Elsevier

Social Science & Medicine

Volume 63, Issue 12, December 2006, Pages 3013-3029
Social Science & Medicine

Racial disparities in low birthweight and the contribution of residential segregation: A multilevel analysis

https://doi.org/10.1016/j.socscimed.2006.08.017Get rights and content

Abstract

This study investigates the geography of racial disparities in low birthweight in New York City by focusing on racial residential segregation and its effect on the risk of low birthweight among African-American infants and mothers. This cross-sectional multilevel analysis uses birth records at the individual level (n=96,882) and racial isolation indices at the census tract or neighborhood level (n=2095) to measure their independent and cross-level effects on low birthweight. This study found that residential segregation and neighborhood poverty operate at different scales to increase the risk of low birthweight. At the neighborhood scale residential segregation is positively and significantly associated with low birthweight, after controlling for individual-level risk factors and neighborhood poverty. Residential segregation explains neighborhood variation in low birthweight means and race effects across census tracts, which cannot be accounted for by neighborhood poverty alone. At the individual scale-increasing levels of residential segregation does not significantly reduce or exacerbate individual-level risk factors for low birthweight; whereas increasing levels of neighborhood poverty significantly eliminates the race effect and reduces the protective effect of being foreign-born on low birthweight, after controlling for other individual-level risk factors and residential segregation. These findings are contradictory to previous health research that shows protective mechanisms associated with ethnic density in local areas. It is likely that structural factors underlying residential segregation, i.e., racial isolation, impose additional stressors on African-American women that may offset or disguise positive attributes associated with ethnic density. However, as poverty is concentrated within these neighborhoods, differences between races in low birthweight cease to exist. This study demonstrates that residential segregation and neighborhood poverty are important determinants of racial disparity in low birthweight in New York City.

Introduction

Low birthweight, the percentage of babies weighting less than 2500 g at birth, is a major public health problem in the US, contributing substantially to infant mortality and childhood morbidity. Low birthweight reflects not only the infant's health, but also the mother's health, and is a useful indicator of women's reproductive health and how it varies among neighborhoods and communities (McLafferty & Tempalski, 1995). In New York City, low birthweight is unevenly distributed at the borough and health center district levels (New York Department of Health & Office of Vital Statistics and Epidemiology, 2000). These geographic inequalities reflect the combined and interacting effects of differences in income, class, race and ethnicity, and other social dimensions. Of these, the effect of race and how it translates into the social and economic environment to affect birth outcome is poorly understood. In New York City, the low birthweight rate for ‘African-American’ and ‘Hispanic’ infants exceeds the rate for ‘white’ and ‘Asian’ infants and this disparity has persisted for several decades.

The purpose of this research is to investigate the geography of racial disparities in low birthweight in New York City. This cross-sectional multilevel study focuses on racial residential segregation and its effect on the risk of low birthweight among African-American infants and mothers. Recent studies suggest that residential segregation contributes to the sharp racial inequalities in health that exist in the US (Acevedo-Garcia, 2000; Acevedo-Garcia, Lochner, Osypuk, & Subramanian, 2003; Fang, Madhavan, Bosworth, & Alderman, 1998; Williams and Collins, 2001). We know that residential segregation makes neighborhoods particularly vulnerable to disinvestments and decay but we do not know if African-American women who live in segregated areas have poorer reproductive health outcomes than similar women who do not live in segregated areas. Residential segregation may contribute to racial disparities in low birthweight because it isolates African-American women from amenities, opportunities, and resources, and such isolation may result in stress-related conditions and/or detrimental lifestyle behaviors affecting birth outcome.

This study starts from the premise that race is a social construct. Race is a category of difference defined or assigned to individuals by social groups. Racial definitions vary from one society to another and shift with changes in socio-political relations. In the US four major racial groups are identified by the Census: American Indian or Alaskan Native, Asian, Black or African-American, and White.1 When race is socially stratified Whites are considered the majority and all other racial groups are referred to as minorities. Of the minority groups, African-Americans face a unique set of social, economic, and political disadvantages that are rooted in slavery and maintained by racism. The degree to which these historical perceptions shape society to impact the reproductive health of African-American women today is an underlying theme of this research.

Section snippets

Background

Residential segregation is the degree to which racial groups live separated from one another in the urban environment (Kaplan & Holloway, 1998). Residential segregation by race is the outcome of historical, social, economic, and political processes. In US cities, these processes can be traced back to emancipation and the freeing of African-American slaves in the late 19th century. For northern cities like New York, the pace and scope of racial segregation changed markedly in the 20th century.

Study area

The study area includes the five boroughs of New York City, specifically, The Bronx, Brooklyn, Manhattan, Queens, and Staten Island. New York City was selected as the study area because of its high levels of local racial residential segregation.

Residential segregation

A local spatial segregation index (Wong, 2002) was calculated at the census tract level using blacks (B) and all others (A) as population groups, where bi and ai are the population counts of the two groups in areal unit i, respectively. Using a simple

Descriptive analysis

In New York City, 355 (15.51%) census tracts were identified as highly segregated (Fig. 1). High segregation was determined as those census tracts with a segregation index greater than or equal to 0.6. This cut-off is commonly used in the literature to measure highly segregated areas at the metropolitan level (Massey & Denton (1988), Massey & Denton (1989)). The highly segregated tracts were primarily located in Northern Manhattan in Central and East Harlem and Washington Heights, and in the

Discussion

The purpose of this research was to investigate the geography of racial disparities in low birthweight in New York City. Race was viewed as a social construct; therefore, it was hypothesized that racial disparities in low birthweight could be explained by geographic inequalities in income, class, race and ethnicity and other social dimensions. This cross-sectional multilevel study focused on racial residential segregation and its effect on the risk of low birthweight among African-American

Acknowledgments

I acknowledge Sara McLafferty, my Ph.D. advisor for her respectful guidance and review; David Rindskopf, for his instruction on multilevel modelling; and David Wong, who provided the script to calculate the segregation indices. I also acknowledge the New York City Department of Health for providing the birth data.

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