Journal Article

Testing the Association Between Traditional and Novel Indicators of County-Level Structural Racism and Birth Outcomes among Black and White Women

Brown-Jeffy, Shelly, Tanner, Amanda E., Erausquin, Jennifer Toller, Nichols, Tracy R., Chambers, Brittany D.

2018

Overview

Despite decreases in infants born premature and at low birth weight in the United States (U.S.), racial disparities between Black and White women continue. In response, the purpose of this analysis was to examine associations between both traditional and novel indicators of county-level structural racism and birth outcomes among Black and White women. We merged individual-level data from the California Birth Statistical Master Files 2009–2013 with county-level data from the United States (U.S.) Census American Community Survey. We used hierarchical linear modeling to examine Black-White differences among 531,170 primiparous women across 33 California counties. Traditional (e.g., dissimilarity index) and novel indicators (e.g., Black to White ratio in elected office) were associated with earlier gestational age and lower birth weight among Black and White women. A traditional indicator was more strongly associated with earlier gestational age for Black women than for White women. This was the first study to empirically demonstrate that structural racism, measured by both traditional and novel indicators, is associated with poor health and wellbeing of infants born to Black and White women. However, findings indicate traditional indicators of structural racism, rather than novel indicators, better explain racial disparities in birth outcomes. Results also suggest the need to develop more innovative approaches to: (1) measure structural racism at the county-level and (2) reform public policies to increase integration and access to resources.

• Publisher: Springer Science + Business Media,Springer International Publishing,Springer Nature B.V
• Subject: Babies / Birth weight / Black people / Black white differences / Black women / Censuses / Childbirth & labor / Counties / Educational attainment / Epidemiology / Gestational age / Health disparities / Health status / Imprisonment / Indicators / Individual differences / Inequality / Infant mortality / Infants / Linear analysis / Low birth weight / Medicine / Medicine & Public Health / ORIGINAL PAPERS / Pregnancy / Premature babies / Premature birth / Public policy / Quality of Life Research / Race factors / Race relations / Racial differences / Racial inequality / Racism / Segregation / Social Inequality / Social Structure / Society / Systemic racism / Well being / White people / Women / Womens health