A multidimensional tool for quantifying structural racism: Application to adverse pregnancy outcomes in Chicago, Illinois.

Understanding the relationship between structural racism and health is essential for identifying practice- and policy-based interventions to reduce health inequities. We developed neighborhood-based measures of structural racism and tested their associations with adverse pregnancy outcomes, health outcomes characterized by some of the most pronounced racial inequities. We leveraged electronic health records from 89,410 pregnant patients at six Chicago-area hospitals. Patients were linked with neighborhood exposure to 22 experiences reflective of structural racism based on home address, geocoded to the census tract. Measures were summarized into six domains identified as salient to Black women in the literature: law enforcement, housing, medical, employment, education, and community infrastructure. The primary outcome was preterm birth and models were stratified by race and ethnicity. After adjustment for neighborhood socioeconomic status, Black patients in neighborhoods with unfavorable law enforcement practices and school characteristics were more likely to deliver preterm (law RR: 1.07; 95 % CI: 1.02, 1.12; education RR: 1.08; 95 % CI: 1.03, 1.14). This study developed an approach for quantifying multiple domains of structural racism and illustrated its value in the context of preterm birth risk among Black patients.