Racialized economic segregation in relation to fecundability in a preconception cohort study

Area of Science:

• Reproductive Epidemiology
• Social Determinants of Health
• Environmental Health

Background:

• Racialized economic segregation is a known determinant of health disparities.
• Previous research linked segregation to adverse pregnancy outcomes.
• No studies had examined the association between segregation and fecundability.

Purpose of the Study:

• To investigate the association between residential segregation and fecundability.
• To assess the impact of economic, racial, and racialized economic segregation on the per-cycle probability of conception.

Main Methods:

• Analysis of 10,438 U.S. participants from the Pregnancy Study Online cohort (2013-2022).
• Calculation of Index of Concentration at the Extremes (ICE) for economic, racial, and racialized economic segregation using residential addresses.
• Use of proportional probabilities regression models to estimate fecundability ratios (FRs), adjusting for relevant variables.

Main Results:

• A monotonic inverse association was observed between increasing quintiles of economic segregation (ICE_income) and racialized economic segregation (ICE_{income + white/black}) with fecundability.
• Living in the most disadvantaged neighborhoods (quintile 1) for racialized economic segregation was associated with a moderate decrease in fecundability (FR = 0.79).
• Less evidence of association was found between racial segregation (ICE_white/black) and fecundability.

Conclusions:

• Neighborhood racialized economic segregation is associated with reduced fecundability.
• These findings highlight the impact of social and economic environmental factors on conception.
• Further research is needed to understand the mechanisms underlying this association.