Rammah Amal, Drake Jasmine, Moussa Iman, Whitworth Kristina W, Henderson Howard, Alvarez Juan, Symanski Elaine
Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA.
Department of Administration of Justice, Texas Southern University, Houston, TX, USA.
J Racial Ethn Health Disparities. 2025 Jul 9. doi: 10.1007/s40615-025-02511-9.
While there is growing evidence of the negative impact of neighborhood segregation on maternal and infant health, the evidence for stillbirth is limited.
A retrospective cohort study of live births and stillbirths for 2007-2020 was conducted in greater Houston, TX, to examine the associations of racialized economic segregation, assessed using the Index of Concentrations at the Extremes (ICE), with stillbirth. Here, ICE contrasted census tract-level racial and economic privilege with disadvantage (i.e., high-income non-Hispanic White persons vs. low-income Persons of Color). Additionally, Oaxaca-Blinder decomposition methods were applied to examine the degree to which segregation and maternal risk factors explained observed racial disparities in stillbirth.
The prevalence of stillbirth was highest among non-Hispanic Black mothers (9.1/1000) compared with Hispanic mothers (4.7/1000), non-Hispanic White mothers (3.8/1000), and mothers whose race or ethnicity was unknown or classified as other (3.7/1000). In models adjusted for age, pre-pregnancy body mass index (BMI), smoking during pregnancy, and education, odds of stillbirth were reduced for non-Hispanic White mothers living in the most privileged neighborhoods (OR = 0.82, 95% CI 0.60, 1.12 for ICE tertile 3 vs. ICE tertile 1). In contrast, residing in more privileged neighborhoods did not confer the same benefit for mothers of other racial and ethnic groups. Based on the decomposition analysis, maternal age, education, pre-pregnancy BMI, smoking, and ICE explained 21.2% of the disparity in stillbirth between non-Hispanic Black and non-Hispanic White mothers; of which, having a high school education or less (12.3%), living in the most privileged neighborhoods (9.7%), and being obese (7.2%) contributed the most.
Neighborhood privilege appears to confer benefits for White mothers but not for non-White mothers, potentially due to experiences of racial discrimination that offset economic advantages. While racialized economic segregation contributed modestly to Black-White disparities in stillbirth, much of the disparity remains unexplained by the factors examined. Future research should explore additional individual- and neighborhood-level contributors to these disparities while addressing inequities to reduce stillbirth risks across all populations.
虽然越来越多的证据表明社区隔离对母婴健康有负面影响，但关于死产的证据有限。
在德克萨斯州休斯顿市开展了一项针对2007 - 2020年活产和死产的回顾性队列研究，以检验使用极端集中度指数（ICE）评估的种族化经济隔离与死产之间的关联。在此，ICE将普查区层面的种族和经济特权与劣势进行了对比（即高收入非西班牙裔白人 vs. 低收入有色人种）。此外，应用了瓦哈卡 - 布林德分解方法来检验隔离和孕产妇风险因素在多大程度上解释了观察到的死产种族差异。
与西班牙裔母亲（4.7/1000）、非西班牙裔白人母亲（3.8/1000）以及种族或族裔未知或归类为其他的母亲（3.7/1000）相比，非西班牙裔黑人母亲的死产患病率最高（9.1/1000）。在对年龄、孕前体重指数（BMI）、孕期吸烟和教育程度进行调整的模型中，居住在最具特权社区的非西班牙裔白人母亲的死产几率降低（ICE三分位数3与ICE三分位数1相比，OR = 0.82，95%CI 0.60，1.12）。相比之下，居住在更具特权的社区对其他种族和族裔群体的母亲并没有带来同样的益处。基于分解分析，孕产妇年龄、教育程度、孕前BMI、吸烟和ICE解释了非西班牙裔黑人母亲与非西班牙裔白人母亲之间死产差异的21.2%；其中，高中及以下学历（12.3%）、居住在最具特权的社区（9.7%）和肥胖（7.2%）的贡献最大。
社区特权似乎对白种母亲有益，但对非白种母亲则不然，这可能是由于种族歧视经历抵消了经济优势。虽然种族化经济隔离对黑人和白人之间的死产差异贡献不大，但所考察的因素仍无法解释大部分差异。未来的研究应探索导致这些差异的其他个体和社区层面的因素，同时解决不平等问题，以降低所有人群的死产风险。
