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Updated: Jun 29, 2025

A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting
Published on: January 12, 2018
Inequity in US Racial/Ethnic Infant Health and Birth Outcomes: The Role of the Adult Sex Ratio as a Potential
Enrique R Pouget1, Garumma T Feyissa2, Tracy Wong2
1Department of Health and Nutrition Sciences, Brooklyn College, The City University of New York, 2900 Bedford Avenue, Brooklyn, NY, 11210, USA. Enrique.pouget@brooklyn.cuny.edu.
Background:
Structural racism accounts for inequity in health outcomes in ways that are difficult to measure. To conduct more actionable research and measure the impact of intervention programs, there is a need to develop indicator measures of structural racism. One potential candidate is the Adult Sex Ratio (ASR), which was identified by Du Bois as an important indicator of social life functioning over 100 years ago and has remained significant up to the present day. This study investigated the utility of this measure.
Methods:
We compared birth/infant health outcomes using the US 2000 Linked Birth/Infant Death Cohort Data Set matched with 2000 Census data on adult sex ratios in multilevel logistic regression models, stratified by the racial/ethnic category of the mothers.
Results:
In an adjusted model, the odds of infant death was 21% higher among non-Hispanic Black (NHB) women living in counties in the lowest ASR tertile category when compared to their counterparts in counties in the highest ASR tertile. Similarly, the odds of giving birth to a preterm or a low birth weight infant were each 20% higher among NHB women living in counties in the lowest ASR tertile compared to their counterparts in counties in the highest ASR tertile.
Conclusion:
ASRs may serve as a useful indicator of anti-Black structural racism at the local level. More research is needed to determine the circumstances under which this factor may serve to improve assessment of structural racism and facilitate health equity research.
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