Applying mixtures methodology to analyze how exposure to structural racism and economic disadvantage affect perinatal health outcomes: an ECHO study

Our objective was to examine the role of structural racism and economic disadvantage in perinatal health inequities using the Environmental influences on Child Health Outcomes Cohort. Participants' addresses were linked to area-level measures of life expectancy, education, unemployment, health insurance, jail rate, segregation, and housing cost burden. We created absolute measures to represent economic disadvantage and relative measures comparing values for Black or Latinx people to White people in the same area to represent structural racism. We used quantile G-computation to estimate the effects of a one-quartile increase in all exposures simultaneously on fetal growth and gestational age measures. A one-quartile increase in economic disadvantage was associated with a reduction in birthweight [(-25.65 grams, 95% CI (-45.83, -5.48)], but not gestational age [-0.02 weeks, 95% CI (-0.13, 0.09)]. With a one-quartile increase in Latinx-White structural racism, we observed reductions in birthweight [-80.83, 95% CI (-143.42, -18.23)] among Latinx participants. A one-quartile increase in Black-White structural racism was weakly associated with lower birthweight among Black participants [-15.70, 95% CI (-82.89, 51.48)] but was associated with higher birthweight among White participants [57.47, 95% CI (13.26, 101.67)]. Our findings suggest co-occurring forms of structural inequity likely influence racialized disparities in fetal growth outcomes.

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Publication Details

Journal
American Journal of Epidemiology
Published
2025-10-18
DOI
https://doi.org/10.1093/aje/kwaf224
Primary Topic
Health disparities and outcomes
Type
article
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article

Applying mixtures methodology to analyze how exposure to structural racism and economic disadvantage affect perinatal health outcomes: an ECHO study

Maristella Lucchini, Holly B. Schuh, Emily S. Barrett, Nicholas G. Cragoe et al.
American Journal of Epidemiology
Health disparities and outcomes
article

Applying mixtures methodology to analyze how exposure to structural racism and economic disadvantage affect perinatal health outcomes: an ECHO study

Maristella Lucchini, Holly B. Schuh, Emily S. Barrett, Nicholas G. Cragoe, T. Michael O’Shea, Sarah Dee Geiger, Morgan E. Nelson, Marie Camerota, Dana E. Goin, Stephanie Marie Eick, Shilpi S. Mehta‐Lee, Tracey J. Woodruff, L. R. Dean, Benjamin Steiger, Theresa M. Bastain, Rosalind J. Wright, Rachel A. Morello-Frosch, BENNETT L. LEVENTHAL, Jessie Poulin Buckley, Jordan R. Kuiper, Linda G. Kahn, Tamarra James‐Todd, Frank D. Gilliland, Gwendolyn Norman, Amy Padula, Anne Lang Dunlop, Lara Cushing, Kecia N. Carroll, Chaela Nutor, Nicole R. Bush, Matt Kasman, Ronel Ghidey, Amy Elliott, Dana Dabelea, Susan L. Schantz, Tali Felson
article en

Abstract

Our objective was to examine the role of structural racism and economic disadvantage in perinatal health inequities using the Environmental influences on Child Health Outcomes Cohort. Participants' addresses were linked to area-level measures of life expectancy, education, unemployment, health insurance, jail rate, segregation, and housing cost burden. We created absolute measures to represent economic disadvantage and relative measures comparing values for Black or Latinx people to White people in the same area to represent structural racism. We used quantile G-computation to estimate the effects of a one-quartile increase in all exposures simultaneously on fetal growth and gestational age measures. A one-quartile increase in economic disadvantage was associated with a reduction in birthweight [(-25.65 grams, 95% CI (-45.83, -5.48)], but not gestational age [-0.02 weeks, 95% CI (-0.13, 0.09)]. With a one-quartile increase in Latinx-White structural racism, we observed reductions in birthweight [-80.83, 95% CI (-143.42, -18.23)] among Latinx participants. A one-quartile increase in Black-White structural racism was weakly associated with lower birthweight among Black participants [-15.70, 95% CI (-82.89, 51.48)] but was associated with higher birthweight among White participants [57.47, 95% CI (13.26, 101.67)]. Our findings suggest co-occurring forms of structural inequity likely influence racialized disparities in fetal growth outcomes.

American Journal of EpidemiologyVol. 195(2)
University of North Carolina at Chapel Hill (US), Brookings Institution (US), University of Southern California (US), Milken Institute (US), Harvard University (US), Johns Hopkins University (US), Emory University (US), University of Illinois Urbana-Champaign (US), University of California, Los Angeles (US), University of California, San Francisco (US), Wayne State University (US), Brown University (US), Avera Health (US), University of Chicago (US), NYU Langone Health (US), Reproductive Science Center (US), Environmental and Occupational Health Sciences Institute (US), Berkeley Public Health Division (US), University of Colorado Anschutz Medical Campus (US), New York University (US), Oklahoma State University Center for Health Sciences (US), Columbia University (US), University of California, Berkeley (US), Icahn School of Medicine at Mount Sinai (US)
Openalex Percentile: Top 63%
Health disparities and outcomes
DOISourceOpenAlex
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