Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York.
JAMA Netw Open. 2023 Mar 1;6(3):e236173. doi: 10.1001/jamanetworkopen.2023.6173.
The US has high rates of adverse birth outcomes, with substantial racial disparities augmented by stress and neighborhood disadvantage. Black people are more likely to live in neighborhoods with high rates of incarceration, which is a source of both stress and neighborhood disadvantage and, thus, may contribute to adverse birth outcomes.
To determine whether neighborhoods with high incarceration rates also have higher rates of adverse birth outcomes compared with neighborhoods with lower rates.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used publicly available data from the New York City Department of Health (2010-2014). Censored Poisson regression, with the US Census tract as the unit of analysis, was used to examine the association of neighborhood incarceration rate and birth outcomes. Multivariable models included percentage of births aggregated to the Census tract by maternal factors (age, parity, singleton vs multiple birth, insurance, and race) and neighborhood factors (poverty, education, and violent crime). Analyses were performed between May 2021 and October 2022.
Neighborhood incarceration rate, categorized into quintiles.
The primary outcome was the incidence rate ratio (IRR) of preterm birth and low birth weight. Secondary outcomes were IRRs of very preterm birth, extremely preterm birth, and very low birth weight. Hypotheses were formulated before data collection.
Among 2061 Census tracts with 562 339 births, incarceration rates varied from 0 to 4545 people incarcerated per 100 000, and high-incarceration neighborhoods had more residents of Black race (54.00% vs 1.90%), living in poverty (32.30% vs 10.00%), and without a general educational development equivalent (28.00% vs 12.00%) compared with low-incarceration neighborhoods. In fully adjusted models, high-incarceration neighborhoods had a 13% higher IRR of preterm birth (IRR, 1.13; 95% CI, 1.08-1.18), 45% higher IRR of very preterm birth (IRR, 1.45; 95% CI, 1.24-1.71), 125% higher IRR of extremely preterm birth (IRR, 2.25; 95% CI, 1.59-3.18), 10% higher IRR of low birth weight (IRR, 1.10; 95% CI, 1.05-1.16), and 52% higher IRR of very low birth weight compared with low-incarceration neighborhoods (IRR, 1.52; 95% CI, 1.28-1.81).
Neighborhood incarceration rate was positively associated with adverse birth outcomes, particularly those associated with infant mortality. Black people were significantly more likely to live in high-incarceration neighborhoods, suggesting that mass incarceration may contribute to racial disparities in birth outcomes.
美国的不良生育结局发生率较高，且存在显著的种族差异，而压力和邻里劣势则加剧了这种差异。黑人更有可能生活在监禁率较高的社区，这些社区既是压力和邻里劣势的来源，因此可能导致不良生育结局。
确定监禁率较高的社区与监禁率较低的社区相比，不良生育结局的发生率是否更高。
设计、地点和参与者：本横断面研究使用了纽约市卫生局（2010-2014 年）的公开数据。使用受 censored Poisson 回归分析，以美国人口普查区为分析单位，来检验社区监禁率与生育结局之间的关联。多变量模型包括按产妇因素（年龄、产次、单胎与多胎、保险和种族）和社区因素（贫困、教育和暴力犯罪）聚合到人口普查区的出生比例。分析于 2021 年 5 月至 2022 年 10 月进行。
社区监禁率，分为五分位数。
主要结局是早产和低出生体重的发病率比值（IRR）。次要结局是极早产、极度早产和极低出生体重的 IRR。在数据收集之前就提出了假设。
在 2061 个人口普查区的 562339 例分娩中，监禁率从 0 至每 100000 人中有 4545 人被监禁不等，而高监禁率社区的黑人比例（54.00%比 1.90%）、生活在贫困中的比例（32.30%比 10.00%）和没有普通教育发展同等学历的比例（28.00%比 12.00%）均高于低监禁率社区。在完全调整的模型中，高监禁率社区的早产发病率比值（IRR）高 13%（IRR，1.13；95%CI，1.08-1.18），极早产发病率比值高 45%（IRR，1.45；95%CI，1.24-1.71），极度早产发病率比值高 125%（IRR，2.25；95%CI，1.59-3.18），低出生体重发病率比值高 10%（IRR，1.10；95%CI，1.05-1.16），极低出生体重发病率比值高 52%（IRR，1.52；95%CI，1.28-1.81）。
社区监禁率与不良生育结局呈正相关，尤其是与婴儿死亡率相关的结局。黑人更有可能生活在监禁率较高的社区，这表明大规模监禁可能导致生育结局的种族差异。
