Bell Janice F, Zimmerman Frederick J, Almgren Gunnar R, Mayer Jonathan D, Huebner Colleen E
University of Washington, Seattle, WA, USA.
Soc Sci Med. 2006 Dec;63(12):3030-45. doi: 10.1016/j.socscimed.2006.08.011. Epub 2006 Sep 25.
Residential segregation is a common aspect of the urban experiences of African-Americans in the United States (US), yet few studies have considered how segregation might influence perinatal health. Here, we develop a conceptual model of relationships between segregation and birth outcomes and test the implications of the model in a sample of 434,376 singleton births to African-American women living in 225 US Metropolitan Statistical Areas (MSAs). Data from the National Center for Health Statistics 2002 birth files were linked to data from the 2000 US Census and two distinct measures of segregation: an index of isolation (the probability that an African-American resident will encounter another African-American resident in any random neighborhood encounter) and an index of clustering (the extent to which African-Americans live in contiguous neighborhoods). Using multilevel regression models, controlling for individual- and MSA-level socioeconomic status and other covariates, we found higher isolation was associated with lower birthweight, higher rates of prematurity and higher rates of fetal growth restriction. In contrast, higher clustering was associated with more optimal outcomes. We propose that isolation reflects factors associated with segregation that are deleterious to health including poor neighborhood quality, persistent discrimination and the intra-group diffusion of harmful health behaviors. Associations with clustering may reflect factors associated with segregation that are health-promoting such as African-American political power empowerment, social support and cohesion. 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. Segregation is a complex multidimensional construct with both deleterious and protective influences on birth outcomes, depending on the dimensions under consideration. Further research to understand racial/ethnic and economic health disparities could benefit from a focus on the contributory role of neighborhood attributes associated with the dimensions segregation and other social geographies.
居住隔离是美国非裔美国人城市生活经历中的一个常见现象，但很少有研究考虑过这种隔离可能如何影响围产期健康。在此，我们构建了一个隔离与出生结局之间关系的概念模型，并在居住在美国225个大都市统计区（MSA）的434,376名非裔美国妇女单胎分娩样本中检验了该模型的影响。来自国家卫生统计中心2002年出生档案的数据与2000年美国人口普查数据以及两种不同的隔离测量方法相关联：隔离指数（非裔美国居民在任何随机邻里相遇中遇到另一名非裔美国居民的概率）和聚集指数（非裔美国人居住在相邻邻里的程度）。使用多层次回归模型，控制个体和MSA层面的社会经济地位及其他协变量，我们发现较高的隔离与较低的出生体重、较高的早产率和较高的胎儿生长受限率相关。相比之下，较高的聚集与更优的结局相关。我们认为，隔离反映了与隔离相关的对健康有害的因素，包括邻里质量差、持续的歧视以及有害健康行为在群体内的传播。与聚集的关联可能反映了与隔离相关的促进健康的因素，如非裔美国人政治权力的增强、社会支持和凝聚力。隔离程度的下降可能代表着朝着改善非裔美国婴儿出生结局迈出的积极步伐，而种族相邻的方面似乎正在减轻影响或确实有益。隔离是一个复杂的多维结构，对出生结局既有有害影响也有保护影响，这取决于所考虑的维度。关注与隔离维度及其他社会地理相关的邻里属性的促成作用，可能有助于进一步研究理解种族/族裔和经济健康差异。
