Primary Submission Category: Reproductive health
The association between racial discrimination and preterm birth subtype by education
Authors: Ashley Judge, Christina Ludema, Kelli Ryckman,
Presenting Author: Ashley Judge*
Black women have the highest rates of preterm birth (PTB) in the US. Racial discrimination and depression are associated with PTB among US Black women. Few studies have examined the association between racial discrimination and PTB subtype.
This study assessed the association between lifetime racial discrimination and PTB with and without mediation by depression. We used 2010-2013 data limited to 1214 women who self-reported non-Hispanic Black race/ethnicity from a prospective cohort study of nulliparous women recruited from eight clinical, US sites. Racial discrimination was measured by the Experiences of Discrimination scale. We used conditional log-binomial regression (CLR) to estimate the association between racial discrimination and 1) PTB (<37 weeks gestation), 2) spontaneous PTB (sPTB) and 3) medically indicated PTB (mPTB) adjusted for age, income, education, and marital status. We stratified by education to assess effect modification.
Approximately 42% of women experienced ≥1 situations of racial discrimination, which varied by age and education (≤high school: ~30%, ≥ bachelors: 70%). Racial discrimination was not associated with PTB. CLR models revealed a J-shaped relationship with sPTB. Compared to none, ≥3 situations of racial discrimination were associated with 1.7 (95% CI: 1.0, 3.1) times the risk of sPTB, and 0.4 (0.2, 1.0) times the risk of mPTB. Estimates were strongest among women with some college education (OR=3.7 (95% CI: 1.5, 9.0)).
Our null results for PTB differ from other studies. However, this study offers new insights into the particularly strong association between racial discrimination and sPTB for women with some college education.