The Mediating Role of Social and Environmental Determinants of Health in the Association Between Race and Preterm Birth Risk

<b><i>Objective:</i></b> To evaluate the mediating role of social and environmental determinants of health (SEDH) in the relationship between self-identified race and preterm birth risk. <b><i>Methods:</i></b> Data on birth outcomes and five broad domains of SEDH were obtained from the Pregnancy, Race, Environment, Genes study, a prospective cohort of pregnant women (50% Black American) in Richmond, Virginia. Configural consistency across racial groups for SEDH domains assessed <i>via</i> multiple indicators was evaluated using unidimensional confirmatory factor models. Mediation models tested the extent to which individual variables/constructs and broader SEDH domains accounted for the association between self-identified <i>race</i> and <i>gestational age at delivery</i> (<i>GAD</i>). <b><i>Results:</i></b> Economic Stability, Education, Health/Health Care, and Social/Community Context showed evidence of mediation through one or more specific subdimensions. Education and Economic Stability fully mediated the association between <i>race</i> and <i>GAD</i>, indexed by maternal educational attainment and current job duration, respectively. In contrast, consideration of Social/Community Context exposed an even larger association between <i>race</i> and <i>GAD</i>. <b><i>Conclusions:</i></b> This study highlights the role of specific and broader SEDH domains in the association between <i>race</i> and spontaneous preterm birth (PTB) risk. Findings underscore the significant impact of educational access and economic security on reproductive outcomes.