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The Association Between Structural Disadvantage and Adverse Birth Outcomes: Analyzing Preterm Birth and Low Birth
Emma A Blackson1, Briana Williams2, Jé Judson3
1Department of Social, Behavioral, and Population Sciences, Celia Scott Weatherhead School of Public Health & Tropical Medicine, Tulane University, New Orleans, Louisiana, USA. eblackson@tulane.edu.
Journal of Racial and Ethnic Health Disparities
|April 29, 2025
Summary
Structural disadvantage, measured by the Structural Racism Effect Index (SREI), significantly increases risks for preterm birth and low birth weight. Higher SREI levels correlate with greater adverse birth outcome likelihoods, especially among certain racial groups.
Area of Science:
- Public Health
- Sociology
- Epidemiology
Background:
- Adverse birth outcomes like low birth weight and preterm birth are linked to societal disadvantages.
- The Structural Racism Effect Index (SREI) quantifies structural disadvantages across nine domains.
Purpose of the Study:
- To investigate the association between structural disadvantage, using the SREI, and adverse birth outcomes in the USA.
- To analyze how varying levels of structural disadvantage impact the risks of low birth weight and preterm birth.
Main Methods:
- Utilized the 2020 National Center for Health Statistics natality file.
- Employed modified Poisson regression models to estimate relative risks, adjusting for covariates.
- Assessed the relationship between SREI levels at the maternal county of residence and birth outcomes.
Main Results:
- Higher SREI scores were significantly associated with increased risks for preterm birth and low birth weight.
- Medium and high SREI levels showed dose-response increases in risks: preterm birth (7.4% and 18.8%), low birth weight (6.1% and 17.0%).
- Stratified analyses indicated that the SREI's impact on adverse birth outcomes differed significantly across maternal race.
Conclusions:
- Structural disadvantage, as measured by SREI, is a significant risk factor for adverse birth outcomes.
- The findings underscore a clear dose-response relationship between structural disadvantage and adverse birth outcomes.
- Differential effects by maternal race highlight the need for targeted interventions addressing racial disparities in birth outcomes.
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