Contributions of neighborhood physical and social environments to racial and ethnic disparities in birth outcomes in California: A mediation analysis

• Published in: Environmental research Vol. 260; p. 119578
• Main Authors: Li, Shiwen, Cushing, Lara J., Nianogo, Roch A., Liu, Jonathan, Connolly, Rachel, Yu, Yu, Jerrett, Michael, Ritz, Beate
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-11-2024
• Subjects: Adult; Birth outcomes; California - epidemiology; Ethnicity - statistics & numerical data; Female; Greenspace; Health Status Disparities; Humans; Infant, Low Birth Weight; Infant, Newborn; Mediation Analysis; Neighborhood Characteristics - statistics & numerical data; Neighborhood deprivation; Pregnancy; Pregnancy Outcome - epidemiology; Pregnancy Outcome - ethnology; Premature Birth - epidemiology; Premature Birth - ethnology; Racial disparity; Racial Groups - statistics & numerical data; Social Environment; California; Greenspace; Birth outcomes; Racial disparity; Neighborhood deprivation
• ISSN: 0013-9351; 1096-0953; 1096-0953
• DOI: 10.1016/j.envres.2024.119578

Racially minoritized populations experience higher rates of adverse birth outcomes than White populations in the U.S. We estimated the mediating effect of neighborhood social and physical environments on disparities in adverse birth outcomes in California.
We used birthing parent's residential address for California live birth records from 2019 to estimate census block group Area Deprivation Index and census tract level measures of ambient fine particulate matter (PM2.5), drinking water contamination, tree canopy coverage, as a measure of greenspace, potential heat vulnerability, and noise. We performed mediation analysis to assess whether neighborhood factors explain racial/ethnic disparities in preterm birth (PTB) and term-birth low birth weight (TLBW) comparing Black, Latinx, and Asian with White births after controlling for individual-level factors.
Black, Latinx, and Asian parents had PTB rates that were 67%, 36%, and 11% higher, and TLBW rates that were 150%, 38%, and 81% higher than Whites. Neighborhood deprivation contributed 7% (95% CI: 3%, 11%) to the Black-White and 9% (95% CI: 6%, 12%) to the Latinx-White disparity in PTB, and 8% (95% CI: 3%, 12%) of the Black-White and 9% (95% CI: 5%, 15%) of the Latinx-White disparity in TLBW. Drinking water contamination contributed 2% (95% CI: 1%, 4%) to the Latinx-White disparity in PTB. Lack of greenspace accounted for 7% (95% CI: 2%, 10%) of the Latinx-White PTB disparity and 7% (95% CI: 3%, 12%) of the Asian-White PTB disparity. PM2.5 contributed 11% (95% CI: 5%, 18%), drinking water contamination contributed 3% (95% CI: 1%, 7%), and potential heat vulnerability contributed 2% (95% CI: 1%, 3%) to the Latinx-White TLBW disparity. Lack of green space contributed 3% (95% CI: 1%, 6%) to the Asian-White TLBW disparity.
Our study suggests social environments explain portions of Black/Latinx-White disparities while physical environments explain Latinx/Asian-White disparities in PTB and TLBW.
•Neighborhood deprivation contributed to Black/Latinx vs. White disparities.•Air pollution and drinking water contamination explained some Latinx vs. White disparities.•Lack of greenspace contributed to Latinx/Asian vs White disparities.•Equitable access to better environment in community of color may reduce racial disparity.