Racial/Ethnic Disparities in Very Preterm Birth and Preterm Birth Before and During the COVID-19 Pandemic

Janević, Teresa; Glazer, Kimberly B.; Vieira, Luciana; Weber, Ellerie; Stone, Joanne; Stern, Toni; Bianco, Angela; Wagner, Brian; Dolan, Siobhan M.; Howell, Elizabeth A.

doi:10.1001/jamanetworkopen.2021.1816

Cited by 41 publications

(47 citation statements)

References 15 publications

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“…* At p < 0¢1 significance level, the variables were added in the following order: income, occupation. adverse obstetric or neonatal outcomes, but have not focused on a community-level population [24,25]. Cuyahoga County data demonstrate only 30% of the population is Black, therefore, it is readily apparent that pregnant Black women with SARS-CoV-2 are disproportionately represented as 50% of the total cases.…”

Section: Discussionmentioning

confidence: 99%

“…The literature has shown that pregnant women are at risk for severe illness from SARS-CoV-2 infections and pre-term birth, and additional prevention measures for their infection should be considered [ [21] , [22] , [23] ]. The few studies on pregnancy and race have yet to demonstrate increased risk of adverse obstetric or neonatal outcomes, but have not focused on a community-level population [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

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Structural racism and risk of SARS-CoV-2 in pregnancy

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Background: Structural racism leads to adverse health outcomes, as highlighted by inequities in COVID-19 infections. We characterized Black/White disparities among pregnant women with SARS-CoV-2 in Cuyahoga County which has some of the most extreme health disparities in the U.S., such as a rate of Black infant mortality that is three times that of White counterparts. Methods: This was a retrospective cohort study using data collected as part of public health surveillance between March 16, 2020 until October 1, 2020. This study aimed to compare Black and Non-Black pregnant women infected with SARS-CoV-2 to understand how the distribution of risk factors may differ by race. Outcomes included age, gestational age at infection, medical co-morbidities, exposure history, socio-economic status, occupation, symptom severity and pregnancy complications. Findings: One hundred and sixty-two women were included. 81 (50%) were Black, 67 (41%) White, 9 (0¢05%) Hispanic, 2 (0¢01%) Asian; and three did not self-identify with any particular race. More than half who supplied occupational information (n = 132) were essential workers as classified by the CDC definition (55%, n = 73). Black women were younger (p = 0¢0062) and more likely to identify an occupational contact as exposing them to SARS-CoV-2 (p = 0¢020). Non-Black women were more likely to work from home (p = 0¢018) and indicate a personal or household contact as their exposure (p = 0¢020). Occupation was a risk factor for severe symptoms (aOR 4¢487, p = 0¢037). Most Black women lived in areas with median income <$39,000 and Black women were more likely to have a preterm delivery (22¢2% versus 0%, p = 0¢026). Interpretation: Many pregnant women infected by SARS-CoV-2 are essential workers. Black women are more likely than White counterparts to have occupational exposure as the presumed source for their infection. Limitations in occupational options and controlling risk in these positions could be related to lower socioeconomic status, resulting from a long history of structural racism in Cuyahoga County as evidenced by redlining and other policies limiting opportunities for people of color.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Structural racism and risk of SARS-CoV-2 in pregnancy

et al. 2021

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“…6,15,16 However, little research has examined racial/ethnic disparities in COVID-19 prevalence, determinants, and impacts in pregnancy. 19,21 This study will generate important policy implications on birth equity in the time of COVID-19 and guide future research studies related to SARS-CoV-2 infection in pregnant women. The study outcomes will help to illuminate larger community prevalence rates and provide insights on population disparities and equity issues among pregnant women.…”

Section: Discussionmentioning

confidence: 99%

“…19,20 However, few studies have examined racial disparities in perinatal outcomes of COVID-19. 19,21 More research is critical for developing clinical care guidelines that promote birth and reproductive health equity. New Jersey is a particularly important setting to study disparities in COVID-19 during pregnancy because of its diverse population and the high incidence of COVID-19 that affected the population of New Jersey in the early months of the pandemic.…”

Section: Introductionmentioning

confidence: 99%

Racial disparities in prevalence, determinants, and impacts of COVID-19 in pregnancy: Protocol for a study using data from New Jersey hospitals

Rokicki

Nguyen²,

Sharpe³

et al. 2021

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Introduction Racial and ethnic disparities in COVID-19 related infections, hospitalizations, and deaths have been well-documented. However, little research has examined racial and ethnic disparities in COVID-19 prevalence, determinants, and impacts among pregnant women. Within the United States, New Jersey was an early epicenter of the pandemic and experienced high rates of disease in the fall of 2020. Methods This study uses data from two New Jersey hospitals, which implemented universal testing of COVID-19 of pregnant women admitted for labor and delivery starting in March 2020. We will estimate prevalence of COVID-19 between March 2020 and November 2020 and compare prevalence rates across race and ethnicity. We will conduct multivariable logistic regression analysis to examine the associations of COVID-19 infection with patient demographic and health status predictors. We will also use multivariable linear and logistic regressions to examine the impact of COVID-19 symptomatic and asymptomatic infection on maternal and infant birth outcomes. Discussion This study will generate important policy implications on birth equity in the time of COVID-19 and guide future research studies related to COVID-19 in pregnant women. Results of this study will help to guide interventions and policies to center safe, accessible, and equitable maternity care within the strategic response to the pandemic.

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“…At JAMA Network Open, we are making concerted efforts to right these wrongs and are cognizant that our efforts must evolve and expand over time. We will continue to publish studies [12][13][14] and commentaries [15][16][17] that examine the innumerable ways in which racism affects health and health care, and the potential means to mitigate these effects. Ten months ago, we issued a call for papers on the effects of systemic racism in health.…”

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confidence: 99%

Structural Racism and JAMA Network Open

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Like so many in our academic community, we were distressed by the February 2021 JAMA podcast and corresponding tweet suggesting that structural racism does not exist and that no physicians are racist. Although we have not written about this issue until now, these events have prompted a deep internal reexamination of how we engage constructively to acknowledge and reverse structural racism and of our own contributions to perpetuating it. We are challenging ourselves to consider how we can be truly antiracist in our roles as physicians, scientists, editors, and members of the communities in which we work and live.First, we, the editors of JAMA Network Open, affirm the entrenched history and ongoing harms of structural racism. In recent times, the horrific killings of George Floyd, Breonna Taylor, Philando Castile, and hundreds of other individuals who were members of racially/ethnically marginalized groups, such as Black and Latinx individuals, at the hands of police have forced critical and long overdue conversations about this centuries-old problem. Structural racism persists in essentially every social system in the US, including, but not confined to, housing, employment, education, health care, finance, transportation, law enforcement, the environment, criminal justice, and politics.Although not always visible, prejudice is embedded in all aspects of US life. Acknowledging the problem is necessary but insufficient. Structural racism requires active dismantling, not only to reverse the status quo but also to counteract ongoing efforts to worsen structural racism through active steps, such as legislation targeted at impeding voting rights.Second, structural racism has deeply and adversely affected health and health care specifically, as manifested by reduced life expectancy, 1,2 higher burden of various illnesses, 3 and higher infant and maternal mortality, 4,5 especially among Black and Hispanic or Latinx individuals. This stark disparity has become further exacerbated during the COVID-19 pandemic. Black and Hispanic or Latinx populations have experienced rates of hospitalizations and deaths due to COVID-19 that are 3-fold higher than White populations. 6,7 This discrepancy has led to a further widening the nearly 6-year lower in life expectancy among Black persons compared with White persons in the US. 8 This distressing trend is a direct manifestation of the disparities in the availability of and access to highquality health services, with associated inferior treatment and outcomes. Uneven access to highly effective vaccines risks deepening these disparities, which have been documented for decades, in many cases without any evidence of improvement over time. The disparate risks of infection with SARS-CoV-2 and subsequent death from COVID-19 among people of racial and ethnic minority backgrounds, such as Black and Hispanic or Latinx individuals, have appropriately attracted attention but must be viewed in the context of systems that have failed the communities in which people of racial and ethnic minority backg...

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Racial/Ethnic Disparities in Very Preterm Birth and Preterm Birth Before and During the COVID-19 Pandemic

Cited by 41 publications

References 15 publications

Structural racism and risk of SARS-CoV-2 in pregnancy

Structural racism and risk of SARS-CoV-2 in pregnancy

Racial disparities in prevalence, determinants, and impacts of COVID-19 in pregnancy: Protocol for a study using data from New Jersey hospitals

Structural Racism and JAMA Network Open

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