alaska Native women (AIAN) than White women. The Patient Protection and Affordable Care Act's (ACA) Medicaid expansions may uniquely impact access and use of cervical cancer screening among AIAN women and ultimately alleviate this disparity. METHODS Using Medicaid eligible AIAN (N = 4681) and White (N = 57,661) women aged 18-64 years from the 2010-2020 Behavioral Risk Factor Surveillance System, we implemented difference-in-differences regression to estimate the association between the Medicaid expansions and guideline-adherent cervical cancer screening and health care coverage. RESULTS The Medicaid expansions were not associated with guideline-adherent cervical cancer screening (AIAN: -1 percentage point [ppt] [95% confidence interval, CI: -4, 2 ppts]; White: 3 ppts [95% CI: -0, 6 ppts]), but were associated with a 2 ppt increase (95% CI: 0, 4 ppt) in having had a pap test in the last 5 years among White women. The Medicaid expansions were also associated with increases in having a health plan (AIAN: 5 ppts [95% CI: 1, 9]; White: 11 ppts [95% CI: 7, 15]) and decreases in avoiding medical care due to costs (AIAN: -8 ppts [95% CI: -13, -2]; White: -6 ppts [95% CI: -9, -4]). CONCLUSIONS While we observed improvements in health care coverage, we did not observe changes to guideline-adherent cervical cancer screening following the ACA's Medicaid expansions. Given the disproportionate burden of cervical cancer among AIAN women, identifying ways to improve cervical cancer screening uptake and delivery should be prioritized to reduce preventable deaths.
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Affiliation(s)
- Danielle R. Gartner
- Department of Epidemiology and Biostatistics, College of Human MedicineMichigan State UniversityEast LansingMichiganUSA
| | - Jessica Y. Islam
- Cancer Epidemiology ProgramH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
- Center for Immunization and Infection Research in CancerH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
- Department of Oncologic SciencesUniversity of South FloridaTampaFloridaUSA
| | - Claire E. Margerison
- Department of Epidemiology and Biostatistics, College of Human MedicineMichigan State UniversityEast LansingMichiganUSA
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Gartner DR, Debbink MP, Brooks JL, Margerison CE. Inequalities in cesarean births between American Indian & Alaska Native people and White people. Health Serv Res 2023; 58:291-302. [PMID: 36573019 PMCID: PMC10012218 DOI: 10.1111/1475-6773.14122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To explore population-level American Indian & Alaska Native-White inequalities in cesarean birth incidence after accounting for differences in cesarean indication, age, and other individual-level risk factors. DATA SOURCES AND STUDY SETTING We used birth certificate data inclusive of all live births within the United States between January 1 and December 31, 2017. STUDY DESIGN We calculated propensity score weights that simultaneously incorporate age, cesarean indication, and clinical and obstetric risk factors to estimate the American Indian and Alaska Native-White inequality. DATA COLLECTION/EXTRACTION METHODS Births to individuals identified as American Indian, Alaska Native, or White, and residing in one of the 50 US states or the District of Columbia were included. Births were excluded if missing maternal race/ethnicity or any other covariate. PRINCIPAL FINDINGS After weighing the American Indian and Alaska Native obstetric population to be comparable to the distribution of cesarean indication, age, and clinical and obstetric risk factors of the White population, the cesarean incidence among American Indian and Alaska Natives increased to 33.4% (95% CI: 32.0-34.8), 3.2 percentage points (95% CI: 1.8-4.7) higher than the observed White incidence. After adjustment, cesarean birth incidence remained higher and increased in magnitude among American Indian and Alaska Natives in Robson groups 1 (low risk, primary), 6 (nulliparous, breech presentation), and 9 (transverse/oblique lie). CONCLUSIONS The unadjusted lower cesarean birth incidence observed among American Indian and Alaska Native individuals compared to White individuals may be related to their younger mean age at birth. After adjusting for this demographic difference, we demonstrate that American Indian and Alaska Native individuals undergo cesarean birth more frequently than White individuals with similar risk profiles, particularly within the low-risk Robson group 1 and those with non-cephalic presentations (Robson groups 6 and 9). Racism and bias in clinical decision making, structural racism, colonialism, or other unidentified factors may contribute to this inequality.
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Affiliation(s)
- Danielle R. Gartner
- Department of Epidemiology & Biostatistics, College of Human MedicineMichigan State UniversityEast LansingMichiganUSA
| | - Michelle P. Debbink
- Department of Obstetrics and GynecologyUniversity of Utah Health and Intermountain HealthcareSalt Lake CityUtahUSA
| | - Jada L. Brooks
- School of NursingUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Claire E. Margerison
- Department of Epidemiology & Biostatistics, College of Human MedicineMichigan State UniversityEast LansingMichiganUSA
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Margerison CE, Bruckner TA, MacCallum-Bridges C, Catalano R, Casey JA, Gemmill A. Exposure to the early COVID-19 pandemic and early, moderate and overall preterm births in the United States: A conception cohort approach. Paediatr Perinat Epidemiol 2023; 37:104-112. [PMID: 35830303 PMCID: PMC9350314 DOI: 10.1111/ppe.12894] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/27/2022] [Accepted: 05/01/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND The United States (US) data suggest fewer-than-expected preterm births in 2020, but no study has examined the impact of exposure to the early COVID-19 pandemic at different points in gestation on preterm birth. OBJECTIVE Our objective was to determine-among cohorts exposed to the early COVID-19 pandemic-whether observed counts of overall, early and moderately preterm birth fell outside the expected range. METHODS We used de-identified, cross-sectional, national birth certificate data from 2014 to 2020. We used month and year of birth and gestational age to estimate month of conception for birth. We calculated the count of overall (<37 weeks gestation), early (<33 weeks gestation) and moderately (33 to <37 weeks gestation) preterm birth by month of conception. We employed time series methods to estimate expected counts of preterm birth for exposed conception cohorts and identified cohorts for whom the observed counts of preterm birth fell outside the 95% detection interval of the expected value. RESULTS Among the 23,731,146 births in our study, the mean prevalence of preterm birth among monthly conception cohorts was 9.7 per 100 live births. Gestations conceived in July, August or December of 2019-that is exposed to the early COVID-19 pandemic in the first or third trimester-yielded approximately 3245 fewer moderately preterm and 3627 fewer overall preterm births than the expected values for moderate and overall preterm. Gestations conceived in August and October of 2019-that is exposed to the early COVID-19 pandemic in the late second to third trimester-produced approximately 498 fewer early preterm births than the expected count for early preterm. CONCLUSIONS Exposure to the early COVID-19 pandemic may have promoted longer gestation among close-to-term pregnancies, reduced risk of later preterm delivery among gestations exposed in the first trimester or induced selective loss of gestations.
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Affiliation(s)
| | - Tim A. Bruckner
- Department of Health, Society, and Behavior, and the Center for Population, Inequality, and Policy, University of California, Irvine
| | | | - Ralph Catalano
- School of Public Health, University of California, Berkeley
| | - Joan A. Casey
- Department of Environmental Health Sciences, Columbia Mailman School of Public Health
| | - Alison Gemmill
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
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Abstract
This cross-sectional study assesses changes in pregnancy-associated mortality from drug overdose, homicide, suicide, and other causes in the US from 2018 through 2020.
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Affiliation(s)
- Claire E. Margerison
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing
| | - Xueshi Wang
- Department of Economics, Michigan State University, East Lansing
| | - Alison Gemmill
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Johnson JE, Roman L, Key KD, Meulen MV, Raffo JE, Luo Z, Margerison CE, Olomu A, Johnson-Lawrence V, White JM, Meghea C. Study protocol: The Maternal Health Multilevel Intervention for Racial Equity (Maternal Health MIRACLE) Project. Contemp Clin Trials 2022; 120:106894. [PMID: 36028193 PMCID: PMC9809987 DOI: 10.1016/j.cct.2022.106894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/09/2022] [Accepted: 08/20/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To test the effectiveness and cost-effectiveness of a multilevel intervention for population-level African American (AA) severe maternal morbidity and mortality. BACKGROUND Severe maternal morbidity and mortality in the U.S. disproportionately affect AA women. Inequities occur at many levels, including community, provider, and health system levels. DESIGN Intervention. Throughout the two intervention counties, we will expand access to enhanced prenatal care services using telehealth and flexible scheduling (community level), provide actionable maternal health-focused anti-racism training (provider level), and implement equity-focused community care maternal safety bundles (health system level). Partnership. Interventions were developed/co-developed by intervention county partners, including AA women, enhanced prenatal care staff, and health providers. For equity, 46% of project direct cost dollars go to our partners. Most study investigators are female (75%) and/or AA (38%). Partners are overwhelmingly AA women. Sample, measures, analyses. We use a quasi-experimental difference-in-differences with propensity scores approach to compare pre (2016-2019) to post (2022-2025) changes in outcomes for Medicaid-insured women in intervention counties to similar women in the other Michigan, USA, counties. The sample includes all Medicaid-insured deliveries in Michigan during these years (n ~ 540,000), with women observed during pregnancy, at birth, and up to 1 year postpartum. Measures are taken from a linked dataset that includes Medicaid claims and vital records. CONCLUSION This study is among the first to examine effects of any multilevel intervention on AA severe maternal morbidity and mortality. It features a rigorous quasi-experimental design, multilevel multi-partner county-wide interventions developed by community partners, and assessment of intervention effects using population-level data.
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Affiliation(s)
- Jennifer E Johnson
- Division of Public Health, Michigan State University College of Human Medicine, 200 East 1(st) St Room 366, Flint, MI 48502, United States of America.
| | - LeeAnne Roman
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University College of Human Medicine, 965 Wilson Rd, Room, Room A629B, East Lansing, MI 48823, United States of America.
| | - Kent D Key
- Division of Public Health, Michigan State University College of Human Medicine, 200 East 1(st) St Room 367, Flint, MI 48502, United States of America.
| | - Margaret Vander Meulen
- Strong Beginnings - Healthy Start, 751 Lafayette NE, Grand Rapids, MI 49503, United States of America.
| | - Jennifer E Raffo
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University College of Human Medicine, MSU Secchia Center, 15 Michigan St. NE, Grand Rapids, MI 49503, United States of America.
| | - Zhehui Luo
- Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, B627 West Fee Hall, 909 Wilson Road, East Lansing, MI 48823, United States of America.
| | - Claire E Margerison
- Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, 909 Wilson Rd. Rm 601B, East Lansing, MI 48823, United States of America.
| | - Adesuwa Olomu
- Department of Medicine, Michigan State University College of Human Medicine, B323 Clinical Center, East Lansing, MI 48824, United States of America.
| | - Vicki Johnson-Lawrence
- Department of Family Medicine, Michigan State University College of Human Medicine, B106 Clinical Center, 788 Service Road, East Lansing, MI 48824., United States of America.
| | - Jonne McCoy White
- Division of Public Health, Michigan State University College of Human Medicine, 200 East 1(st) St Room 371, Flint, MI 48502, United States of America.
| | - Cristian Meghea
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University College of Human Medicine, 965 Wilson Rd, Room A627, East Lansing, MI 48823, USA.
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Montgomery BW, Roberts MH, Margerison CE, Anthony JC. Estimating the effects of legalizing recreational cannabis on newly incident cannabis use. PLoS One 2022; 17:e0271720. [PMID: 35862417 PMCID: PMC9302774 DOI: 10.1371/journal.pone.0271720] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/06/2022] [Indexed: 11/19/2022] Open
Abstract
Liberalized state-level recreational cannabis policies in the United States (US) fostered important policy evaluations with a focus on epidemiological parameters such as proportions [e.g., active cannabis use prevalence; cannabis use disorder (CUD) prevalence]. This cannabis policy evaluation project adds novel evidence on a neglected parameter–namely, estimated occurrence of newly incident cannabis use for underage (<21 years) versus older adults. The project’s study populations were specified to yield nationally representative estimates for all 51 major US jurisdictions, with probability sample totals of 819,543 non-institutionalized US civilian residents between 2008 and 2019. Standardized items to measure cannabis onsets are from audio computer-assisted self-interviews. Policy effect estimates are from event study difference-in-difference (DiD) models that allow for causal inference when policy implementation is staggered. The evidence indicates no policy-associated changes in the occurrence of newly incident cannabis onsets for underage persons, but an increased occurrence of newly onset cannabis use among older adults (i.e., >21 years). We offer a tentative conclusion of public health importance: Legalized cannabis retail sales might be followed by the increased occurrence of cannabis onsets for older adults, but not for underage persons who cannot buy cannabis products in a retail outlet. Cannabis policy research does not yet qualify as a mature science. We argue that modeling newly incident cannabis use might be more informative than the modeling of prevalences when evaluating policy effects and provide evidence of the advantages of the event study model over regression methods that seek to adjust for confounding factors.
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Affiliation(s)
- Barrett Wallace Montgomery
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, United States of America
- * E-mail:
| | - Meaghan H. Roberts
- Department of Economics, College of Social Science, Michigan State University, East Lansing, MI, United States of America
| | - Claire E. Margerison
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, United States of America
| | - James C. Anthony
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, United States of America
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Gemmill A, Casey JA, Catalano R, Karasek D, Margerison CE, Bruckner T. Changes in preterm birth and caesarean deliveries in the United States during the SARS-CoV-2 pandemic. Paediatr Perinat Epidemiol 2022; 36:485-489. [PMID: 34515360 PMCID: PMC8662112 DOI: 10.1111/ppe.12811] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/03/2021] [Accepted: 08/07/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Preliminary studies suggest that the SARS-CoV-2 pandemic and associated social, economic and clinical disruptions have affected pregnancy decision-making and outcomes. Whilst a few US-based studies have examined regional changes in birth outcomes during the pandemic's first months, much remains unknown of how the pandemic impacted perinatal health indicators at the national-level throughout 2020, including during the 'second wave' of infections that occurred later in the year. OBJECTIVES To describe changes in monthly rates of perinatal health indicators during the 2020 pandemic for the entire US. METHODS For the years 2015 to 2020, we obtained national monthly rates (per 100 births) for four perinatal indicators: preterm (<37 weeks' gestation), early preterm (<34 weeks' gestation), late preterm (34-36 weeks' gestation) and caesarean delivery. We used an interrupted time-series approach to compare the outcomes observed after the pandemic began (March 2020) to those expected had the pandemic not occurred for March through December of 2020. RESULTS Observed rates of preterm birth fell below expectation across several months of the 2020 pandemic. These declines were largest in magnitude in early and late 2020, with a 5%-6% relative difference between observed and expected occurring in March and November. For example, in March 2020, the observed preterm birth rate of 9.8 per 100 live births fell below the 95% prediction interval (PI) of the rate predicted from history, which was 10.5 preterm births per 100 live births (95% PI 10.2, 10.7). We detected no changes from expectation in the rate of caesarean deliveries. CONCLUSIONS Our findings provide nationwide evidence of unexpected reductions in preterm delivery during the 2020 SARS-CoV-2 pandemic in the US. Observed declines below expectation were differed by both timing of delivery and birth month, suggesting that several mechanisms, which require further study, may explain these patterns.
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Affiliation(s)
- Alison Gemmill
- Department of Population, Family and Reproductive HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Joan A. Casey
- Department of Environmental Health SciencesColumbia University Mailman School of Public HealthNew YorkNYUSA
| | - Ralph Catalano
- School of Public HealthUniversity of California, BerkeleyBerkeleyCAUSA
| | - Deborah Karasek
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of California, San FranciscoSan FranciscoCAUSA,California Preterm Birth InitiativeUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Claire E. Margerison
- Department of Epidemiology and BiostatisticsMichigan State UniversityEast LansingMIUSA
| | - Tim Bruckner
- Program in Public HealthUniversity of California, IrvineIrvineCAUSA
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Gemmill A, Casey JA, Margerison CE, Zeitlin J, Catalano R, Bruckner TA. Patterned Outcomes, Unpatterned Counterfactuals, and Spurious Results: Perinatal Health Outcomes Following COVID-19. Am J Epidemiol 2022; 191:1837-1841. [PMID: 35762139 PMCID: PMC9278230 DOI: 10.1093/aje/kwac110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 04/27/2022] [Accepted: 06/23/2022] [Indexed: 02/01/2023] Open
Abstract
The epidemiologic literature estimating the indirect or secondary effects of the coronavirus disease 2019 (COVID-19) pandemic on pregnant people and gestation continues to grow. Our assessment of this scholarship, however, leads us to suspect that the methods most commonly used may lead researchers to spurious inferences. This suspicion arises because the methods do not account for temporal patterning in perinatal outcomes when deriving counterfactuals, or estimates of the outcomes had the pandemic not occurred. We illustrate the problem in 2 ways. First, using monthly data from US birth certificates, we describe temporal patterning in 5 commonly used perinatal outcomes. Notably, for all but 1 outcome, temporal patterns appear more complex than much of the emerging literature assumes. Second, using data from France, we show that using counterfactuals that ignore this complexity produces spurious results. We recommend that subsequent investigations on COVID-19 and other perturbations use widely available time-series methods to derive counterfactuals that account for strong temporal patterning in perinatal outcomes.
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Affiliation(s)
- Alison Gemmill
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States,Correspondence to Alison Gemmill, Department of Population, Family and Reproductive Health, Johns Hopkins School of Public Health, 615 N. Wolfe Street, Room E4148, Baltimore, MD 21205 (e-mail: )
| | - Joan A Casey
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, United States
| | - Claire E Margerison
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, United States
| | - Jennifer Zeitlin
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center of Research in Epidemiology and Statistics Sorbonne Paris Cité, Université de Paris and Institut National de la Santé et de la Recherche Médicale, Institut National de la Recherche Agronomique, Paris, France
| | - Ralph Catalano
- School of Public Health, University of California, Berkeley, Berkeley, California, United States
| | - Tim A Bruckner
- Program in Public Health, University of California, Irvine, Irvine, California, United States
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Gartner DR, Kaestner R, Margerison CE. Impacts of the Affordable Care Act's Medicaid Expansion on Live Births. Epidemiology 2022; 33:406-414. [PMID: 35067567 PMCID: PMC9040191 DOI: 10.1097/ede.0000000000001462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND We hypothesize that the Affordable Care Act's (ACA) Medicaid expansion, which extended health insurance coverage to preconception, between-conception, and postconception periods for women meeting income eligibility guidelines, impacted the number of live births in the United States by increasing access to contraception and financial well-being. These impacts may differ by maternal socioeconomic and demographic characteristics. METHODS Using data from birth certificates aggregated to the state-year level and a difference-in-differences design, we estimated the association between Medicaid expansion and count of live births. We also examined whether associations differed by socioeconomic and demographic characteristics. RESULTS Overall, Medicaid expansion was not meaningfully associated with the count of births (difference-in-differences ß = 0.002; 95% confidence interval [CI] = -0.010, 0.015). However, among certain groups, Medicaid expansion was associated with meaningful changes in the count of live births, though all confidence intervals included the null value. The estimate of the relation between Medicaid expansion and the count of live births was -0.025 (95% CI = -0.052, 0.001) for those ages 18-24 years; -0.078 (95% CI = -0.231, 0.075) for those who were married, and -0.035 (95% CI = -0.104, 0.034) for those who were unmarried. CONCLUSIONS Despite its potential to impact live births, our results indicate that the ACA's Medicaid expansion was not, in general, associated with live births of US residents of reproductive age. However, for younger, married, and unmarried women, the magnitude of estimates supports the hypothesis of a potentially meaningful effect of Medicaid expansions on live births.
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Affiliation(s)
- Danielle R. Gartner
- Department of Epidemiology & Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Robert Kaestner
- Harris School of Public Policy, University of Chicago, Chicago, Illinois
| | - Claire E. Margerison
- Department of Epidemiology & Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
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13
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Gemmill A, Berger BO, Crane MA, Margerison CE. Mortality Rates Among U.S. Women of Reproductive Age, 1999-2019. Am J Prev Med 2022; 62:548-557. [PMID: 35135719 PMCID: PMC8940663 DOI: 10.1016/j.amepre.2021.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/21/2021] [Accepted: 10/03/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION High and increasing levels of pregnancy-related mortality and morbidity in the U.S. indicate that the underlying health status of reproductive-aged women may be far from optimal, yet few studies have examined mortality trends and disparities exclusively among this population. METHODS All-cause and cause-specific mortality data for 1999-2019 were obtained from the Centers for Disease Control and Prevention WONDER Underlying Cause of Death database. Levels and trends in mortality between 1999 and 2019 for women aged 15-44 years stratified by age, race/ethnicity, and state were examined. Given the urgent need to address pregnancy-related health disparities, the correlation between all-cause and pregnancy-related mortality rates across states for the years 2015-2019 was also examined. RESULTS Age-adjusted, all-cause mortality rates among women aged 15-44 years improved between 2003 and 2011 but worsened between 2011 and 2019. The recent increase in mortality among this age group was not driven solely by increases in external causes of death. Patterns differed by age, race/ethnicity, and geography, with non-Hispanic American Indian and Alaskan Native women having 2.3 and non-Hispanic Black women having 1.4 times the risk of all-cause mortality in 2019 compared with that of non-Hispanic White women. Age-adjusted all-cause mortality rates and pregnancy-related mortality rates were strongly correlated at the state level (r=0.75). CONCLUSIONS Increasing mortality among reproductive-aged women has substantial implications for maternal, women's, and children's health. Given the high correlation between pregnancy-related mortality and all-cause mortality at the state level, addressing the structural factors that shape mortality risks may have the greatest likelihood of improving women's health outcomes across the life course.
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Affiliation(s)
- Alison Gemmill
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Blair O Berger
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Matthew A Crane
- Johns Hopkins University School of Medicine, Baltimore, Maryland; USC Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Claire E Margerison
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
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14
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Zamani-Hank Y, Margerison CE, Talge NM, Holzman C. Differences in Psychosocial Protective Factors by Race/Ethnicity and Socioeconomic Status and Their Relationship to Preterm Delivery. Women's Health Reports 2022; 3:243-255. [PMID: 35262063 PMCID: PMC8896219 DOI: 10.1089/whr.2021.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/21/2022]
Abstract
Background: Non-Hispanic Black (“Black”) women in the United States deliver preterm at persistently higher rates than non-Hispanic White (“White”) women, and disparities in preterm delivery (PTD) also exist by socioeconomic factors. Research is needed to identify and understand factors that are protective against PTD for Black women and low socioeconomic status (SES) women. Methods: We examined seven potential protective factors at the individual, interpersonal, and neighborhood levels during pregnancy to determine if they (1) differed in prevalence by race/ethnicity and SES and (2) were associated with risk of PTD overall or within specific race/ethnicity and SES groups. We used prospectively collected data from n = 2474 women who were enrolled in the Pregnancy Outcomes and Community Health Study conducted in Michigan (1998–2004). Results: White women reported higher levels of self-esteem, mastery, perceived social support, instrumental social support, and reciprocity compared to Black women (all p < 0.01), while Black women reported higher levels of religiosity compared to white women (p < 0.01). High SES women reported higher levels of all protective factors compared to middle and low SES women (all p < 0.01). While protective factors were not independently associated with PTD, religiosity was associated with lower odds of PTD among low SES women (OR 0.6, 95% CI 0.4-0.9) and among Black women (OR 0.6, 95% CI 0.4–1.0), respectively. Conclusions: Our findings highlight the importance of assessing how protective factors may operate differently across race/ethnicity and SES to promote healthy pregnancy outcomes. Future studies should examine mechanisms that elucidate potential causal pathways between religiosity and PTD for Black women and low SES women.
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Affiliation(s)
- Yasamean Zamani-Hank
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Claire E. Margerison
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Nicole M. Talge
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Claudia Holzman
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
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15
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Margerison CE, Hettinger K, Kaestner R, Goldman-Mellor S, Gartner D. Medicaid Expansion Associated With Some Improvements In Perinatal Mental Health. Health Aff (Millwood) 2021; 40:1605-1611. [PMID: 34606358 DOI: 10.1377/hlthaff.2021.00776] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Poor perinatal mental health is a common pregnancy-related morbidity with potentially serious impacts that extend beyond the individual to their family. A possible contributing factor to poor perinatal mental health is discontinuity in health insurance coverage, which is particularly important among low-income people. We examined impacts of Medicaid expansion on prepregnancy depression screening and self-reported depression and postpartum depressive symptoms and well-being among low-income people giving birth. Medicaid expansion was associated with a 16 percent decline in self-reported prepregnancy depression but was not associated with postpartum depressive symptoms or well-being. Associations between Medicaid expansion and prepregnancy mental health measures increased with time since expansion. Expanding health insurance coverage to low-income people before pregnancy may improve perinatal mental health.
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Affiliation(s)
- Claire E Margerison
- Claire E. Margerison is an associate professor in the Department of Epidemiology and Biostatistics, Michigan State University, in East Lansing, Michigan
| | - Katlyn Hettinger
- Katlyn Hettinger is a graduate research assistant in the Department of Epidemiology and Biostatistics and a doctoral student in the Department of Economics, Michigan State University
| | - Robert Kaestner
- Robert Kaestner is a research professor in the Harris School of Public Policy, University of Chicago, in Chicago, Illinois
| | - Sidra Goldman-Mellor
- Sidra Goldman-Mellor is an associate professor of public health at the University of California Merced, in Merced, California
| | - Danielle Gartner
- Danielle Gartner is a research associate in the Department of Epidemiology and Biostatistics, Michigan State University
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16
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Margerison CE, Kaestner R, Chen J, MacCallum-Bridges C. Impacts of Medicaid Expansion Before Conception on Prepregnancy Health, Pregnancy Health, and Outcomes. Am J Epidemiol 2021; 190:1488-1498. [PMID: 33423053 DOI: 10.1093/aje/kwaa289] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/30/2020] [Indexed: 01/04/2023] Open
Abstract
Preconception health care is heralded as an essential method of improving pregnancy health and outcomes. However, access to health care for low-income US women of reproductive age has been limited because of a lack of health insurance. Expansions of Medicaid program eligibility under the Affordable Care Act (as well as prior expansions in some states) have changed this circumstance and expanded health insurance coverage for low-income women. These Medicaid expansions provide an opportunity to assess whether obtaining health insurance coverage improves prepregnancy and pregnancy health and reduces prevalence of adverse pregnancy outcomes. We tested this hypothesis using vital statistics data from 2011-2017 on singleton births to female US residents aged 15-44 years. We examined associations between preconception exposure to Medicaid expansion and measures of prepregnancy health, pregnancy health, and pregnancy outcomes using a difference-in-differences empirical approach. Increased Medicaid eligibility was not associated with improvements in prepregnancy or pregnancy health measures and did not reduce the prevalence of adverse birth outcomes (e.g., prevalence of preterm birth increased by 0.1 percentage point (95% confidence interval: -0.2, 0.3)). Increasing Medicaid eligibility alone may be insufficient to improve prepregnancy or pregnancy health and birth outcomes. Preconception programming in combination with attention to other structural determinants of pregnancy health is needed.
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17
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Margerison CE, Kaestner R, Chen J, MacCallum-Bridges C. Margerison et al. Respond to "Medicaid Policy and Reproductive Autonomy". Am J Epidemiol 2021; 190:1502-1503. [PMID: 33423058 PMCID: PMC8327192 DOI: 10.1093/aje/kwaa291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 12/17/2020] [Accepted: 12/28/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Claire E Margerison
- Correspondence to Dr. Claire E. Margerison, Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 909 Wilson Road, Room 601B, East Lansing, MI 48824 (e-mail: )
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18
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Brase P, MacCallum-Bridges C, Margerison CE. Racial inequity in preterm delivery among college-educated women: The role of racism. Paediatr Perinat Epidemiol 2021; 35:482-490. [PMID: 33956351 DOI: 10.1111/ppe.12772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/26/2021] [Accepted: 03/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Non-Hispanic Black (NHB) women face a 50% increased risk of delivering preterm compared to non-Hispanic White (NHW) women in the United States. Sociodemographic and pregnancy risk factors do not fully explain this inequity. This inequity exists even among women with a college education, although recent empirical analysis on racial inequities in preterm delivery (PTD) among college-educated women is lacking. Furthermore, the contribution of preconception risk factors to the racial inequity in PTD has not been examined. OBJECTIVES To determine whether: (i) there is a NHB-NHW inequity in PTD among college-educated women; (ii) the prevalence of known, measured sociodemographic, pregnancy, and preconception PTD risk factors differs between NHB and NHW college-educated women; (iii) equalising the distribution of risk factors between college-educated NHB and NHW women reduces or eliminates the racial inequity in PTD. METHODS We analysed US natality data from 2015 to 2016 among women with a college degree or higher (n = 2 326 512). We calculated frequencies of sociodemographic, pregnancy, and preconception risk factors among all women and separately by race/ethnicity. We used modified Poisson regression models to estimate the association between race/ethnicity and PTD controlling for known, measured sociodemographic, pregnancy, and preconception factors. RESULTS The largest percentage point differences in risk factors between NHW and NHB women were observed for marital status, trimester of care initiation, body mass index, and birth interval. Among college-educated women, the unadjusted risk of PTD for NHB women was 1.77 (95% CI 1.74, 1.79) times the risk for NHW women. After controlling for sociodemographic, pregnancy, and preconception factors, this attenuated to RR 1.47 (95% CI 1.45, 1.49). CONCLUSIONS A racial inequity in PTD persists among college-educated women. Racism contributes to the NHB-NHW inequity in PTD, in part, through its influence on known sociodemographic, pregnancy, and preconception risk factors for PTD and, in part, through unmeasured pathways.
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Affiliation(s)
- Piper Brase
- Lyman Briggs College, Michigan State University, East Lansing, MI, USA
| | | | - Claire E Margerison
- Department of Epidemiology & Biostatistics, Michigan State University, East Lansing, MI, USA
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19
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Margerison CE, Pearson AL, Lin Z, Sanciangco J. Changes in residential greenness between pregnancies and birth outcomes: longitudinal evidence from Michigan births 1990--2012. Int J Epidemiol 2021; 50:190-198. [PMID: 33130859 DOI: 10.1093/ije/dyaa158] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Residential exposure to greenness is associated with better birth outcomes, but it remains unknown whether this is explained by maternal characteristics associated with both place of residence and birth outcomes. We examined whether changes in residential greenness are associated with preterm birth (PTB) and birthweight. METHODS We examined cross-sectional associations between maternal exposure to residential greenness [normalized difference vegetation index (NDVI)] and PTB (<37 weeks of gestation) and birthweight in grams, using all births in Michigan (1990-2012) linked by mother (n = 1 730 424). We used maternal fixed effects analysis to estimate associations within mothers across multiple pregnancies and associations for mothers who did not move, but for whom greenness changed between pregnancies, to mimic an intervention. RESULTS Each 0.1-unit change in NDVI was associated with 0.98 [95% confidence interval (CI): 0.97, 0.99] times lower odds of PTB and a 9.0 (95% CI: 8.1, 9.9)-gram increase in birthweight after adjusting for individual and neighbourhood covariates. When we controlled for time-invariant maternal unmeasured confounders; these associations were close to null [odds ratio (OR): 1.00 (95% CI: 0.98, 1.01); β: -0.3 (95% CI: -2.0, 3.6)]. We did not find a relationship between greenness and birth outcomes among women who did not move between pregnancies, but for whom greenness changed within their residential location (as in an intervention). CONCLUSIONS Residential greenness does not predict birth outcomes, after controlling for time-invariant maternal characteristics, using longitudinal evidence. Future research should explore residential selection factors, spatial and individual heterogeneity and experimental study designs.
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Affiliation(s)
- Claire E Margerison
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Amber L Pearson
- Department of Public Health, University of Otago, Wellington, New Zealand.,Department of Geography, Environment and Spatial Sciences, Michigan State University, East Lansing, MI, USA
| | - Zihan Lin
- Department of Geography, Environment and Spatial Sciences, Michigan State University, East Lansing, MI, USA.,Center for Global Change and Earth Observations, Michigan State University, East Lansing, MI, USA
| | - Jonnell Sanciangco
- Department of Geography, Environment and Spatial Sciences, Michigan State University, East Lansing, MI, USA
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20
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Kim Y, Vohra-Gupta S, Margerison CE, Cubbin C. Neighborhood Racial/Ethnic Composition Trajectories and Black-White Differences in Preterm Birth among Women in Texas. J Urban Health 2020; 97:37-51. [PMID: 31898203 PMCID: PMC7010896 DOI: 10.1007/s11524-019-00411-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The black-white disparity in preterm birth has been well documented in the USA. The racial/ethnic composition of a neighborhood, as a marker of segregation, has been considered as an underlying cause of the racial difference in preterm birth. However, past literature using cross-sectional measures of neighborhood racial/ethnic composition has shown mixed results. Neighborhoods with static racial/ethnic compositions over time may have different social, political, economic, and service environments compared to neighborhoods undergoing changing racial/ethnic compositions, which may affect maternal health. We extend the past work by examining the contribution of neighborhood racial/ethnic composition trajectories over 20 years to the black-white difference in preterm birth. We used natality files (N = 477,652) from birth certificates for all live singleton births to non-Hispanic black and non-Hispanic white women in Texas from 2009 to 2011 linked to the Neighborhood Change Database. We measured neighborhood racial/ethnic trajectories over 20 years. Hierarchical generalized linear models examined relationships between neighborhood racial/ethnic trajectories and preterm birth, overall and by mother's race. Findings showed that overall, living in neighborhoods with a steady high proportion non-Hispanic black was associated with higher odds of preterm birth, compared with neighborhoods with a steady low proportion non-Hispanic black. Furthermore, while black women's odds of preterm birth was relatively unaffected by neighborhood proportions of the Latinx or non-Hispanic white population, white women had the highest odds of preterm birth in neighborhoods characterized by a steady high proportion Latinx or a steady low proportion non-Hispanic white. Black-white differences were the highest in neighborhoods characterized by a steady high proportion white. Findings suggest that white women are most protected from preterm birth when living in neighborhoods with a steady high concentration of whites or in neighborhoods with a steady low concentration of Latinxs, whereas black women experience high rates of preterm birth regardless of proportion white or Latinx.
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Affiliation(s)
- Yeonwoo Kim
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA.,Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Shetal Vohra-Gupta
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Claire E Margerison
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Catherine Cubbin
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA. .,Population Research Center, The University of Texas at Austin, Austin, TX, USA.
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21
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Margerison CE, MacCallum CL, Chen J, Zamani-Hank Y, Kaestner R. Impacts of Medicaid Expansion on Health Among Women of Reproductive Age. Am J Prev Med 2020; 58:1-11. [PMID: 31761513 PMCID: PMC6925642 DOI: 10.1016/j.amepre.2019.08.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Preconception and interconception health care are critical means of identifying, managing, and treating risk factors originating before pregnancy that can harm fetal development and maternal health. However, many women in the U.S. lack health insurance, limiting their ability to access such care. State-level variation in Medicaid eligibility, particularly before and after the 2014 Medicaid expansions, offers a unique opportunity to test the hypothesis that increasing healthcare coverage for low-income women can improve preconception and interconception healthcare access and utilization, chronic disease management, overall health, and health behaviors. METHODS In 2018-2019, data on 58,365 low-income women aged 18-44 years from the 2011-2016 Behavioral Risk Factor Surveillance System were analyzed, and a difference-in-difference analysis was used to examine the impact of Medicaid expansions on preconception health. RESULTS Expanded Medicaid eligibility was associated with increased healthcare coverage and utilization, better self-rated health, and decreases in avoidance of care because of cost, heavy drinking, and binge drinking. Medicaid eligibility did not impact diagnoses of chronic conditions, smoking cessation, or BMI. Medicaid eligibility was associated with greater gains in health insurance, utilization, and health among married (vs unmarried) women. Conversely, women with any (vs no) dependent children experienced smaller gains in insurance following the Medicaid expansion, but greater take-up of insurance when eligibility increased and larger behavioral responses to gaining insurance. CONCLUSIONS Expanded Medicaid coverage may improve access to and utilization of health care among women of reproductive age, which could ultimately improve preconception health.
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Affiliation(s)
- Claire E Margerison
- Department of Epidemiology & Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan.
| | - Colleen L MacCallum
- Department of Epidemiology & Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Jiajia Chen
- Department of Economics, University of Illinois at Chicago, Chicago, Illinois
| | - Yasamean Zamani-Hank
- Department of Epidemiology & Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Robert Kaestner
- Harris School of Public Policy, University of Chicago, Chicago, Illinois
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22
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MacCallum-Bridges CL, Margerison CE. The Affordable Care Act contraception mandate & unintended pregnancy in women of reproductive age: An analysis of the National Survey of Family Growth, 2008-2010 v. 2013-2015. Contraception 2019; 101:34-39. [PMID: 31655071 DOI: 10.1016/j.contraception.2019.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/06/2019] [Accepted: 09/08/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE(S) The Affordable Care Act contraception mandate could reduce unintended pregnancies by increasing access and affordability of contraceptive resources, e.g., long-acting reversible contraceptives (LARCs). We assessed: (1) whether unintended pregnancies decreased post-mandate, and (2) whether this decrease differed by demographic characteristics. STUDY DESIGN We used data from the National Survey of Family Growth (unweighted n = 7409) in logistic regression analyses to compare odds of unintended pregnancy pre-mandate (2008-2010) vs post-mandate (2013-2015), overall and stratified by demographic characteristics. RESULTS Paralleling an increase in long-acting reversible contraceptive use (p < 0.01), post-mandate, the odds of experiencing unintended pregnancy in the prior year decreased 15% overall (OR: 0.85, 95% CI: 0.62, 1.17), with the greatest reduction observed among women with government-sponsored insurance (OR: 0.63, 95% CI: 0.41, 0.97). CONCLUSIONS Unintended pregnancy decreased following the contraception mandate, although possibly due to chance. The short study period relative to the mandate could under-estimate the mandate's effect.
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Affiliation(s)
- Colleen L MacCallum-Bridges
- Department of Epidemiology and Biostatistics, Michigan State University, 939 Fee Road, East Lansing, MI 48825, United States.
| | - Claire E Margerison
- Department of Epidemiology and Biostatistics, Michigan State University, 939 Fee Road, East Lansing, MI 48825, United States
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23
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Cantu P, Kim Y, Sheehan C, Powers D, Margerison CE, Cubbin C. Downward Neighborhood Poverty Mobility during Childhood Is Associated with Child Asthma: Evidence from the Geographic Research on Wellbeing (GROW) Survey. J Urban Health 2019; 96:558-569. [PMID: 31049846 PMCID: PMC6890910 DOI: 10.1007/s11524-019-00356-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Causal evidence regarding neighborhood effects on health remains tenuous. Given that children have little agency in deciding where they live and spend proportionally more of their lives in neighborhoods than adults, their exposure to neighborhood conditions could make their health particularly sensitive to neighborhood effects. In this paper, we examine the relationship between exposure to poor neighborhoods from birth to ages 4-10 and childhood asthma. We used data from the 2003-2007 California Maternal Infant and Health Assessment (MIHA) and the 2012-2013 Geographic Research on Wellbeing (GROW) survey (N = 2619 mother/child dyads) to fit relative risks of asthma for children who experience different types of neighborhood poverty mobility using Poisson regression controlling for individual-level demographic and socioeconomic characteristics, and neighborhood satisfaction. Our results demonstrate that [1] living in a poor neighborhood at baseline and follow-up and [2] moving into a poor neighborhood were each associated with higher risk of asthma, compared with children not living in a poor neighborhood at either time. Exposure to impoverished neighborhoods and downward neighborhood poverty mobility matters for children's health, particularly for asthma. Public health practitioners and policymakers need to address downward neighborhood economic mobility, in addition to downward family economic mobility, in order to improve children's health.
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Affiliation(s)
- P Cantu
- Population Research Center, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA.,Department of Sociology, The University of Texas at Austin, Austin, TX, USA
| | - Y Kim
- School of Kinesiology and Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - C Sheehan
- School of Social and Family Dynamics, Arizona State University, Tempe, AZ, USA
| | - D Powers
- Population Research Center, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA.,Department of Sociology, The University of Texas at Austin, Austin, TX, USA
| | - C E Margerison
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Catherine Cubbin
- Population Research Center, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA. .,Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA.
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Margerison CE, Luo Z, Li Y. Economic conditions during pregnancy and preterm birth: A maternal fixed-effects analysis. Paediatr Perinat Epidemiol 2019; 33:154-161. [PMID: 30675915 DOI: 10.1111/ppe.12534] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/31/2018] [Accepted: 12/03/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Making causal inference regarding impacts of macrolevel economic conditions during pregnancy on pregnancy outcomes is hampered by the presence of unmeasured variables that may influence women's probability of giving birth under certain economic conditions (ie, exposure) as well as her pregnancy outcomes. Maternal fixed-effects (FE) analyses, in which the association between exposure and outcomes is estimated within mothers who had discordant outcomes, can control for such unmeasured variables when they are invariant across pregnancies. METHODS We utilised a maternally linked data set of all singleton births in Michigan from 1990 to 2012 (n = 2 657 272 for full sample; n = 269 943 for FE analytic sample) to examine the relationship between state-level unemployment rates during pregnancy and preterm birth (PTB, <37 weeks' gestation). Measured maternal characteristics that change across pregnancies, for example, age, marital status, education, parity, and infant sex, were included as covariates in the model. RESULTS Using an FE approach, we found that each one percentage point increase in state unemployment in the first trimester of pregnancy was associated with a modest 3% increase in odds of PTB. Our results were consistent with previously published results in a national sample and held across random- versus fixed-effect models, analytic samples, and outcome measures. CONCLUSIONS Our findings provide further evidence that economic downturn during early pregnancy may be associated with modest increases in PTB.
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Affiliation(s)
- Claire E Margerison
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Zhehui Luo
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Yu Li
- Centers for Epidemiology and Environmental Health, School of Public Health, Brown University, Providence, Rhode Island
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Margerison CE, Goldman-Mellor S. Association Between Rural Residence and Nonfatal Suicidal Behavior Among California Adults: A Population-Based Study. J Rural Health 2019; 35:262-269. [PMID: 30703850 PMCID: PMC6436983 DOI: 10.1111/jrh.12352] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Suicide mortality rates in rural areas of the United States are twice that of rates in urban areas, and identifying which factors-eg, higher rates of suicidal distress, lower rates of help-seeking behaviors, or greater access to firearms-contribute to this rural/urban disparity could help target interventions. METHOD Using 2015-2016 data on adult respondents to the California Health Interview Survey (n = 40,041), we examined associations between residence in a rural (vs nonrural) census tract and nonfatal suicidal ideation and attempt. RESULTS We found that living in a rural area was not associated with nonfatal suicidal behavior (OR for past-year suicidal ideation = 0.87, 95% CI: 0.63-1.20; OR for past-year suicide attempt = 0.55, CI: 0.20-1.48). Women living in rural areas had higher odds of lifetime suicidal ideation compared to women living in nonrural areas, but this difference was not significant (OR = 1.17, CI: 0.94-1.44). We also found that, among individuals reporting suicidal behavior, there were few rural/nonrural differences in perceived need for treatment, such as seeing a physician or taking a prescription for mental health problems. CONCLUSIONS Our results do not suggest higher suicidal distress or lower treatment-seeking behaviors as explanations for the rural/urban disparity in suicide mortality rates. Further attention is needed to the unique risk factors driving suicidality in rural areas, as well as exploring heterogeneity in these factors across different rural contexts.
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Affiliation(s)
- Claire E. Margerison
- Department of Epidemiology & Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, California
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Fleischer NL, Abshire C, Margerison CE, Nitcheva D, Smith MG. The South Carolina Multigenerational Linked Birth Dataset: Developing Social Mobility Measures Across Generations to Understand Racial/Ethnic Disparities in Adverse Birth Outcomes in the US South. Matern Child Health J 2018; 23:787-801. [PMID: 30569299 DOI: 10.1007/s10995-018-02695-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives To describe the creation of a multigenerational linked dataset with social mobility measures for South Carolina (SC), as an example for states in the South and other areas of the country. Methods Using unique identifiers, we linked birth certificates along the maternal line using SC birth certificate data from 1989 to 2014, and compared the subset of records for which linking was possible with two comparison groups on sociodemographic and birth outcome measures. We created four multi-generational social mobility measures using maternal education, paternal education, presence of paternal information, and a summary score incorporating the prior three measures plus payment source for births after 2004. We compared social mobility measures by race/ethnicity. Results Of the 1,366,288 singleton birth certificates in SC from 1989 to 2014, we linked 103,194, resulting in 61,229 unique three-generation units. Mothers and fathers were younger and had lower education, and low birth weight was more common, in the multigenerational linked dataset than in the two comparison groups. Based on the social mobility summary score, only 6.3% of White families were always disadvantaged, compared to 30.4% of Black families and 13.2% of Hispanic families. Moreover, 32.8% of White families were upwardly mobile and 39.1% of Black families were upwardly mobile, but only 29.9% of Hispanic families were upwardly mobile. Conclusions for Practice When states are able to link individuals, birth certificate data may be an excellent source for examining population-level relationships between social mobility and adverse birth outcomes. Due to its location in the Deep South, the multigenerational SC dataset may be particularly useful for understanding racial/ethnic difference in social mobility and birth outcomes.
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Affiliation(s)
- Nancy L Fleischer
- Department of Epidemiology, School of Public Health, Center for Social Epidemiology and Population Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Chelsea Abshire
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Claire E Margerison
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Daniela Nitcheva
- Division of Biostatistics, South Carolina Department of Health and Environmental Control, Columbia, SC, USA
| | - Michael G Smith
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN, USA
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Li Y, Luo Z, Holzman C, Liu H, Margerison CE. Paternal race/ethnicity and risk of adverse birth outcomes in the United States, 1989-2013. AIMS Public Health 2018; 5:312-323. [PMID: 30280118 PMCID: PMC6141552 DOI: 10.3934/publichealth.2018.3.312] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/10/2018] [Indexed: 11/29/2022] Open
Abstract
Objectives Investigate adverse birth outcomes in the United States (US) from 1989–2013 in relation to paternal and maternal race/ethnicity. Design We used US natality data for singleton births to women 15–44 with information on birthweight, gestational age, and covariates (n = 90,771,339). We calculated unadjusted and adjusted probabilities of preterm birth (PTB, < 37 weeks gestation) and small for gestational age (SGA, < 10th percentile) among all combinations of maternal and paternal race/ethnicity: non-Hispanic black (NHB), non-Hispanic white (NHW), Hispanic, and Asian, and where paternal race/ethnicity was missing. Results Missing, followed by NHB, paternal race/ethnicity had the two highest risks of PTB within each maternal racial/ethnic group. Asian, followed by NHW, paternal race/ethnicity had the two lowest risks of PTB. For SGA, however, Asian, followed by missing, paternal race/ethnicity had the two highest risks, and NHW race/ethnicity had the lowest risk. Our findings also demonstrate effect modification on the additive scale, with missing and NHB paternal race/ethnicity conferring a larger increase in risk of PTB for NHB women compared to women of other race/ethnicity groups. Conclusions These data confirm US disparities in adverse birth outcomes by maternal and paternal race/ethnicity and argue for increased resources and interventions in response.
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Affiliation(s)
- Yu Li
- Department of Epidemiology, Brown University, USA
| | - Zhehui Luo
- Department of Epidemiology and Biostatistics, Michigan State University, USA
| | - Claudia Holzman
- Department of Epidemiology and Biostatistics, Michigan State University, USA
| | - Hui Liu
- Department of Sociology, Michigan State University, USA
| | - Claire E Margerison
- Department of Epidemiology and Biostatistics, Michigan State University, USA
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Abstract
BACKGROUND The black-white disparity in hypertension (HTN) among U.S. women persists after accounting for known risk factors. Pregnancy complications may reveal increased risks for later HTN. We examined the contribution of HTN risk factors measured at both midlife and pregnancy to black-white disparities in midlife HTN. METHODS Data came from a Michigan-based longitudinal study beginning in pregnancy. At 7-15 years postpregnancy (n = 615, mean age = 37), women were assessed for cardiovascular health, including blood pressure, and categorized as hypertensive (n = 126), prehypertensive (n = 149), and normotensive (n = 340). Midlife risk factors for HTN were assessed in four domains: socioeconomic status (SES), psychosocial, behavioral, and physiological. We used generalized logit models to assess the degree to which each domain attenuated the black (vs. white) odds ratio (OR) for HTN at midlife. We then added indicators of pregnancy health, that is, preterm delivery, prepregnancy body mass index (BMI), C-reactive protein (CRP) levels, depressive symptoms, smoking, hypertensive disorders, and lipid levels. RESULTS Black women had 3.3 (95% CI: 2.0-5.5) times the odds of HTN compared to white women after adjusting for age. Following adjustment for midlife SES, and psychosocial, behavioral, and physiological factors, the OR was 2.1 (95% CI: 1.2-4.0). Adjustment for prepregnancy BMI, CRP, and depressive symptoms during pregnancy reduced the OR to 1.9 (95% CI: 1.0-3.7). CONCLUSIONS Known risk factors measured at midlife explained some, but not all, of the race disparity in midlife HTN. Indicators of pregnancy health also contributed to the race disparity in HTN at midlife.
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Affiliation(s)
- Claire E Margerison
- 1 Department of Epidemiology and Biostatistics, Michigan State University , East Lansing, Michigan
| | - Janet Catov
- 2 Department of Obstetrics and Gynecology, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Claudia Holzman
- 1 Department of Epidemiology and Biostatistics, Michigan State University , East Lansing, Michigan
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