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Socioeconomic Risk Factors for Extreme Preterm Birth in Hawai'i
Joanna P Reinhardt1, Maile M Taualii2
1Internal Medicine, Kaiser Permanente Moanalua Medical Center.
Hawai'I Journal of Health & Social Welfare
|January 22, 2026
Summary
Socioeconomic status (SES) impacts extreme preterm birth risk differently across racial groups in Hawaii. While overall rates were similar, specific risk factors varied by income level, suggesting SES partially explains racial disparities.
Area of Science:
- Public Health
- Reproductive Health
- Health Disparities
Background:
- Socioeconomic status (SES) and race/ethnicity are known determinants of adverse birth outcomes.
- Previous studies faced limitations due to unavailable income data in health records and aggregated racial reporting.
- Understanding these factors is crucial for addressing health inequities in birth outcomes.
Purpose of the Study:
- To evaluate the relationship between socioeconomic status and extreme preterm birth outcomes.
- To examine these associations within the diverse ethnic population of Hawai'i.
- To identify how income level modifies the risk factors for extreme preterm birth.
Main Methods:
- Utilized Hawai'i birth records (2004-2013) linked with American Community Survey data based on maternal residence.
- Stratified community-level income demographics into wealth quintiles.
- Calculated stratum-specific odds ratios for extreme preterm birth, focusing on the highest and lowest income quintiles.
Main Results:
- Overall rates of extreme preterm birth were similar across high and low-income communities.
- Individual risk factors for extreme preterm birth differed significantly by income.
- In low-income communities, young maternal age (<20) and Black race increased risk; in high-income communities, Native Hawaiian and Black race increased risk. Previous preterm birth, first birth, and maternal medical conditions were risk factors across all income levels.
Conclusions:
- The increased risk of extreme preterm birth for Native Hawaiian women observed in high-income communities suggests socioeconomic status may partially explain previously attributed racial disparities.
- Risk factors for extreme preterm birth are income-dependent, highlighting the need for tailored public health interventions.
- Addressing socioeconomic factors is critical for reducing race-based disparities in adverse birth outcomes.
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