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Primary Submission Category: Race/Ethnicity
Distinguishing Temporal Exposures to Structural Racism that Manifest in Single Indicators: The Case of Maternal Hypertension and Diabetes and Preterm Birth Disparities
Authors: Jessica Polos,
Presenting Author: Jessica Polos*
Preterm birth (PTB) is a leading cause of neonatal mortality and long-term morbidity. In the U.S., racial disparities in PTB are persistent and substantial with non-Hispanic Black mothers experiencing higher rates of PTB (14.65%), compared to non-Hispanic white mothers (9.44%). Maternal, population-level manifestations of structural racism (SR) that shape PTB – such as differential risk of hypertension and diabetes – can result from exposure to SR across the life course. Even a single maternal manifestation of SR can embed past and present exposures to SR. Determining whether a maternal manifestation of SR influences PTB due to SR experienced earlier in a mother’s life course or SR experienced in pregnancy has important implications for generating solutions to preterm birth and other health disparities, but this timing has not been well studied.
Using NVSS Birth Data from 2022-2023 and a Kitagawa-Oaxaca-Blinder approach, we decompose the Black-white gap in preterm birth into the part attributable to differences in the composition of maternal hypertension and diabetes and the part attributable to differences in the effects of maternal hypertension and diabetes. Composition differences in hypertension and diabetes reflect chronic, distal maternal exposures to structural racism (e.g. via weathering) that lead to greater prevalence of hypertension and diabetes among Black mothers. Effect differences of maternal hypertension and diabetes reflect differences in the acute exposure to structural racism in pregnancy (e.g. via treatment differences). Results suggest that composition differences explain a smaller portion of the prematurity gap (2-2.5%) compared to effect differences (approximately 5-15%). This implies that interventions aimed at equitable treatment of maternal diabetes and hypertension in pregnancy may reduce PTB disparities to a greater extent than interventions aimed at upstream structural racism in social determinants of health.