TY - JOUR
T1 - Remapping racial and ethnic inequities in severe maternal morbidity
T2 - The legacy of redlining in California
AU - Gao, Xing
AU - Snowden, Jonathan M.
AU - Tucker, Curisa M.
AU - Allen, Amani
AU - Morello-Frosch, Rachel
AU - Abrams, Barbara
AU - Carmichael, Suzan L.
AU - Mujahid, Mahasin S.
N1 - Publisher Copyright:
© 2022 John Wiley & Sons Ltd.
PY - 2023/7
Y1 - 2023/7
N2 - Background: Historical mortgage redlining, a racially discriminatory policy designed to uphold structural racism, may have played a role in producing the persistently elevated rate of severe maternal morbidity (SMM) among racialised birthing people. Objective: This study examined associations between Home-Owner Loan Corporation (HOLC) redlining grades and SMM in a racially and ethnically diverse birth cohort in California. Methods: We leveraged a population-based cohort of all live hospital births at ≥20 weeks of gestation between 1997 and 2017 in California. SMM was defined as having one of 21 procedures and diagnoses, per an index developed by Centers for Disease Control and Prevention. We characterised census tract-level redlining using HOLC's security maps for eight California cities. We assessed bivariate associations between HOLC grades and participant characteristics. Race and ethnicity-stratified mixed effects logistic regression models assessed the risk of SMM associated with HOLC grades within non-Hispanic Black, Asian/Pacific Islander, American Indian/Alaskan Native and Hispanic groups, adjusting for sociodemographic information, pregnancy-related factors, co-morbidities and neighbourhood deprivation index. Results: The study sample included 2,020,194 births, with 24,579 cases of SMM (1.2%). Living in a census tract that was graded as “Hazardous,” compared to census tracts graded “Best” and “Still Desirable,” was associated with 1.15 (95% confidence interval [CI] 1.03, 1.29) and 1.17 (95% CI 1.09, 1.25) times the risk of SMM among Black and Hispanic birthing people, respectively, independent of sociodemographic factors. These associations persisted after adjusting for pregnancy-related factors and neighbourhood deprivation index. Conclusions: Historical redlining, a tool of structural racism that influenced the trajectory of neighbourhood social and material conditions, is associated with increased risk of experiencing SMM among Black and Hispanic birthing people in California. These findings demonstrate that addressing the enduring impact of macro-level and systemic mechanisms that uphold structural racism is a vital step in achieving racial and ethnic equity in birthing people's health.
AB - Background: Historical mortgage redlining, a racially discriminatory policy designed to uphold structural racism, may have played a role in producing the persistently elevated rate of severe maternal morbidity (SMM) among racialised birthing people. Objective: This study examined associations between Home-Owner Loan Corporation (HOLC) redlining grades and SMM in a racially and ethnically diverse birth cohort in California. Methods: We leveraged a population-based cohort of all live hospital births at ≥20 weeks of gestation between 1997 and 2017 in California. SMM was defined as having one of 21 procedures and diagnoses, per an index developed by Centers for Disease Control and Prevention. We characterised census tract-level redlining using HOLC's security maps for eight California cities. We assessed bivariate associations between HOLC grades and participant characteristics. Race and ethnicity-stratified mixed effects logistic regression models assessed the risk of SMM associated with HOLC grades within non-Hispanic Black, Asian/Pacific Islander, American Indian/Alaskan Native and Hispanic groups, adjusting for sociodemographic information, pregnancy-related factors, co-morbidities and neighbourhood deprivation index. Results: The study sample included 2,020,194 births, with 24,579 cases of SMM (1.2%). Living in a census tract that was graded as “Hazardous,” compared to census tracts graded “Best” and “Still Desirable,” was associated with 1.15 (95% confidence interval [CI] 1.03, 1.29) and 1.17 (95% CI 1.09, 1.25) times the risk of SMM among Black and Hispanic birthing people, respectively, independent of sociodemographic factors. These associations persisted after adjusting for pregnancy-related factors and neighbourhood deprivation index. Conclusions: Historical redlining, a tool of structural racism that influenced the trajectory of neighbourhood social and material conditions, is associated with increased risk of experiencing SMM among Black and Hispanic birthing people in California. These findings demonstrate that addressing the enduring impact of macro-level and systemic mechanisms that uphold structural racism is a vital step in achieving racial and ethnic equity in birthing people's health.
KW - ethnic and racial minorities
KW - maternal health
KW - maternal morbidity
KW - systemic racism
UR - http://www.scopus.com/inward/record.url?scp=85142768996&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85142768996&partnerID=8YFLogxK
U2 - 10.1111/ppe.12935
DO - 10.1111/ppe.12935
M3 - Article
C2 - 36420897
AN - SCOPUS:85142768996
SN - 0269-5022
VL - 37
SP - 379
EP - 389
JO - Paediatric and Perinatal Epidemiology
JF - Paediatric and Perinatal Epidemiology
IS - 5
ER -