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Racial Disparities in Prematurity Persist among Women of High Socioeconomic Status.
Am J Obstet Gynecol MFM. 2020 08; 2(3):100104.AJ

Abstract

Objectives

Despite persistent racial disparities in preterm birth (PTB) in the US among non-Hispanic (NH) black women compared to NH white women, it remains controversial whether sociodemographic factors can explain these differences. We sought to evaluate whether disparities in PTB persist among NH black women with high socioeconomic status (SES).

Study Design

We conducted a population-based cohort study of all live births in the US from 2015-2017 using birth certificate data from the National Vital Statistics System. We included singleton, non-anomalous live births among women who were of high SES (defined as having ≥ 16 years of education, private insurance, and not receiving Women, Infants and Children [WIC] benefits) and who identified as NH white, NH black, or 'mixed' NH black and white race. The primary outcome was PTB <37 weeks; secondary outcomes included PTB <34 and <28 weeks. In addition, analyses were repeated considering birthweight <2500g as a surrogate for preterm birth <37 weeks, birthweight <1500g as a surrogate for preterm birth <34 weeks, and birthweight <750g as a surrogate for preterm birth <28 weeks' gestation. Data were analyzed with chi-square, t-test, and logistic regression.

Results

2,170,686 live births met inclusion criteria, with 92.9% NH white, 6.7% NH black, and 0.4% both NH white and black race. Overall, 5.9% delivered <37, 1.3% <34, and 0.3 % <28 weeks. In unadjusted analyses of women with high SES, the PTB rate at each gestational age cutoff was higher for women of 'mixed' NH white and black race, and highest for women who were NH black only compared to women who were NH white only. In regression models we further adjusted for women with insurance and prenatal care their entire pregnancy, maternal race was associated with higher odds of PTB at each GA cutoff, with the highest odds observed at <28 weeks. Finally, in further adjustement analysis including only the 1,934,912 women who received prenatal care in the first trimester, findings were similar. Rates of preterm birth at each gestational age cutoff remained highest for women who identified as non-Hispanic black, intermediate for women identifying as both non-Hispanic black and white race, and lowest for non-Hispanic white women at <37 weeks (9.9% vs. 6.1% vs. 5.5%, respectively; p<0.001), <34 weeks (3.5% vs. 1.5% vs. 1.1%, respectively; p<0.001), and <28 weeks' gestation (1.2% vs. 0.4% vs. 0.2%, respectively, p<0.001).

Conclusions

Even among college-educated women with private insurance who are not receiving WIC, racial disparities in prematurity persist. These national findings are consistent with prior studies that suggest factors other than socio-demographics are important in the underlying pathogenesis of PTB.

Authors+Show Affiliations

Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC.Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC.Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC.Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

33179010

Citation

Johnson, Jasmine D., et al. "Racial Disparities in Prematurity Persist Among Women of High Socioeconomic Status." American Journal of Obstetrics & Gynecology MFM, vol. 2, no. 3, 2020, p. 100104.
Johnson JD, Green CA, Vladutiu CJ, et al. Racial Disparities in Prematurity Persist among Women of High Socioeconomic Status. Am J Obstet Gynecol MFM. 2020;2(3):100104.
Johnson, J. D., Green, C. A., Vladutiu, C. J., & Manuck, T. A. (2020). Racial Disparities in Prematurity Persist among Women of High Socioeconomic Status. American Journal of Obstetrics & Gynecology MFM, 2(3), 100104. https://doi.org/10.1016/j.ajogmf.2020.100104
Johnson JD, et al. Racial Disparities in Prematurity Persist Among Women of High Socioeconomic Status. Am J Obstet Gynecol MFM. 2020;2(3):100104. PubMed PMID: 33179010.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial Disparities in Prematurity Persist among Women of High Socioeconomic Status. AU - Johnson,Jasmine D, AU - Green,Celeste A, AU - Vladutiu,Catherine J, AU - Manuck,Tracy A, Y1 - 2020/03/23/ PY - 2020/11/12/entrez PY - 2020/11/13/pubmed PY - 2020/11/13/medline KW - health disparities KW - prematurity KW - preterm birth KW - preterm delivery SP - 100104 EP - 100104 JF - American journal of obstetrics & gynecology MFM JO - Am J Obstet Gynecol MFM VL - 2 IS - 3 N2 - Objectives: Despite persistent racial disparities in preterm birth (PTB) in the US among non-Hispanic (NH) black women compared to NH white women, it remains controversial whether sociodemographic factors can explain these differences. We sought to evaluate whether disparities in PTB persist among NH black women with high socioeconomic status (SES). Study Design: We conducted a population-based cohort study of all live births in the US from 2015-2017 using birth certificate data from the National Vital Statistics System. We included singleton, non-anomalous live births among women who were of high SES (defined as having ≥ 16 years of education, private insurance, and not receiving Women, Infants and Children [WIC] benefits) and who identified as NH white, NH black, or 'mixed' NH black and white race. The primary outcome was PTB <37 weeks; secondary outcomes included PTB <34 and <28 weeks. In addition, analyses were repeated considering birthweight <2500g as a surrogate for preterm birth <37 weeks, birthweight <1500g as a surrogate for preterm birth <34 weeks, and birthweight <750g as a surrogate for preterm birth <28 weeks' gestation. Data were analyzed with chi-square, t-test, and logistic regression. Results: 2,170,686 live births met inclusion criteria, with 92.9% NH white, 6.7% NH black, and 0.4% both NH white and black race. Overall, 5.9% delivered <37, 1.3% <34, and 0.3 % <28 weeks. In unadjusted analyses of women with high SES, the PTB rate at each gestational age cutoff was higher for women of 'mixed' NH white and black race, and highest for women who were NH black only compared to women who were NH white only. In regression models we further adjusted for women with insurance and prenatal care their entire pregnancy, maternal race was associated with higher odds of PTB at each GA cutoff, with the highest odds observed at <28 weeks. Finally, in further adjustement analysis including only the 1,934,912 women who received prenatal care in the first trimester, findings were similar. Rates of preterm birth at each gestational age cutoff remained highest for women who identified as non-Hispanic black, intermediate for women identifying as both non-Hispanic black and white race, and lowest for non-Hispanic white women at <37 weeks (9.9% vs. 6.1% vs. 5.5%, respectively; p<0.001), <34 weeks (3.5% vs. 1.5% vs. 1.1%, respectively; p<0.001), and <28 weeks' gestation (1.2% vs. 0.4% vs. 0.2%, respectively, p<0.001). Conclusions: Even among college-educated women with private insurance who are not receiving WIC, racial disparities in prematurity persist. These national findings are consistent with prior studies that suggest factors other than socio-demographics are important in the underlying pathogenesis of PTB. SN - 2589-9333 UR - https://www.unboundmedicine.com/medline/citation/33179010/Racial_Disparities_in_Prematurity_Persist_among_Women_of_High_Socioeconomic_Status_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/33179010/ DB - PRIME DP - Unbound Medicine ER -