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Published on: August 25, 2022
Racial Segregation and Intraventricular Hemorrhage in Preterm Infants
Daria Murosko1,2, Molly Passerella3, Scott Lorch4
1Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Insights
Residential racial segregation (RRS) is linked to a higher risk of intraventricular hemorrhage (IVH) in preterm infants. This association is particularly pronounced in Black neonates, highlighting RRS as a novel risk factor.
Area of Science:
- Neonatal Medicine
- Public Health
- Sociology
Background:
- Intraventricular hemorrhage (IVH) disproportionately impacts Black neonates.
- Conditions like low birth weight and preterm birth, more common in Black neonates, are linked to residential racial segregation (RRS).
Purpose of the Study:
- To investigate the association between residential racial segregation (RRS) and the risk of intraventricular hemorrhage (IVH) in preterm neonates.
Main Methods:
- Retrospective cohort study of 70,775 neonates (24-32 weeks gestation) using birth certificates and medical records (1995-2009).
- Measured RRS using the dissimilarity index and linked it to infant data.
- Employed propensity score analysis to compare IVH risk between infants from high and low segregation areas.
Main Results:
- Infants born to mothers in the most segregated quartile had a significantly higher risk of IVH (12.9% vs 10.4%, P < .001).
- Propensity score matching revealed an increased IVH risk in segregated environments (RR=1.08).
- The association was stronger for Black infants (RR=1.16).
Conclusions:
- Residential racial segregation (RRS) is associated with an increased risk of IVH in preterm neonates.
- This association persists after controlling for community factors and birth weight.
- RRS represents a novel risk factor for IVH, with varying effect sizes by race.
Background:
Intraventricular hemorrhage (IVH) disproportionately affects black neonates. Other conditions that are more common in black neonates, including low birth weight and preterm delivery, have been linked with residential racial segregation (RRS). In this study, we investigated the association between RRS and IVH.
Methods:
A retrospective cohort of neonates born between 24 and 32 weeks' gestation was constructed by using birth certificates linked to medical records from California, Missouri, and Pennsylvania between 1995 and 2009. Dissimilarity, a measure of RRS indicating the proportion of minorities in the census tract of the mother in comparison to the larger metropolitan area, was linked to patient data, yielding a cohort of 70 775 infants. Propensity score analysis matched infants born to mothers living in high segregation to those living in less segregated areas on the basis of race, sociodemographic factors, and medical comorbidities to compare the risk of developing IVH.
Results:
Infants born to mothers in the most segregated quartile had a greater risk of developing IVH compared with those in the lowest quartile (12.9% vs 10.4%; P < .001). In 17 918 pairs matched on propensity scores, the risk of developing IVH was greater in the group exposed to a segregated environment (risk ratio = 1.08, 95% confidence interval: 1.01-1.15). This effect was stronger for black infants alone (risk ratio = 1.16; 95% confidence interval: 1.03-1.30).
Conclusions:
RRS is associated with an increased risk of IVH in preterm neonates, but the effect size varies by race. This association persists after balancing for community factors and birth weight, representing a novel risk factor for IVH.
