Racial disparities in low birthweight and the contribution of residential segregation: A multilevel analysis
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.
References (48)
Residential segregation and the epidemiology of infectious diseases
Social Science & Medicine
(2000)- et al.
Residential segregation and mortality in New York City
Social Science & Medicine
(1998) - et al.
Contributions of social context to inequalities in years of life lost to heart disease in Texas, USA
Social Science & Medicine
(2003) - et al.
Ethnicity, environment, and health: Putting ethnic inequalities in health in their place
Social Science & Medicine
(2002) An examination of social capital and social disorganization in neighbourhoods in the British household panel study
Social Science & Medicine
(2003)- et al.
Restructuring and women's reproductive health: Implications for low birthweight in New York City
Geoforum
(1995) Love thy neighbour—it's good for your health: A study of racial homogeneity, mortality and social cohesion in the United States
Social Science & Medicine
(2003)- et al.
Risk factors for low birth weight: A review
European Journal of Obstetrics & Gynecology and Reproductive Biology
(2004) - et al.
Future directions in residential segregation and health research: A multilevel approach
American Journal of Public Health
(2003) - et al.
Spatial patterns of immigrant assimilation
The Professional Geographer
(1996)