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Updated: Jul 11, 2025
A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting
Published on: January 12, 2018
Spatial Patterning of Spontaneous and Medically Indicated Preterm Birth in Philadelphia
Insights
Racial disparities in preterm birth (PTB) persist, with medically indicated PTB showing a greater gap. Understanding geographic patterns of PTB, spontaneous PTB, and medically indicated PTB is crucial for public health.
Area of Science:
- Reproductive Health
- Public Health
- Epidemiology
Background:
- Preterm birth (PTB) is a significant public health concern, disproportionately affecting Black individuals.
- Spontaneous PTB (sPTB) and medically indicated PTB (mPTB) may have distinct etiologies and require different interventions.
- Quantifying racial disparities and geographic patterns in PTB phenotypes is essential for targeted public health strategies.
Purpose of the Study:
- To quantify racial disparities in spontaneous preterm birth (sPTB) and medically indicated preterm birth (mPTB) between non-Hispanic Black and non-Hispanic White individuals.
- To characterize the geographic distribution of PTB, sPTB, and mPTB risks and their associated racial disparities.
- To highlight the importance of differentiating PTB phenotypes in public health and preventive medicine.
Main Methods:
- Analysis of a cohort of 83,952 singleton births from 2 Philadelphia hospitals (2008-2020).
- Classification of PTB into spontaneous (sPTB) and medically indicated (mPTB) categories.
- Application of binomial regression to assess racial disparities and Bayesian modeling for small area estimation of PTB risks and disparities.
Main Results:
- Significant racial disparities were observed for both sPTB (RR=1.83) and mPTB (RR=2.20).
- The racial disparity was 20% greater for mPTB compared to sPTB.
- Substantial geographic variation in PTB risk, sPTB, mPTB, and racial disparities was identified.
Conclusions:
- Distinguishing between sPTB and mPTB is critical for understanding and addressing racial disparities in preterm birth.
- Geographic variations in PTB risk and disparities suggest the influence of localized social and environmental factors.
- Future research should investigate these exposures to explain observed geographic differences in PTB and racial inequities.
Abstract:
Preterm birth (PTB) remains a key public health issue that disproportionately affects Black individuals. Since spontaneous PTB (sPTB) and medically indicated PTB (mPTB) may have different causes and interventions, we quantified racial disparities for sPTB and mPTB, and we characterized the geographic patterning of these phenotypes, overall and according to race/ethnicity. We examined a pregnancy cohort of 83,952 singleton births at 2 Philadelphia hospitals from 2008-2020, and classified each PTB as sPTB or mPTB. We used binomial regression to quantify the magnitude of racial disparities between non-Hispanic Black and non-Hispanic White individuals, then generated small area estimates by applying a Bayesian model that accounts for small numbers and smooths estimates of PTB risk by borrowing information from neighboring areas. Racial disparities in both sPTB and mPTB were significant (relative risk of sPTB = 1.83, 95% confidence interval: 1.70, 1.98; relative risk of mPTB = 2.20, 95% confidence interval: 2.00, 2.42). The disparity was 20% greater in mPTB than sPTB. There was substantial geographic variation in PTB, sPTB, and mPTB risks and racial disparity. Our findings underscore the importance of distinguishing PTB phenotypes within the context of public health and preventive medicine. Future work should consider social and environmental exposures that may explain geographic differences in PTB risk and disparities.
