Birth outcomes among urban African-American women: A multilevel analysis of the role of racial residential segregation
Section snippets
Background
Differences in health status between Black (or African-American) and White infants have persisted for generations in the United States despite advances in perinatal care and declines in infant mortality rates (National Center for Health Statistics [NCHS], 2004; Yankauer, 1950). In 2002, African-American infants were more likely than White infants to have low birthweight (13.3% versus 7.8%), shortened gestation (17.5% versus 12.0%) or fetal growth impairment (16.0% versus 9.0%) and were more
Purpose
We tested two specific hypotheses in a population of singleton births to US-born, African-American women:
- 1.
Isolation is associated with poor birth outcomes, controlling for clustering, maternal race/ethnicity, SES and other important individual and ecological covariates.
- 2.
Clustering is associated with improved birth outcomes, controlling for isolation, maternal race/ethnicity, SES and other important individual and ecological covariates.
Design and data
A cross-sectional design and data from three publicly available sources were used to describe relationships between segregation and birth outcomes. Maternal and infant data were obtained from the 2002 US birth files issued by the National Center for Health Statistics and linked to MSA-level data collected for the 2000 US Census (Summary File 3) and measures of African-American–White segregation obtained from the US Census Bureau, Housing and Household Economic Statistics Division (Iceland et
Results
In the 225 MSAs, the mean population was 2.5 million residents (Standard Deviation=570,275; Median=194,378; Range: 102,008 to 9,519,338). The mean proportion of African-American residents was 0.16 (Standard Deviation=0.09; Median=0.14; Range=0.02–0.51). A summary of the distribution of the study variables is presented in Table 2.
Although isolation and clustering are correlated (Cutler, Glaeser, & Vigdor, 1999; Massey & Denton, 1988; Massey et al., 1996), the correlation coefficients for the
Discussion
This study adds to the growing evidence of associations between segregation and birth outcomes among African-American infants. Our analysis indicates that some of the risk of poor birth outcomes is indeed associated with segregation but that the effects might differ according to the dimension considered. We defined segregation in terms of isolation and clustering, finding that both dimensions had meaningful, opposite associations with infant birth status. We found that segregation was
Conclusions
The conceptual model established for this study is a basis for future work on segregation and health. This model and the results of our analysis suggest that aspects of segregation may be both deleterious and protective, depending on the dimension of segregation under investigation. Future declines in isolation could represent positive steps toward improving birth outcomes among African-American infants while aspects of racial contiguity appear to be mitigating or indeed beneficial. These
Acknowledgements
Dr. Bell gratefully acknowledges receiving funding for this work from the Agency for Healthcare Research and Quality (Grant #: T32-HS013853-01).
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