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

Abstract

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.

Scoping Review of Racial and Ethnic Representation of Participants in Mental Health Research Conducted in the Perinatal Period During the COVID-19 Pandemic

“…Moreover, the fear, distrust ( George et al., 2014 ), and historical misconduct associated with the Tuskegee study ( Shavers et al., 2000 ) may be related to the low percentage of Black or African American participants (8.9%). On a more practical level, during the pandemic, women of color were more likely to be classified as essential workers ( Pope et al., 2021 ; Rogers et al., 2020 ) and faced unemployment if they did not continue to work ( Pew Research Center, 2020a ), which may have left women without the time or desire to participate in research.…”

“…(2021) compared public health surveillance data of 162 pregnant women infected with COVID-19 to identify risk factors among Black ( n = 81, 50%) and non-Black ( n = 81, 50%) women. The results indicated that Black women infected with COVID-19 were significantly more likely to have preterm birth ( p = .026) and be exposed to COVID-19 at work ( p = .020) than non-Black women infected with COVID-19 ( Pope et al., 2021 ).…”

“…For example, compared with White women, those of color were more likely to experience discrimination in health care (e.g., Black women, 40.0% and Latina women, 35.3%; Janevic et al., 2021 ), be less satisfied with the birth ( Breman et al., 2021 ; Janevic et al., 2021 ), and have less access to health care ( Masters et al., 2021 ). Additionally, in a retrospective design, Pope et al. (2021) compared public health surveillance data of 162 pregnant women infected with COVID-19 to identify risk factors among Black ( n = 81, 50%) and non-Black ( n = 81, 50%) women.…”

Characteristics of People With and Without Laboratory-Confirmed SARS-CoV-2 Infection During Pregnancy, Massachusetts, March 2020–March 2021

“…people. [7][8][9] We compared the characteristics of pregnant people with and without laboratory-confirmed SARS-CoV-2 infection in Massachusetts.…”

“…This comparison is critical to identify disparities and enrich our understanding of who is being most impacted by COVID-19 during pregnancy, especially as initial hospital-based and community-level studies suggest that racially and ethnically minoritized groups might experience higher rates of SARS-CoV-2 infection during pregnancy when compared with non-Hispanic White pregnant people. 7 - 9 We compared the characteristics of pregnant people with and without laboratory-confirmed SARS-CoV-2 infection in Massachusetts.…”