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The interplay of race, socioeconomic status and neighborhood residence upon birth outcomes in a high black infant mortality community.

ABSTRACT: This study examined the interrelationship of race and socioeconomic status (SES) upon infant birthweight at the individual and neighborhood levels within a Midwestern US county marked by high Black infant mortality. The study conducted a multi-level analysis utilizing individual birth records and census tract datasets from 2010, linked through a spatial join with ArcGIS 10.0. The maternal population of 2861 Black and White women delivering infants in 2010, residing in 57 census tracts within the county, constituted the study samples. The main outcome was infant birthweight. The predictors, race and SES were dichotomized into Black and White, low-SES and higher-SES, at both the individual and census tract levels. A two-part Bayesian model demonstrated that individual-level race and SES were more influential birthweight predictors than community-level factors. Specifically, Black women had 1.6 higher odds of delivering a low birthweight (LBW) infant than White women, and low-SES women had 1.7 higher odds of delivering a LBW infant than higher-SES women. Moderate support was found for a three-way interaction between individual-level race, SES and community-level race, such that Black women achieved equity with White women (4.0% Black LBW and 4.1% White LBW) when they each had higher-SES and lived in a racially congruous neighborhood (e.g., Black women lived in disproportionately Black neighborhood and White women lived in disproportionately White neighborhood). In sharp contrast, Black women with higher-SES who lived in a racially incongruous neighborhood (e.g., disproportionately White) had the worst outcomes (14.5% LBW). Demonstrating the layered influence of personal and community circumstances upon health, in a community with substantial racial disparities, personal race and SES independently contribute to birth outcomes, while environmental context, specifically neighborhood racial congruity, is associated with mitigated health risk.

SUBMITTER: Kothari CL

PROVIDER: S-EPMC5757914 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundIn the United States, due to residential segregation, racial minorities and families with low socioeconomic status (SES) tend to live in less safe neighborhoods than their White and high SES counterparts. As such, in the US, race and SES closely correlate with neighborhood safety. Due to the high chronicity of stress in unsafe neighborhoods, perceived neighborhood safety may be a mechanism through which race and SES are linked to children's mental health. Simultaneously, race and SES may alter the effects of perceived neighborhood safety on children's mental health.AimTo explore racial and SES differences in the effects of neighborhood safety on children's internalizing symptoms, we compared racially and SES diverse groups of American children for the effects of parents' perceived neighborhood safety on children's internalizing symptoms.MethodsThis cross-sectional study included 10484 children from the Adolescent Brain Cognitive Development (ABCD) study. Mixed-effects regression was used for data analysis. The predictor variable was parents' perceived neighborhood safety which was treated as a continuous measure. The primary outcome was children's internalizing symptoms reported by children. Race, parental education, household income, and family structure were moderators.ResultsOverall, the parents' high neighborhood safety was associated with lower levels of internalizing symptoms in children. Race and household income showed statistically significant interactions with subjective neighborhood safety on children's internalizing symptoms. Parents' perceived neighborhood safety showed a stronger inverse association with children's internalizing symptoms for Black than White families. Parents' perceived neighborhood safety showed a stronger inverse association with children's internalizing symptoms for high income than low-income families. Parental education or family structure did not show any significant interaction with parents' perceived neighborhood safety on children's internalizing symptoms.ConclusionThe degree to which neighborhood safety may be associated with children's internalizing symptoms may depend on race and household income. Some of the effects of race and SES on children's mental health outcomes may be due to interactions with contextual factors such as neighborhood safety. More research is needed on why and how diverse racial and SES groups differ in the association between perceived neighborhood safety and children's well-being.

Project description:ObjectiveThis study developed and internally validated a predictive model for preterm birth (PTB) to examine the ability of neighbourhood socioeconomic status (SES) to predict PTB.DesignCohort study using individual-level data from two community-based prospective pregnancy cohort studies (All Our Families (AOF) and Alberta Pregnancy Outcomes and Nutrition (APrON)) and neighbourhood SES data from the 2011 Canadian census.SettingCalgary, Alberta, Canada.ParticipantsPregnant women who were <24 weeks of gestation and >15 years old were enrolled in the cohort studies between 2008 and 2012. Overall, 5297 women participated in at least one of these cohorts: 3341 women participated in the AOF study, 2187 women participated in the APrON study and 231 women participated in both studies. Women who participated in both studies were only counted once.Primary and secondary outcome measuresPTB (delivery prior to 37 weeks of gestation).ResultsThe rates of PTB in the least and most deprived neighbourhoods were 7.54% and 10.64%, respectively. Neighbourhood variation in PTB was 0.20, with an intra-class correlation of 5.72%. Neighbourhood SES, combined with individual-level predictors, predicted PTB with an area under the receiver-operating characteristic curve (AUC) of 0.75. The sensitivity was 91.80% at a low-risk threshold, with a high false-positive rate (71.50%), and the sensitivity was 5.70% at a highest risk threshold, with a low false-positive rate (0.90%). An agreement between the predicted and observed PTB demonstrated modest model calibration. Individual-level predictors alone predicted PTB with an AUC of 0.60.ConclusionAlthough neighbourhood SES combined with individual-level predictors improved the overall prediction of PTB compared with individual-level predictors alone, the detection rate was insufficient for application in clinical or public health practice. A prediction model with better predictive ability is required to effectively find women at high risk of preterm delivery.

Project description:BackgroundReducing disparities in men with prostate cancer (PCa) that may be caused by racial and socioeconomic differences is a major public health priority. Few reports have studied whether these disparities have changed over time.MethodsMen diagnosed with PCa from January 1, 2000 to December 31, 2015 were identified from the Massachusetts and Pennsylvania cancer registries. All-cause mortality and PCa and cardiovascular cause-specific mortality were assessed. To estimate neighborhood socioeconomic position (nSEP), a summary score was generated using census tract-level measures of income, wealth, educational attainment, and racial and income segregation. Participants were grouped by diagnosis year (2000-2003, 2004-2007, 2008-2011, or 2012-2015), and changing trends in the mortality rate ratio by race and nSEP were estimated using covariate-adjusted Cox models with follow-up for up to 10 years, until death, or until censoring on January 1, 2018.ResultsThere were 193,883 patients with PCa and 43,661 deaths over 1,404,131 person-years of follow-up. The Black-White adjusted hazard ratio (aHR) from 2000 to 2003 through 2012 to 2015 was stable for all-cause mortality (aHR, 1.14 to 0.97; P for heterogeneity = .42), decreased for PCa-specific mortality (aHR, 1.38 to 0.93; P for heterogeneity = .005), and increased for cardiovascular mortality (aHR, 1.09 to 1.28; P for heterogeneity = .034). The aHR comparing those in the lowest versus the highest nSEP quintile increased significantly for all-cause mortality (aHR, 1.54 to 1.79; P for heterogeneity = .008), but not for PCa-specific mortality (aHR, 1.60 to 1.72; P for heterogeneity = .40) or cardiovascular mortality (aHR, 1.72 to 1.89; P for heterogeneity = .085).ConclusionsAlthough Black-White disparities in prostate mortality declined in Massachusetts and Pennsylvania over the study period, nSEP mortality disparity trends were stagnant or increased, warranting further attention.Lay summaryFew reports have examined whether racial and socioeconomic disparities in prostate cancer mortality have widened or narrowed in recent years. Using data from 2 state registries (Massachusetts and Pennsylvania) with differing intensities of government-mandated health insurance, trends in racial and neighborhood socioeconomic disparities were studied among Black and White men diagnosed from 2000 to 2015. Overall, trends in racial disparities were stagnant for all-cause mortality, shrank for prostate mortality, and widened for cardiovascular mortality. Disparities associated with neighborhood socioeconomic status either were stagnant or widened across all mortality end points. In general, disparities were more pronounced in Pennsylvania than in Massachusetts.

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The interplay of race, socioeconomic status and neighborhood residence upon birth outcomes in a high black infant mortality community.

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