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Neighborhood Racial/Ethnic Composition Trajectories and Black-White Differences in Preterm Birth among Women in Texas

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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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Acknowledgments

This work was supported by the St. David’s Center for Health Promotion & Disease Prevention Research in Underserved Populations, University of Texas, School of Nursing. The authors also acknowledge the Population Research Center at the University of Texas at Austin, P2CHD042849, NICHD. St. David’s Center for Health Promotion & Disease Prevention Research in Underserved Populations had no role in the design, analysis or writing of this article.

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Kim, Y., Vohra-Gupta, S., Margerison, C.E. et al. Neighborhood Racial/Ethnic Composition Trajectories and Black-White Differences in Preterm Birth among Women in Texas. J Urban Health 97, 37–51 (2020). https://doi.org/10.1007/s11524-019-00411-y

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