The Racial Social Structure and Unequal Risk of Adverse Birth Outcomes among Black Infants

项目总结/摘要 与白人相比，黑人母亲早产和小于胎龄儿的几率更高 (SGA)导致婴儿死亡率的种族差异。存在着令人信服的种族歧视证据， 居住隔离是这种不利生育结果的决定因素。更全面的评估 种族社会结构需要确定额外的结构因素和母亲调解的作用 途径。我们将通过测试两个特定目标来阐明黑色PTB和SGA风险的结构预测因子。 目的1：系统地检验早产和小于胎龄儿风险不相等的结构性预测因素- 黑人母亲的生育年龄，以及孕产妇和地区一级调解人的作用。结构性因素将是 使用不同的公共数据源在县或大都市统计区（MSA）进行评估，包括：1） 地区反黑人偏见从聚集的基于网络的测量偏见和种族主义; 2）黑人住宅 隔离作为隔离指数; 3）黑人社会经济不利因素的多维复合; 4)社区暴力犯罪暴露和黑人居民的监禁风险;和5）结构性障碍， 医疗保健，衡量标准为a）初级保健的空间可及性，B）黑人医生的可用性，c-d）无保险 黑人母亲的产前护理率不足，以及e）公共卫生和避孕药具的供应情况 服务黑白（B-W）在结构因素的差异也将被检查。使用国家出生记录 （2014-2017年），样本将包括非西班牙裔美国出生的黑人和白色母亲的单胎分娩， 至少有10，000名黑人居民。多水平模型将允许预测PTB和SGA风险， 黑人母亲，风险的地区差异，以及特定地区的B-W风险差异。结构因素的中介作用 将对产妇和地区一级的社会人口和健康变量进行测试。有PTB病史的母亲也 将被视为结构性因素可能会限制这一人群获得所需的卫生干预措施。 目的2：估计种族社会压力对黑人早产风险的影响。时间上的变化 和地点的高度宣传杀害黑人，可能被视为不公正或种族动机，将是 被用来做一个自然实验高宣传后黑人早产风险预计会增加 黑人杀人，特别是在怀孕的前四个月内暴露，最公开的杀人， 在凶案现场附近由于有可能引起媒体的广泛报道，杀害黑人将 来自于警察和极端分子的杀戮数据。媒体报道的数量 60-杀戮的天数将用于确定高度公开的杀戮（前十分之一;约35起杀戮）。 该项目将提供种族社会结构和种族社会压力的新颖和严格的测试， 黑人母亲患PTB和SGA风险不相等的预测因子。通过审查调解途径和障碍， 该项目可以为健康预防工作提供信息，以改善黑人的生育结果。

PROJECT SUMMARY/ABSTRACT Relative to Whites, Black mothers have higher odds of preterm birth (PTB) and small-for-gestational-age birth (SGA), leading to racial differences in infant mortality. Compelling evidence exists for racial discrimination and residential segregation as determinants of such adverse birth outcomes. Yet, more complete assessments of the racial social structure are needed to identify the role of additional structural factors and maternal mediating pathways. We will elucidate structural predictors of Black PTB and SGA risk by testing two Specific Aims. Aim 1: Systematically test structural predictors of unequal risk of preterm and small-for-gestational- age birth for Black mothers, and the role of maternal- and area-level mediators. Structural factors will be assessed at the county or metropolitan statistical area (MSA) using diverse public data sources and include: 1) area anti-Black prejudice from aggregated web-based measurements of bias and racism; 2) Black residential segregation as the isolation index; 3) Black socioeconomic disadvantage from a multidimensional composite; 4) neighborhood violent crime exposure and incarceration risk for Black residents; and 5) structural barriers to healthcare, measured as a) spatial access to primary care, b) availability of Black physicians, c-d) uninsurance and inadequate prenatal care rates for Black mothers, and e) availability of public health and contraceptive services. Black-White (B-W) differences in structural factors also will be examined. Using national birth records (2014-2017), the sample will include singleton births to non-Hispanic US born Black and White mothers in MSAs with at least 10,000 Black residents. Multilevel models will allow for prediction of PTB and SGA risk for Black mothers, area variance in risk, and area-specific B-W differences in risk. Mediation of structural factors by maternal- and area-level sociodemographic and health variables will be tested. Mothers with prior PTB also will be considered as structural factors may restrict access to needed health interventions for this population. Aim 2: Estimate the effect of racial societal stressors on Black preterm birth risk. Variation in timing and location of high publicity killings of Black persons, likely to be viewed as unjust or racially motivated, will be exploited to create a natural experiment. Black preterm birth risk is expected to increase after high publicity Black killings, particularly for exposure in the first four gestational months, for the most publicized killings, and in areas proximate to the killing. Due to their potential for intense media coverage, killings of Black persons will come from datasets of police-perpetrated and extremist-perpetrated killings. Number of media stories within 60-days of the killing will be used to identify high publicity killings (top decile; ~35 killings). The project will provide novel and rigorous tests of the racial social structure and racial societal stressors as predictors of unequal risk of PTB and SGA for Black mothers. By examining mediating paths and barriers to healthcare access, the project can inform health prevention efforts to improve Black birth outcomes.