Impacts of structural racism on racial and ethnic disparities in perinatal health

摘要 在美国，有色人种女性的不良妊娠结局的比率高于非西班牙裔白人。 例如，黑人、西班牙裔和非西班牙裔的早产率分别为14.4%、10.0%和9.3% 分别是白人母亲。西班牙裔和黑人妇女患产妇疾病的风险也更高，例如 妊娠高血压和妊娠期糖尿病。伴随着令人信服的证据表明不利的影响 围产期健康对母亲和婴儿整个生命过程的健康具有高度的社会性和 经济成本。然而，有色人种妇女不良妊娠结局的病因还没有完全解释。 遗传、行为或获得护理的机会以及包括结构性种族主义在内的其他因素可能起到一定作用。 从历史上看，有色人种社区一直并将继续受到红线的下游影响的负担 做法，包括住房歧视和邻里隔离。考虑到他们的距离很近 社区到空气、水和土壤污染的关键来源(红线的另一个后果)，社区 肤色的人也经历了环境种族主义，即环境暴露的不成比例的负担。 此外，高危社区的妇女受到不成比例的警务工作的溢出压力，警察 暴力、逮捕和监禁。虽然越来越多的证据表明结构性种族主义对 围产期健康的研究结果是模棱两可的，研究涉及多种形式的结构性疾病的联合影响 这里缺少种族主义。在本应用程序中，我们将评估结构性种族主义在多个领域的独立影响 关于产妇发病率(妊娠期高血压和妊娠期高血压)的种族/民族差异领域 糖尿病)和不良妊娠结局(低出生体重和早产)，探索是否合并 暴露在结构性种族主义的多个领域会加剧差异，并将机器学习方法应用于 确定导致不良围产期健康后果的主要结构性种族主义预测因素。为了实现我们的目标，我们将 建立在第三大产科医院分娩的妇女的回顾性分娩队列 美国(休斯顿所在的哈里斯县)将包括在母亲怀孕期间的随访 她的婴儿的出生。我们的项目利用贝勒医学院之间建立的合作伙伴关系， UTHealth麦戈文医学院和德克萨斯南方大学通过我们的NIMHD/NIEHS/NICHD P50 环境健康差距研究英才中心，重点是减少环境健康 孕产妇和儿童健康方面的差距，并利用我们在环境和围产期方面的集体专门知识 流行病学、妇女健康、母婴医学、刑事司法、社会科学、生物统计学和 生物信息学。这项工作有望阐明结构性种族主义在多个领域的贡献 关于几个关键围产期健康结果的种族/族裔差异。重要的是，这项研究的结果将 还增进了我们对复杂的相互作用和确定主要结构性种族主义驱动因素的了解 并为今后促进干预措施的研究奠定了基础。

ABSTRACT Women of color have higher rates of poor pregnancy outcomes than non-Hispanic whites in the U.S. For example, the prevalence of preterm birth is 14.4%, 10.0% and 9.3% among Black, Hispanic, and non-Hispanic white mothers, respectively. Hispanic and Black women are also at higher risk of maternal morbidities such as hypertension in pregnancy and gestational diabetes. Along with the compelling evidence of the impact of adverse perinatal health on the health of a mother and her infant throughout the life course comes high societal and economic costs. Yet, the etiology of adverse pregnancy outcomes among women of color is not fully explained by genetics, behavior, or access to care and other factors, including structural racism, likely play a role. Historically, communities of color have been, and continue to be, burdened by downstream effects of redlining practices, including housing discrimination and neighborhood segregation. Given the proximity of their neighborhoods to key sources of air, water, and soil pollution (another consequence of redlining), communities of color also experience environmental racism, i.e., a disproportionate burden of environmental exposures. Moreover, women in high-risk communities are subject to spillover stress from disproportionate policing, police violence, arrests, and incarceration. While there is growing evidence of the impact of structural racism on perinatal health, findings are equivocal, and research related to the joint impact of multiple forms of structural racism is lacking. In this application, we will assess the independent effects of structural racism across multiple domains on racial/ethnic disparities in both maternal morbidity (hypertension in pregnancy and gestational diabetes) and adverse pregnancy outcomes (low birth weight and preterm birth), explore whether combined exposures to multiple domains of structural racism enhance disparities, and apply machine learning methods to identify the key structural racism predictors of adverse perinatal health outcomes. To achieve our aims, we will construct a retrospective birth cohort of women who delivered infants at major obstetric hospitals in the 3rd largest county (Harris) in the U.S. (where Houston is located) that will include follow-up throughout a mother’s pregnancy to the birth of her infant. Our project leverages established partnerships among Baylor College of Medicine, UTHealth McGovern Medical School, and Texas Southern University through our NIMHD/NIEHS/NICHD P50 Center of Excellence on Environmental Health Disparities Research, focused on reducing environmental health disparities in maternal and child health, and draws on our collective expertise in environmental and perinatal epidemiology, women’s health, maternal-fetal medicine, criminal justice, social science, biostatistics, and bioinformatics. This work is expected to elucidate the contribution of structural racism across multiple domains on racial/ethnic disparities in several key perinatal health outcomes. Importantly, the results from this study will also enhance our understanding of the complex interplay and identification of key structural racism drivers of perinatal health disparities and lay the foundation for future studies to promote interventions.