Decomposition Analysis of Black-White Disparities in Birth Outcomes: The Relative Contribution of Air Pollution and Social Factors in California

By Benmarhnia, Tarik; Huang, Jonathan et al. | Environmental Health Perspectives, October 2017 | Go to article overview

Decomposition Analysis of Black-White Disparities in Birth Outcomes: The Relative Contribution of Air Pollution and Social Factors in California


Benmarhnia, Tarik, Huang, Jonathan, Basu, Rupa, Wu, Jun, Bruckner, Tim A., Environmental Health Perspectives


Introduction

Infants born to non-Hispanic black mothers show a much higher prevalence of preterm birth (PTB; delivered <37 weeks of gestation) relative to infants born to non-Hispanic white mothers in the U.S. (Braveman et al. 2015; McKinnon et al. 2016). In California, where more births occur than in any other state in the U.S. (Murphy et al. 2015), 12.8% of births to black mothers between 2003 and 2010 were preterm in comparison with 7.4% births to white mothers (Braveman et al. 2015). PTB serves as a key antecedent of neonatal mortality (Braveman et al. 2015; Lu et al. 2010), and health and developmental deficits throughout life (Saigal and Doyle 2008; Moster et al. 2008). For this reason, reducing PTB disparities may reduce lifelong black-white health disparities in the United States.

Although numerous studies identify a variety of individual maternal characteristics (e.g., education, age, and socioeconomic status) as potential explanations for this racial disparity in PTB (Blumenshine et al. 2010; lorch and Enlow 2015), clinical interventions (e.g., screening and referral for smoking, substance use, or poor nutrition) to reduce black-white disparities (Lu et al. 2010) or to specifically reduce PTB among black mothers have been thus far equivocal at best (Butler and Behrman 2007). For this reason, increased focus has recently turned toward modifiable aspects of the environment, including physical characteristics such as neighborhood air pollution (Burris et al. 2011; Shah 2010; Arroyo et al. 2016; Green et al. 2015), to reduce disparities in PTB.

Studies often acknowledge that disparities arise from a number of social and environmental factors (Braveman et al. 2015; Lorch and Enlow 2015), of which most are unmeasured (Schempf et al. 2011). However, few studies attempt to assess the contributions of major explanatory variables while simultaneously accounting for some unmeasured factors using fixed effects (Kaufman 2008). This gap in research limits the ability to identify and prioritize potential nonclinical interventions and limits our understanding of the relative contribution of social and physical environmental factors as they produce disparities. To address this issue, our study decomposes the difference (disparity) in PTB prevalence observed in the births of non-Hispanic black and non-Hispanic white infants. We partition this PTB disparity into several relevant predictors, including individual demographics, neighborhood socioeconomic environment, and neighborhood air pollution. We examined multiple factors that contribute to the black-white disparity in PTB in California births from 20052010. This analysis highlights the potential contribution of interventions aimed at reducing air pollution levels and to propose alternative strategies to reduce racial/ethnic disparities in birth outcomes.

Our decomposition analysis improves on existing work in several important ways. First, we focus on policy-relevant, modifiable, physical environmental factors (e.g., transit corridors) and account for nonmodifiable factors (e.g., age). This focus facilitates clear interpretation of results for public-health intervention and policy. Second, our methods make explicit the fact that much of the black-white disparity in PTB remains unexplained by measured factors. Third, we investigate related black-white disparities in other birth outcomes including birth weight, intrauterine growth, very preterm birth (VPTB), and small for gestational age (SGA) (Lorch and Enlow 2015). Fourth, we take advantage of a unique data linkage among individual natality files, neighborhood socioeconomic and demographic data, and objectively measured environmental data for the population base of births in California. The overall objective of this research is to apply decomposition methods to understand disparities in various birth outcomes' prevalence found between non-Hispanic black and non-Hispanic white births in California, according to individual demographics, neighborhood socioeconomic environment, and neighborhood air pollution. …

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