Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts.
Office of the Vice Chancellor for Health Affairs, University of Illinois, Chicago.
JAMA Netw Open. 2024 Sep 3;7(9):e2432766. doi: 10.1001/jamanetworkopen.2024.32766.
In the US, infants born to non-Hispanic Black birthing parents are 50% more likely to be born preterm than those born to non-Hispanic White birthing parents, and individual-level factors do not fully account for this inequity. Neighborhood context, rooted in historic patterns of structural racism, may facilitate understanding patterns of inequity in preterm birth.
To estimate the association between neighborhood opportunity level, measured by the Child Opportunity Index (COI), and preterm birth among infants in Massachusetts.
DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional, population-based study, Massachusetts birth certificates from 3 large metropolitan areas (Boston, Springfield, and Worcester) were linked to US Census tract-level data from the COI, and log binomial regression models and generalized estimating equations were fit to examine associations of different levels of opportunity with preterm birth. Singleton infants born in Massachusetts between February 1, 2011, and December 31, 2015, were included. Analyses were originally conducted in 2019 and updated in 2024.
Level of child opportunity (measured by the COI) at the US Census tract level. Race and ethnicity were ascertained from the birth certificate, as reported by the birthing parent.
Live birth before 37 completed weeks' gestation.
The analytic dataset included 267 553 infants, of whom 18.9% were born to Hispanic, 10.1% to non-Hispanic Asian or Pacific Islander, 10.1% to non-Hispanic Black, and 61.0% to non-Hispanic White birthing parents. More than half of infants born to non-Hispanic Black and Hispanic birthing parents were born into very low opportunity neighborhoods, and in crude models, this was associated with greater prevalence of preterm birth relative to very high opportunity neighborhoods (prevalence ratio, 1.44; 95% CI, 1.37-1.52). After adjustment for covariates, infants born into very low opportunity neighborhoods still had a greater prevalence of preterm birth (prevalence ratio, 1.16; 95% CI, 1.10-1.23).
In this cross-sectional study of neighborhood opportunity and preterm birth, elevated risk associated with exposure to a very low opportunity neighborhood, coupled with the disproportionate exposure by race and ethnicity, points to a modifiable factor that may contribute to racial and ethnic inequities in preterm birth. Future research should investigate interventions that seek to address neighborhood opportunity.
在美国，非西班牙裔黑人产妇所生婴儿比非西班牙裔白人产妇所生婴儿早产的可能性高 50%，而个体因素并不能完全解释这种不平等。以历史上结构性种族主义模式为根源的邻里环境可能有助于理解早产方面的不平等模式。
评估马萨诸塞州儿童机会指数（COI）衡量的邻里机会水平与婴儿早产之间的关联。
设计、地点和参与者：在这项横断面、基于人群的研究中，将马萨诸塞州三个大都市区（波士顿、斯普林菲尔德和伍斯特）的出生证明与 COI 的美国人口普查区层面数据相联系，并拟合对数二项式回归模型和广义估计方程，以检验不同机会水平与早产之间的关联。纳入 2011 年 2 月 1 日至 2015 年 12 月 31 日期间在马萨诸塞州出生的单胎婴儿。分析最初于 2019 年进行，并于 2024 年进行了更新。
美国人口普查区层面的儿童机会水平（由 COI 衡量）。种族和民族是从出生证明中由分娩父母报告的。
在 37 周妊娠前活产。
分析数据集包括 267553 名婴儿，其中 18.9%的婴儿出生于西班牙裔，10.1%的婴儿出生于非西班牙裔亚裔或太平洋岛民，10.1%的婴儿出生于非西班牙裔黑人，61.0%的婴儿出生于非西班牙裔白人。超过一半的非西班牙裔黑人及西班牙裔产妇所生婴儿出生于机会非常低的社区，而在原始模型中，这与早产的发生率相对非常高的社区更高相关（患病率比，1.44；95%CI，1.37-1.52）。在调整了协变量后，出生于机会非常低社区的婴儿早产的发生率仍然更高（患病率比，1.16；95%CI，1.10-1.23）。
在这项关于邻里机会和早产的横断面研究中，接触机会非常低的社区与风险增加有关，再加上种族和民族的不成比例暴露，这表明这是一个可改变的因素，可能导致早产方面的种族和民族不平等。未来的研究应调查旨在解决邻里机会的干预措施。
