A recent study from Boston University School of Public Health (BUSPH) reveals that living in neighborhoods with limited educational, health, environmental, and socioeconomic resources significantly increases the risk of preterm birth. This finding highlights a contributing factor to the racial disparities in preterm birth rates observed in Massachusetts.
Preterm birth, defined as a live birth occurring before 37 weeks of gestation, is the second leading cause of infant mortality in the United States, disproportionately impacting Black and Hispanic communities. While individual factors such as poverty, age, and health status are known contributors to these disparities, researchers assert that broader structural issues play a pivotal role.
The study, published in JAMA Network Open, analyzed preterm births in Massachusetts, where approximately 1 in 11 live births are premature. It found that over half of Black and Hispanic infants were born in neighborhoods classified as having very low opportunity, and these infants faced a 16% higher risk of being born preterm compared to those in more resource-rich environments. The researchers evaluated neighborhood opportunity using the Childhood Opportunity Index (COI), a composite measure that incorporates 44 indicators related to educational, health, environmental, and socioeconomic factors at the census tract level.
This research underscores the health implications of structural racism and historical discriminatory practices, such as redlining and disproportionate exposure to environmental toxins, which continue to shape neighborhood conditions today. The COI serves as a critical tool for understanding both historical and ongoing structural inequities, according to the study’s authors.
“Our findings suggest that the context of social opportunity can affect children’s health even before birth, contributing to enduring racial and ethnic disparities in preterm birth rates,” said Dr. Candice Belanoff, the study’s lead author and a clinical associate professor of community health sciences at BUSPH. “This effect persisted even after controlling for factors like maternal health and individual socioeconomic status.”
Dr. Belanoff, along with colleagues from BUSPH, Simmons School of Social Work, the University of Illinois Chicago, and Brandeis University, utilized data from Massachusetts birth certificates for over 260,000 singleton infants born in the Boston, Springfield, and Worcester metropolitan areas from February 2011 to December 2015.
The analysis revealed that preterm birth rates were highest among Black infants at 8.4%, followed by Hispanic infants at 7.3%, and both Asian and White infants at 5.8%. Black and Hispanic infants were approximately 54% more likely to be born into very low opportunity neighborhoods compared to their White counterparts (11.8%) and Asian or Pacific Islander infants (19.6%). Conversely, these groups were also the least likely to be born in very high opportunity neighborhoods, with rates of just 6% and 6.7%, respectively.
“While many lower opportunity neighborhoods are vibrant cultural hubs with strong community activism, they still face economic exclusion, proximity to environmental hazards, and a lack of resources necessary for thriving,” Dr. Belanoff noted.
Dr. Joanna Almeida, the study’s senior author and a professor at Simmons SSW, emphasized the need for a broader perspective: “To reduce or eliminate the racial and ethnic gap in birth outcomes, we must address the inequitable distribution of resources and access to neighborhood opportunities.”
The study was co-authored by Adriana Black, director of health affairs diversity, equity, and inclusion at UIC; Dr. Collette Ncube, assistant professor of epidemiology at BUSPH; and Dr. Dolores Acevedo-Garcia, professor of human development and social policy at Brandeis and project director of diversitydatakids.org, which oversees the COI research program.
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