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Despite persistent racial disparities in preterm birth (PTB) in the US among non-Hispanic (NH) black women compared to NH white women, it remains controversial whether socio-economic status (SES) factors can explain these differences. We sought to evaluate whether disparities in PTB persist among NH black women of high SES.
Study Design
We conducted a population-based cohort study using US live birth records from the National Vital Statistics System, 2015-2017.We included singleton, non-anomalous pregnancies among women who were of high SES (defined as having ≥ 16 years of education and private insurance and not receiving Women, Infants and Children [WIC] benefits) and who identified as NH white, NH black, or both NH black and white races. The primary outcome was PTB < 37 weeks; secondary outcomes included PTB < 34 and < 28 weeks. Data were analyzed with chi-square, t-test, logistic regression.
Results
Of 11,376,439 women carrying singleton, non-anomalous pregnancies during the study period, 2,170,686 (19.1%) met inclusion criteria. Of these eligible women, 92.9% were NH white, 6.7% NH black, and 0.4% both NH white and black races. Overall, 5.9% delivered < 37, 1.3% < 34, and 0.3 % < 28 weeks. Demographic and baseline characteristics are in Table 1. In unadjusted analyses, the rate of PTB at each GA cutoff was higher for women of mixed NH white and black race, and highest for women who were NH black only compared to women who were NH white only (Table 1, all p< 0.001). In regression models, maternal race remained significantly associated with PTB at each GA cutoff, with highest odds at the earliest delivery GA cutoffs (Figure 1).
Conclusion
Even among college-educated women with private insurance who are not receiving WIC, racial disparities in prematurity persist. These results suggest that factors other than socio-demographics are important in the underlying pathogenesis of PTB and in etiologies of racial disparities.
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