Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids and East Lansing, Michigan.
Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids and East Lansing, Michigan.
Womens Health Issues. 2024 Jul-Aug;34(4):340-349. doi: 10.1016/j.whi.2024.05.001. Epub 2024 Jun 6.
Residential polarization shaped by racial segregation and concentrations of wealth (hereafter neighborhood racialized economic polarization) results in both highly deprived and highly privileged neighborhoods. Numerous studies have found a negative relationship between neighborhood racialized economic polarization and birth outcomes. We investigated whether community-informed home visiting programs achieve high rates of service coverage in highly deprived neighborhoods and can attenuate the deleterious effect of neighborhood polarization on birth outcomes.
We used 2016-2019 data from Michigan's statewide database that links birth records, Medicaid claims, and program participation (N = 211,412). We evaluated whether 1) home visiting programs achieved high rates of service coverage in highly deprived neighborhoods, 2) participation in home visiting may help to mitigate the negative relationship between neighborhood polarization and birth outcomes, and 3) the reductions in preterm birth and low birthweight were larger among Black birthing individuals. Data were examined using multilevel generalized linear models and mediation analysis.
The statewide home visiting program achieved higher rates of coverage in the most deprived neighborhoods (21.0% statewide, 28.3% in the most deprived vs. 10.4% in the most privileged neighborhoods). For all, home visiting participation was associated with a decrease in the relationship between neighborhood polarization and preterm birth by 6.8% (mean indirect effect, -0.008; 95% confidence interval, -0.011 to -0.005), and by 5.2% (mean indirect effect, -0.013; 95% confidence interval, -0.017 to -0.009) for low birthweight, adjusting for individual-level risk factors. The decrease was larger among Black individuals.
A statewide Medicaid-sponsored home visiting program achieved high rates of service coverage in highly deprived neighborhoods. Program participation may help to mitigate the negative relationship between neighborhood polarization and birth outcomes, and more so among Black individuals. Continued support for home visiting services is required to better engage birthing individuals in neighborhoods with concentrated deprivation and to decrease disparities.
由种族隔离和财富集中（以下简称邻里种族经济极化）形成的居住极化导致了极度贫困和极度富裕的社区同时存在。大量研究发现，邻里种族经济极化与出生结果之间呈负相关。我们调查了社区知情的家访项目是否能在极度贫困的社区达到高服务覆盖率，并能否减轻邻里极化对出生结果的不利影响。
我们使用了 2016-2019 年密歇根州全州数据库的数据，该数据库将出生记录、医疗补助索赔和项目参与情况（N=211412）联系起来。我们评估了以下三个方面：1）家访项目是否在极度贫困的社区达到了高服务覆盖率；2）参与家访是否有助于减轻邻里极化与出生结果之间的负相关关系；3）早产和低出生体重的减少是否在黑人分娩者中更大。使用多层广义线性模型和中介分析来检查数据。
全州范围内的家访项目在最贫困的社区达到了更高的覆盖率（全州范围内为 21.0%，最贫困的社区为 28.3%，最富裕的社区为 10.4%）。对于所有人来说，家访参与与邻里极化和早产之间的关系减少了 6.8%（平均间接效应，-0.008；95%置信区间，-0.011 至-0.005），与低出生体重之间的关系减少了 5.2%（平均间接效应，-0.013；95%置信区间，-0.017 至-0.009），调整了个体风险因素。这种减少在黑人个体中更大。
一个由州医疗补助计划资助的全州范围内的家访项目在极度贫困的社区达到了高服务覆盖率。项目参与可能有助于减轻邻里极化与出生结果之间的负相关关系，而且在黑人个体中更为明显。需要继续支持家访服务，以便更好地让处于贫困集中的社区的分娩者参与进来，并减少差异。
