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Trends in US Preterm Birth Rates by Household Income and Race and Ethnicity.

Erika G Cordova-Ramos1,2,3, Stacey Y Ruiz1, Genevieve G Guyol1

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Preterm birth rates increased significantly for lower-income households from 2011-2021. Black mothers faced higher preterm birth risks across all income levels, highlighting the role of racism in these disparities.

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Area of Science:

  • Reproductive Health
  • Health Disparities
  • Sociodemographic Factors in Pregnancy

Background:

  • Racial and ethnic disparities in preterm birth are well-documented in the US.
  • The influence of household income on temporal preterm birth trends is not well understood.

Purpose of the Study:

  • To analyze US preterm birth trends by household income between 2011 and 2021.
  • To investigate the relationship between income and preterm birth, considering race and ethnicity.

Main Methods:

  • A US population-based, cross-sectional study utilized data from 411,469 mothers in the Pregnancy Risk Assessment Monitoring System (2011-2021).
  • Household income was categorized relative to the federal poverty level (FPL).
  • Modified Poisson regression models were used to examine associations, adjusting for covariates and race/ethnicity.

Main Results:

  • Preterm birth rates rose significantly over time for households below 200% of the FPL.
  • Non-Hispanic Black mothers exhibited the highest preterm birth rates across all income categories.
  • While income disparities in preterm birth widened, the association attenuated after accounting for race and ethnicity, with Black mothers showing increased risk.

Conclusions:

  • Household income disparities in preterm birth have widened over time in the US.
  • Black race significantly moderated the income-preterm birth association, emphasizing the need to address systemic racism in maternal health outcomes.