Racial/Ethnic Disparities in Preterm Birth in an Intergenerational Cohort of Mothers and Babies in California: The Role of Neighborhood Disinvestment

BackgroundPreterm birth in the U.S. is higher than other comparable countries. Babies born preterm are at higher risk of life-threatening complications in their first days as well as a range of health and educational problems over the life course. Despite recent declines in preterm birth, significant racial/ethnic disparities persist. A growing body of literature suggests conditions in the places where people live, especially during critical time periods of development, may be playing a fundamental role in shaping the development of maternal health, and disparities in birth outcomes in the subsequent generation. However, this literature is limited by cross-sectional neighborhood and health data and incomplete definition and measurement of complex historical and economic processes that shape neighborhood environments. The overarching goals of this study are 1) to expand current measurement of neighborhood contexts to capture historical and economic processes of structural marginalization that have shaped them, and to assess the relationship between these expanded measures and preterm birth 2) to develop and apply a framework informed by structural marginalization to catalyze a next-generation practice of Maternal and Child Health.MethodThe Life Course Social Context database, which contains geocoded birth records linked between mothers and babies in California, provides a unique opportunity to assess the relationship between neighborhood-level exposures experienced at two different stages of a mother’s life course (early childhood and adulthood) and preterm birth in the next generation. Using these data and other census measures, we construct histories of neighborhood poverty going back to 1970 and examine associations between these neighborhood poverty histories and preterm birth. Next, we assess the relationship between structural neighborhood inequality and preterm birth and preterm birth disparities, using measures of income inequality, racial/ethnic inequality and a combined measure of income and racial/ethnic inequality. Finally, we develop a conceptual model for understanding the broader context in which inequities in birth outcomes arise and provide case examples and lessons for future development of a next-generation MCH practice that will address the root causes of inequities in birth outcomes. SignificanceClearer understanding of complex neighborhood processes and how they shape health through generations is vital for the development of targeted and impactful public health programs. The development and assessment of new measures that approximate structural forces underlying neighborhood conditions shaping health over the life course will help direct the scope and scale of policy and practice efforts aimed at improving health and reducing inequities in birth outcomes. This study aims to contribute to more complete definition, measurement, and intervention for historical and structural forces that shape neighborhood conditions