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. 2024 Jan:85:103177.
doi: 10.1016/j.healthplace.2024.103177. Epub 2024 Jan 19.

Structural barriers to health care as risk factors for preterm and small-for-gestational-age birth among US-born Black and White mothers

David S Curtis  1 , Norman Waitzman  2 , Michael R Kramer  3 , Julie H Shakib  4
Affiliations

Structural barriers to health care as risk factors for preterm and small-for-gestational-age birth among US-born Black and White mothers

David S Curtis et al. Health Place. 2024 Jan.

Abstract

We develop county-level measures of structural and institutional barriers to care, and test associations between these barriers and birth outcomes for US-born Black and White mothers using national birth records for 2014-2017. Results indicate elevated odds of greater preterm birth severity for Black mothers in counties with higher uninsurance rates among Black adults, fewer Black physicians per Black residents, and fewer publicly-funded contraceptive services. Most structural barriers were not associated with small-for-gestational-age birth, and barriers defined for Black residents were not associated with birth outcomes for White mothers, with the exception of Black uninsurance rate. Structural determinants of care may influence preterm birth risk for Black Americans.

Keywords: Health care access; Health insurance; Preterm birth; Racial disparities; Structural racism.

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Conflict of interest statement

Declarations of interest: none.

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References

    1. Almond D, Chay K, Greenstone M, 2006. Civil rights, the war on poverty, and black-white convergence in infant mortality in the rural South and Mississippi. MIT Dep. Econ. Work. Pap No 07–04.
    1. Alson JG, Robinson WR, Pittman L, Doll KM, 2021. Incorporating measures of structural racism into population studies of reproductive health in the United States: A narrative review. Health Equity 5, 49–58. 10.1089/heq.2020.0081 - DOI - PMC - PubMed
    1. Association of American Medical Colleges, 2017. Geographic distribution of the physician workforce by race and ethnicity: AAMC Interactive Report, 2014 (Diversity in the Physician Workforce: Facts & Figures 2014).
    1. Bekemeier B, Yang Y, Dunbar MD, Pantazis A, Grembowski DE, 2014. Targeted health department expenditures benefit birth outcomes at the county level. Am. J. Prev. Med 46, 569–577. - PMC - PubMed
    1. Blumenshine P, Egerter S, Barclay CJ, Cubbin C, Braveman PA, 2010. Socioeconomic disparities in adverse birth outcomes: A systematic review. Am. J. Prev. Med 39, 263–272. - PubMed

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