Pockets of progress amidst persistent racial disparities in low birthweight rates

Abstract

Racial disparities persist in adverse perinatal outcomes such as preterm birth, low birthweight (LBW), and infant mortality across the U.S. Although pervasive, these disparities are not universal. Some communities have experienced significant improvements in black (or African American) birth outcomes, both in absolute rates and in rate ratios relative to whites. This study assessed county-level progress on trends in black and white LBW rates as an indicator of progress toward more equal birth outcomes for black infants. County-level LBW data were obtained from the 2003 to 2013 U.S. Natality files. Black LBW rates, black-white rate ratios and percent differences over time were calculated. Trend lines were first assessed for significant differences in slope (i.e., converging, diverging, or parallel trend lines). For counties with parallel trend lines, intercepts were tested for statistically significant differences (sustained equality vs. persistent disparities). To assess progress, black LBW rates were compared to white LBW rates, and the trend lines were tested for significant decline. Each county’s progress toward black-white equality was ultimately categorized into five possible trend patterns (n = 408): (1) converging LBW rates with reductions in the black LBW rate (decreasing disparities, n = 4, 1%); (2) converging LBW rates due to worsening white LBW rates (n = 5, 1%); (3) diverging LBW rates (increasing disparities, n = 9, 2%); (4) parallel LBW rates (persistent disparities, n = 373, 91%); and (5) overlapping trend lines (sustained equality, n = 18, 4%). Only four counties demonstrated improvement toward equality with decreasing black LBW rates. There is significant county-level variation in progress toward racial equality in adverse birth outcomes such as low birthweight. Still, some communities are demonstrating that more equitable outcomes are possible. Further research is needed in these positive exemplar communities to identify what works in accelerating progress toward more equal birth outcomes.

Geographic Hotspots for Low Birthweight: An Analysis of Counties With Persistently High Rates

“…[10][11][12][13][14][15] Furthermore, small-area evaluation may be important for identifying mechanisms that may be leading to relatively low rates of adverse birth outcomes in some areas. 16 While a number of individual-level characteristics (eg, maternal age) are associated with adverse birth outcomes, other social determinants at the county-level, such as the number of primary care providers and neighborhood deprivation, additionally impact birth outcomes. 17,18 Despite analyses that evaluate persistency in adverse birth outcomes among larger counties or at the state-level, 16,19 studies that evaluate persistency in county-level rates among individual counties across the United States to identify low birthweight hotspot counties are limited.…”

“… 10 - 15 Furthermore, small-area evaluation may be important for identifying mechanisms that may be leading to relatively low rates of adverse birth outcomes in some areas. 16 While a number of individual-level characteristics (eg, maternal age) are associated with adverse birth outcomes, other social determinants at the county-level, such as the number of primary care providers and neighborhood deprivation, additionally impact birth outcomes. 17 , 18 …”

“…Despite analyses that evaluate persistency in adverse birth outcomes among larger counties or at the state-level, 16 , 19 studies that evaluate persistency in county-level rates among individual counties across the United States to identify low birthweight hotspot counties are limited. The use of data at the county-level has been suggested as the geographic level that provides the smallest stable unit in which policies related to social or healthcare services may be created.…”

“…16 While a number of individual-level characteristics (eg, maternal age) are associated with adverse birth outcomes, other social determinants at the county-level, such as the number of primary care providers and neighborhood deprivation, additionally impact birth outcomes. 17,18 Despite analyses that evaluate persistency in adverse birth outcomes among larger counties or at the state-level, 16,19 studies that evaluate persistency in county-level rates among individual counties across the United States to identify low birthweight hotspot counties are limited. The use of data at the county-level has been suggested as the geographic level that provides the smallest stable unit in which policies related to social or healthcare services may be created.…”

Racial Disparities in Perinatal Outcomes Are a Blight on Our Progress

“…2 ). 4 Positive experiences from these areas could and should set the stage for larger public health interventions to remove health disparities once and for all. That will require political will and a societal call for action.…”