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

项目摘要/摘要 与白人母亲相比，黑人母亲早产(PTB)和小于胎龄儿的几率更高 (SGA)，导致婴儿死亡率的种族差异。存在令人信服的种族歧视证据， 居住隔离是这种不良生育结果的决定因素。然而，更完整的评估 需要种族社会结构来确定其他结构因素和母体调解的作用 小路。我们将通过测试两个特定的目标来阐明黑色肺结核和SGA风险的结构性预测因素。 目标1：系统检验早产儿和小于胎龄儿风险不平等的结构性预测因素 黑人母亲的年龄出生，以及产妇和地区一级调解人的作用。结构性因素将是 在县或大都市统计局(MSA)使用不同的公共数据来源进行评估，包括：1) 地区反黑人偏见，来自基于网络的偏见和种族主义的聚合测量；2)黑人住宅 种族隔离作为隔离指标；3)黑人的社会经济劣势来自多个维度的综合； 4)社区暴力犯罪暴露和黑人居民的监禁风险；5)结构性障碍 医疗保健，衡量为a)获得初级保健的空间，b)黑人医生的可获得性，c-d)未参保 黑人母亲的产前保健率不足，以及e)提供公共卫生和避孕药具 服务。黑白(B-W)结构因素的差异也将被检验。使用国家出生记录 (2014-2017)，样本将包括在美国出生的非西班牙裔黑人和白人母亲的独生子女 至少有10,000名黑人居民的MSA。多水平模型将允许预测肺结核和SGA的风险 黑人母亲，风险的地区差异，以及地区特定的B-W风险差异。结构性因素的中介作用 将按产妇和地区一级对社会人口和健康变量进行测试。有肺结核病史的母亲也有 将被认为是结构性因素，可能限制这一人群获得必要的卫生干预。 目的2：评估种族社会应激源对黑人早产风险的影响。时间上的变化 而高调杀害黑人的地点，可能被视为不公正或出于种族动机，将是 利用它来创造一个自然的实验。黑人早产风险预计在高调宣传后增加 黑人杀戮，特别是前四个月的暴露，最广为人知的杀戮，以及 在案发地点附近。由于它们有可能被媒体密集报道，杀害黑人将 来自警察犯下的和极端分子犯下的杀戮的数据集。内部媒体报道的数量 60天的杀戮将被用来识别高知名度的杀戮(排名前十；~35杀戮)。 该项目将对种族社会结构和种族社会压力因素进行新颖和严格的测试，如 黑人母亲患肺结核和SGA风险不平等的预测因素。通过检查调解路径和障碍 在获得医疗保健方面，该项目可以为卫生预防工作提供信息，以改善黑人出生结果。

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.