Elsevier

Health & Place

Volume 15, Issue 1, March 2009, Pages 1-9
Health & Place

Segregation and preterm birth: The effects of neighborhood racial composition in North Carolina

https://doi.org/10.1016/j.healthplace.2008.01.007Get rights and content

Abstract

Epidemiologic research suggests that racial segregation is associated with poor health among blacks in the United States (US). We used geocoded birth records and US census data to investigate whether neighborhood-level percent black is associated with preterm birth (PTB) for black and white women in two counties in the southern US, whether area-level deprivation modifies this association, and whether the association is influenced by the choice of geographic unit used to approximate a neighborhood. A 20%-point increase in tract-level percent black was found to be associated with increased PTB odds in white (OR=1.09, 95% CI: 1.01, 1.18) and black (OR=1.05, 95% CI: 0.99, 1.11) women. These small associations were similar to those observed in other US regions. Effects were robust to choice of neighborhood proxy and were not modified by area-level deprivation.

Section snippets

Background

Racial residential segregation, the uneven distribution of race groups across a geographic region, is a persistent feature of the United States (US) landscape. In the US, blacks are more highly segregated from whites than are Hispanics and Asians (Fong and Shibuya, 2005; Massey and Denton, 1987, 1989), with levels of black–white segregation in some cities approaching those of apartheid-era South Africa (Massey, 2004). Therefore, racial residential segregation in the US, hereafter segregation,

Data sources

Three consecutive years of birth records (1999–2001) for Wake and Durham Counties, North Carolina, provided data on birth outcomes and individual-level covariates. Maternal addresses were geocoded with latitude and longitude values using Geographic Data Technology, Inc. (GDT) and assigned to year 2000 US census tracts. Of the 98.6% of birth files with complete addresses sent to GDT for geocoding, 93.2% achieved an exact match using GDT's methods. The North Carolina birth records contain

Results

Non-Hispanic women residing in Wake and Durham Counties had 33,220 singleton live births between 1999 and 2001. Of these, we excluded births to women who were non-Hispanic but reported their race as something other than “black” or “white” (N=539), observations with FIPS codes not corresponding to Wake or Durham County (N=2), observations with missing gestational age data (N=7), or with impossible or improbable birth weight values (N=29). In addition, we excluded 928 births occurring to women

Discussion

In this study, we found a small effect of racial residential segregation, approximated by tract-level percent black, on odds of PTB among women living in two counties in the southern US. The magnitude of the association observed in this study is consistent with that observed in studies of neighborhood racial composition and health in the Northeast, Midwest and US as a whole. Among investigators looking at birth outcomes, Baker and Hellerstedt (2006) compared medium- and low- to high-black

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