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Examine differences in social determinants of health (SDH) between non-Hispanic black women who delivered a preterm birth compared to those with a term birth.
Nested case-control study from a prospective cohort analyzing SDH in 261 postpartum Black women at the University of Cincinnati Medical Center, 2011-2020. Sociodemographic, pregnancy and infant outcome data were collected from participants’ medical records. Structured interviews measured participants’ health, physical environment, social support and structural drivers. χ2 quantified differences between Black women with term (≥37 week) and preterm (<37 week) births (PTB). Multivariable logistic regression was used to assess the influence of social determinants on PTB with adjustment for unmarried status, education less than a high school diploma, and Medicaid insurance.
14.5% of participants had a PTB. The social determinants that differed between preterm and term Black mothers were indicators of social, emotional and financial support, joy and resilience, early prenatal care and neighborhood green spaces. Feeling like someone makes decisions for them without consulting them, dust or mold in the home, and food insecurity were associated with preterm birth in Black women adjusting for marital status, less than a high school education, and Medicaid utilization (Tables 1 & 2).
Non-Hispanic black women with less social support, less recreation spaces in neighborhood, less joy and resilience, and food insecurity, and who felt like someone made decisions for them, did not receive prenatal care as early as wanted, and lived with dust or mold in the air in their home, had increased risk of PTB. Prior studies examining PTB risk factors compared non-Hispanic black women to non-Hispanic white women. Our study focuses specifically on understanding the lives of Black women. Public health initiatives focusing on social determinants may attenuate the racial disparity of PTB in the US.