African American Babies Born in Highly Segregated Areas at Higher Risk of Brain Hemorrhage

Infants born to African American mothers living in highly segregated residential areas have an increased risk of intraventricular hemorrhage (IVH), a dangerous condition that involves bleeding in or around the ventricles of the brain, according to an AHRQ-funded study published in Pediatrics. In their analysis of medical and census data of more than 70,000 infants, researchers found that babies born in areas of residential racial segregation had a 1.08 times greater risk of developing IVH. When this risk was stratified by race, white babies in areas of residential racial segregation experienced no increased risk, while the higher risk to African American infants remained (1.16 times greater). Researchers concluded that residential racial segregation is a novel social determinant of the health of African American infants and that more research into the potential causes of this disparity is warranted. Access the abstract.

Racial Segregation and Intraventricular Hemorrhage in Preterm Infants

Daria Murosko 1 2, Molly Passerella 3, Scott Lorch 4

Affiliations

PMID: 32381625
DOI: 10.1542/peds.2019-1508

Abstract

Background: Intraventricular hemorrhage (IVH) disproportionately affects black neonates. Other conditions that are more common in black neonates, including low birth weight and preterm delivery, have been linked with residential racial segregation (RRS). In this study, we investigated the association between RRS and IVH.

Methods: A retrospective cohort of neonates born between 24 and 32 weeks' gestation was constructed by using birth certificates linked to medical records from California, Missouri, and Pennsylvania between 1995 and 2009. Dissimilarity, a measure of RRS indicating the proportion of minorities in the census tract of the mother in comparison to the larger metropolitan area, was linked to patient data, yielding a cohort of 70 775 infants. Propensity score analysis matched infants born to mothers living in high segregation to those living in less segregated areas on the basis of race, sociodemographic factors, and medical comorbidities to compare the risk of developing IVH.

Results: Infants born to mothers in the most segregated quartile had a greater risk of developing IVH compared with those in the lowest quartile (12.9% vs 10.4%; P < .001). In 17 918 pairs matched on propensity scores, the risk of developing IVH was greater in the group exposed to a segregated environment (risk ratio = 1.08, 95% confidence interval: 1.01-1.15). This effect was stronger for black infants alone (risk ratio = 1.16; 95% confidence interval: 1.03-1.30).

Conclusions: RRS is associated with an increased risk of IVH in preterm neonates, but the effect size varies by race. This association persists after balancing for community factors and birth weight, representing a novel risk factor for IVH.