Social Science & Medicine
Volume 60, Issue 10 , May 2005, Pages 2217-2228

Race and ethnic differences in determinants of preterm birth in the USA:
broadening the social context

Patricia B. Reagana, ,  and Pamela J. Salsberryb

aDepartment of Economics, Center for Human Resource Research, Ohio State
University, 1945 N. High St., Columbus, OH 43221, USA
bSchool of Public Health, College of Nursing, Ohio State University, OH,
USA

Available online 7 December 2004.

Abstract
Preterm births occur in 9.7% of all US singleton births. The rate for
blacks is double that of whites and the rate is 25% higher for Hispanics
than for whites. While a number of individual correlates with preterm birth
have been identified, race and ethnic differences have not been fully
explained. Influenced by a growing body of literature documenting a
relationship among health, individual income, and neighborhood
disadvantage, researchers interested in explaining racial differences in
preterm birth are designing studies that extend beyond the individual. No
studies of adverse birth outcomes have considered contextual effects beyond
the neighborhood level. Only a handful of studies, comparing blacks and
whites, have evaluated the influence of neighborhood disadvantage on
preterm birth.

This study examines how preterm birth among blacks, whites and Hispanics is
influenced by social context, broadly defined to include measures of
neighborhood disadvantage and cumulative exposure to state-level income
inequality, controlling for individual risk factors. Neighborhood
disadvantage is determined by Census tract data. Cumulative exposure to
income inequality is measured by the fraction of the mother's life since
age 14 spent residing in states with a state-level Gini coefficient above
the median. The results for neighborhood disadvantage are highly sensitive
across race/ethnicities to the measure used. We find evidence that
neighborhood poverty rates and housing vacancy rates increased the rate of
very preterm birth and decreased the rate of moderately preterm birth for
blacks. The rate of very preterm increased with the fraction of
female-headed households for Hispanics and decreased with the fraction of
people employed in professional occupations for whites. We find direct
effects of cumulative
exposure to income inequality only for Hispanics. However, we do find
indirect effects of context broadly defined on behaviors that increased the
risk of preterm birth.

Keywords: Preterm; Social context; Income inequality; Racial differences

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