Lauren Dyer1, Brittany D Chambers2, Joia Crear-Perry3, Katherine P Theall4, Maeve Wallace4. 1. Department of Social, Behavioral, and Population Sciences, Mary Amelia Women's Center, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA, 70112, USA. ldyer3@tulane.edu. 2. School of Medicine, Epidemiology and Biostatistics, University of San Francisco, 550 16th St., San Francisco, CA, 94158, USA. 3. National Birth Equity Collaborative, 4747 Earhart Blvd, New Orleans, LA, USA. 4. Department of Social, Behavioral, and Population Sciences, Mary Amelia Women's Center, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA, 70112, USA.
Abstract
OBJECTIVES: Social and contextual factors underlying the continually disproportionate and burdensome risk of adverse health outcomes experienced by Black women in the US are underexplored in the literature. The aim of this study was to use an index based on area-level population distributions of race and income to predict risk of death during pregnancy and up to 1 year postpartum among women in Louisiana. METHODS: Using vital records data provided by the Louisiana Department of Health 2016-2017 (n = 125,537), a modified Poisson model was fit with generalized estimating equations to examine the risk of pregnancy-associated death associated with census tract-level values of the Index of Concentration at the Extremes (ICE)-grouped by tertile-while adjusting for both individual and tract-level confounders. RESULTS: Analyses resulted in an estimated 1.73 (95% CI 1.02-2.93) times increased risk for pregnancy-associated death for those in areas which were characterized by concentrated deprivation (high proportions of Black and low-income residents) relative to those in areas of concentrated privilege (high proportions of white and high-income residents), independent of other factors. CONCLUSIONS FOR PRACTICE: In addition to continuing to consider the deeply entrenched racism and economic inequality that shape the experience of pregnancy-associated death, we must also consider their synergistic effect on access to resources, maternal population health, and health inequities.
OBJECTIVES: Social and contextual factors underlying the continually disproportionate and burdensome risk of adverse health outcomes experienced by Black women in the US are underexplored in the literature. The aim of this study was to use an index based on area-level population distributions of race and income to predict risk of death during pregnancy and up to 1 year postpartum among women in Louisiana. METHODS: Using vital records data provided by the Louisiana Department of Health 2016-2017 (n = 125,537), a modified Poisson model was fit with generalized estimating equations to examine the risk of pregnancy-associated death associated with census tract-level values of the Index of Concentration at the Extremes (ICE)-grouped by tertile-while adjusting for both individual and tract-level confounders. RESULTS: Analyses resulted in an estimated 1.73 (95% CI 1.02-2.93) times increased risk for pregnancy-associated death for those in areas which were characterized by concentrated deprivation (high proportions of Black and low-income residents) relative to those in areas of concentrated privilege (high proportions of white and high-income residents), independent of other factors. CONCLUSIONS FOR PRACTICE: In addition to continuing to consider the deeply entrenched racism and economic inequality that shape the experience of pregnancy-associated death, we must also consider their synergistic effect on access to resources, maternal population health, and health inequities.
Authors: Andreea A Creanga; Cynthia J Berg; Jean Y Ko; Sherry L Farr; Van T Tong; F Carol Bruce; William M Callaghan Journal: J Womens Health (Larchmt) Date: 2014-01 Impact factor: 2.681
Authors: Elizabeth McClure; Lydia Feinstein; Evette Cordoba; Christian Douglas; Michael Emch; Whitney Robinson; Sandro Galea; Allison E Aiello Journal: Health Place Date: 2018-11-15 Impact factor: 4.078
Authors: Brittany D Chambers; Brianne Taylor; Tamara Nelson; Jessica Harrison; Arielle Bell; Allison O'Leary; Helen A Arega; Sepehr Hashemi; Safyer McKenzie-Sampson; Karen A Scott; Tina Raine-Bennett; Andrea V Jackson; Miriam Kuppermann; Monica R McLemore Journal: Womens Health Rep (New Rochelle) Date: 2022-05-04