Spaces of Segregation and Health: Complex Associations for Black Immigrant and US-Born Mothers in New York City.

Black immigrants are a growing proportion of the Black population in the USA, and despite the fact that they now comprise nearly a quarter of Black urban residents, few studies address the relationships between racial segregation and maternal and birth outcomes among Black immigrants. In this study of birth outcomes among US-born and immigrant Black mothers in New York City between 2010 and 2014, we applied multilevel models, assessing the association between segregation (measured through a novel kernel-based measure of local segregation) and adverse birth outcomes (preterm birth (PTB) and low birth weight (LBW; < 2500 g)) among African-born, Caribbean-born, and US-born Black mothers. We found that African-born and Caribbean/Latin American-born Black mothers had a significantly lower incidence of PTB compared with US-born Black mothers (7.0 and 10.1, respectively, compared with 11.2 for US-born mothers). We also found disparities in the incidence of infant LBW by nativity, with the highest incidence among infants born to US-born mothers (10.9), compared with African-born (6.9) and Caribbean-born mothers (9.0). After adjusting for maternal (maternal age; higher rates of reported drug use and smoking) and contextual characteristics (neighborhood SES; green space access), we found that maternal residence in an area with high Black segregation increases the likelihood of PTB and LBW among US-born and Caribbean-born Black mothers. In contrast, the association between segregation and birth outcomes was insignificant for African-born mothers. Associations between tract-level socioeconomic disadvantage and birth outcomes also varied across groups, with only US-born Black mothers showing the expected positive association with risk of PTB and LBW.