Remapping racial and ethnic inequities in severe maternal morbidity: The legacy of redlining in California.
Female
Humans
Pregnancy
California
/ epidemiology
Comorbidity
Ethnicity
Hispanic or Latino
/ statistics & numerical data
Residence Characteristics
/ statistics & numerical data
Systemic Racism
/ ethnology
Black or African American
/ statistics & numerical data
Asian American Native Hawaiian and Pacific Islander
/ statistics & numerical data
American Indian or Alaska Native
/ statistics & numerical data
Race Factors
ethnic and racial minorities
maternal health
maternal morbidity
systemic racism
Journal
Paediatric and perinatal epidemiology
ISSN: 1365-3016
Titre abrégé: Paediatr Perinat Epidemiol
Pays: England
ID NLM: 8709766
Informations de publication
Date de publication:
Jul 2023
Jul 2023
Historique:
revised:
20
10
2022
received:
16
06
2022
accepted:
22
10
2022
medline:
17
7
2023
pubmed:
25
11
2022
entrez:
24
11
2022
Statut:
ppublish
Résumé
Historical mortgage redlining, a racially discriminatory policy designed to uphold structural racism, may have played a role in producing the persistently elevated rate of severe maternal morbidity (SMM) among racialised birthing people. This study examined associations between Home-Owner Loan Corporation (HOLC) redlining grades and SMM in a racially and ethnically diverse birth cohort in California. We leveraged a population-based cohort of all live hospital births at ≥20 weeks of gestation between 1997 and 2017 in California. SMM was defined as having one of 21 procedures and diagnoses, per an index developed by Centers for Disease Control and Prevention. We characterised census tract-level redlining using HOLC's security maps for eight California cities. We assessed bivariate associations between HOLC grades and participant characteristics. Race and ethnicity-stratified mixed effects logistic regression models assessed the risk of SMM associated with HOLC grades within non-Hispanic Black, Asian/Pacific Islander, American Indian/Alaskan Native and Hispanic groups, adjusting for sociodemographic information, pregnancy-related factors, co-morbidities and neighbourhood deprivation index. The study sample included 2,020,194 births, with 24,579 cases of SMM (1.2%). Living in a census tract that was graded as "Hazardous," compared to census tracts graded "Best" and "Still Desirable," was associated with 1.15 (95% confidence interval [CI] 1.03, 1.29) and 1.17 (95% CI 1.09, 1.25) times the risk of SMM among Black and Hispanic birthing people, respectively, independent of sociodemographic factors. These associations persisted after adjusting for pregnancy-related factors and neighbourhood deprivation index. Historical redlining, a tool of structural racism that influenced the trajectory of neighbourhood social and material conditions, is associated with increased risk of experiencing SMM among Black and Hispanic birthing people in California. These findings demonstrate that addressing the enduring impact of macro-level and systemic mechanisms that uphold structural racism is a vital step in achieving racial and ethnic equity in birthing people's health.
Sections du résumé
BACKGROUND
BACKGROUND
Historical mortgage redlining, a racially discriminatory policy designed to uphold structural racism, may have played a role in producing the persistently elevated rate of severe maternal morbidity (SMM) among racialised birthing people.
OBJECTIVE
OBJECTIVE
This study examined associations between Home-Owner Loan Corporation (HOLC) redlining grades and SMM in a racially and ethnically diverse birth cohort in California.
METHODS
METHODS
We leveraged a population-based cohort of all live hospital births at ≥20 weeks of gestation between 1997 and 2017 in California. SMM was defined as having one of 21 procedures and diagnoses, per an index developed by Centers for Disease Control and Prevention. We characterised census tract-level redlining using HOLC's security maps for eight California cities. We assessed bivariate associations between HOLC grades and participant characteristics. Race and ethnicity-stratified mixed effects logistic regression models assessed the risk of SMM associated with HOLC grades within non-Hispanic Black, Asian/Pacific Islander, American Indian/Alaskan Native and Hispanic groups, adjusting for sociodemographic information, pregnancy-related factors, co-morbidities and neighbourhood deprivation index.
RESULTS
RESULTS
The study sample included 2,020,194 births, with 24,579 cases of SMM (1.2%). Living in a census tract that was graded as "Hazardous," compared to census tracts graded "Best" and "Still Desirable," was associated with 1.15 (95% confidence interval [CI] 1.03, 1.29) and 1.17 (95% CI 1.09, 1.25) times the risk of SMM among Black and Hispanic birthing people, respectively, independent of sociodemographic factors. These associations persisted after adjusting for pregnancy-related factors and neighbourhood deprivation index.
CONCLUSIONS
CONCLUSIONS
Historical redlining, a tool of structural racism that influenced the trajectory of neighbourhood social and material conditions, is associated with increased risk of experiencing SMM among Black and Hispanic birthing people in California. These findings demonstrate that addressing the enduring impact of macro-level and systemic mechanisms that uphold structural racism is a vital step in achieving racial and ethnic equity in birthing people's health.
Identifiants
pubmed: 36420897
doi: 10.1111/ppe.12935
pmc: PMC10373920
mid: NIHMS1916049
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
379-389Subventions
Organisme : NICHD NIH HHS
ID : F31 HD106772
Pays : United States
Organisme : NINR NIH HHS
ID : 1R01NR020335-01
Pays : United States
Organisme : NINR NIH HHS
ID : R01 NR017020
Pays : United States
Organisme : NINR NIH HHS
ID : R01 NR020335
Pays : United States
Organisme : NINR NIH HHS
ID : 5R01NR017020-04
Pays : United States
Informations de copyright
© 2022 John Wiley & Sons Ltd.
Références
PLoS One. 2016 Nov 23;11(11):e0166846
pubmed: 27880835
Health Place. 2019 Sep;59:102193
pubmed: 31450078
Am J Public Health. 2012 May;102(5):936-44
pubmed: 22420803
PLoS One. 2020 Aug 7;15(8):e0237241
pubmed: 32764800
Am J Epidemiol. 2020 May 5;189(5):412-421
pubmed: 31909419
Obstet Gynecol. 2012 Nov;120(5):1029-36
pubmed: 23090519
Am J Obstet Gynecol. 2005 May;192(5 Suppl):S47-55
pubmed: 15891712
Public Health Rep. 2001 Sep-Oct;116(5):404-16
pubmed: 12042604
Am J Obstet Gynecol. 2014 May;210(5):435.e1-8
pubmed: 24295922
J Urban Health. 2019 Apr;96(2):159-170
pubmed: 29869317
Am J Public Health. 2020 Jul;110(7):1046-1053
pubmed: 32437270
J Urban Health. 2007 Nov;84(6):793-806
pubmed: 17710552
Natl Vital Stat Rep. 2020 Jan;69(2):1-18
pubmed: 32510319
BMJ Open. 2013 Jun 20;3(6):
pubmed: 23794588
Health Aff (Millwood). 2020 May;39(5):768-776
pubmed: 32364858
Health Place. 2014 Jul;28:167-72
pubmed: 24859373
Am J Epidemiol. 2001 Aug 15;154(4):299-304; discussion 305-6
pubmed: 11495851
Matern Child Health J. 2019 Jan;23(1):82-91
pubmed: 30014373
Am J Obstet Gynecol. 2016 May;214(5):643.e1-643.e10
pubmed: 26582168
J Perinatol. 2018 Aug;38(8):997-1008
pubmed: 29593355
Obstet Gynecol. 2014 Apr;123(4):804-10
pubmed: 24785608
Am J Obstet Gynecol. 2016 Jan;214(1):122.e1-7
pubmed: 26283457
Int J Epidemiol. 2001 Aug;30(4):668-77
pubmed: 11511581
Int J Gynaecol Obstet. 2016 Jul;134(1):87-92
pubmed: 27105968
Clin Obstet Gynecol. 2008 Jun;51(2):333-48
pubmed: 18463464
J Urban Health. 2011 Jun;88(3):381-9
pubmed: 21607786
Lancet. 2017 Apr 8;389(10077):1453-1463
pubmed: 28402827
Matern Child Health J. 2019 Mar;23(3):346-355
pubmed: 30712089
Ann Epidemiol. 2020 Dec;52:60-63.e2
pubmed: 32795600
Soc Sci Med. 2011 Nov;73(9):1302-11
pubmed: 21920650
Obstet Gynecol. 2015 Apr;125(4):938-947
pubmed: 25751214
Du Bois Rev. 2011 Apr;8(1):115-132
pubmed: 25632292
Am J Obstet Gynecol. 2005 Jul;193(1):125-34
pubmed: 16021070
Paediatr Perinat Epidemiol. 2020 Jul;34(4):460-468
pubmed: 31106879
Ann Epidemiol. 2019 May;33:30-36
pubmed: 30928320
MMWR Morb Mortal Wkly Rep. 2019 Sep 06;68(35):762-765
pubmed: 31487273
JAMA Netw Open. 2021 Sep 1;4(9):e2126707
pubmed: 34591104
Am Behav Sci. 2013 Aug 1;57(8):
pubmed: 24347666
Am J Obstet Gynecol. 2016 Aug;215(2):143-52
pubmed: 27179441
J Health Soc Behav. 1995;Spec No:80-94
pubmed: 7560851
Soc Sci Med. 2017 Oct;191:237-250
pubmed: 28942206
Obstet Gynecol. 2018 Nov;132(5):1158-1166
pubmed: 30303912
Curr Diab Rep. 2016 Nov;16(11):108
pubmed: 27664041
Int J Environ Res Public Health. 2018 May 28;15(6):
pubmed: 29843403
Obstet Gynecol. 2017 Feb;129(2):285-294
pubmed: 28079772
Obstet Gynecol. 2020 Feb;135(2):294-300
pubmed: 31923072
Am J Obstet Gynecol. 2005 May;192(5 Suppl):S22-9
pubmed: 15891708
Paediatr Perinat Epidemiol. 2012 Nov;26(6):506-14
pubmed: 23061686
Semin Perinatol. 2017 Oct;41(6):332-337
pubmed: 28823579
Am J Obstet Gynecol. 2021 Feb;224(2):219.e1-219.e15
pubmed: 32798461
J Urban Health. 2006 Nov;83(6):1041-62
pubmed: 17031568