Primary Submission Category: Place/Communities
Representation Matters: Racial Composition of County Elected Officials and Birth Outcomes in Georgia, 2020-2021
Authors: Kaitlyn Stanhope Pari Kapila Amal Umerani Afsha Hossein Maha Abu-Salah Vanshika Singisetti Sierra Carter Sheree Boulet
Presenting Author: Kaitlyn Stanhope*
Our goal was to estimate the differences in infant and maternal outcomes by racial representation differences, a novel measure of structural racism. We gathered data on the racial composition of county-level elected officials for all counties in Georgia (n=159) in 2022. We calculated the difference between the percent of non-white residents and the percent of non-white elected officials (“representation difference”, the primary independent variable). We linked this information to data from 2020-2021 birth certificates (n = 238,795) to compare infant outcomes (preterm birth, <37 weeks, low birthweight birth <2500 grams, and continuous birthweight) across county-level representation differences. We fit multilevel log binomial models for binary outcomes and linear models for birthweight with generalized estimating equations. We included individual (age, parity, insurance) and county covariates (% without high school education, % below federal poverty level, % non-Hispanic black, % of female elected officials, rurality) as potential confounders. We assessed interaction by individual race/ethnicity as reported on the birth certificate (non-Hispanic white, non-Hispanic Black, non-Hispanic other, Hispanic). The median representation difference was 17.5 percentage points (interquartile range: 17.2). For Black birthing people, a 25-point larger representation difference was associated with 13% higher risk of preterm birth (adjusted risk ratio (aRR): 1.13 (1.07, 1.2)), 18% higher risk of low birth weight birth [aRR: 1.18 (1.11, 1.25)] and 89 grams lower birthweight (adjusted beta: -88.9 (-115.5, -62.3)]. A similar pattern was observed for non-Hispanic white birthing people. There were no significant differences among Hispanic, or birthing people of other races. Places without representation disparities may foster more positive environments for birthing people.