Applying mixtures methodology to analyze how exposure to structural racism and economic disadvantage affect perinatal health outcomes: an ECHO study

Dana E. Goin, Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States.
Ronel Ghidey, ECHO Data Analysis Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Holly Schuh, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Lori Dean, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Emily Barrett, Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, United States.
Tracy M. Bastain, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, United States.
Jessie P. Buckley, Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Nicole R. Bush, Department of Psychiatry and Behavioral Sciences and Department of Pediatrics, UCSF, San Francisco, CA, United States.
Marie Camerota, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States.
Kecia N. Carroll, Division of General Pediatrics, Department of Pediatrics and Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Nicholas Cragoe, Beckman Institute, University of Illinois Urbana-Champaign, Urbana, IL, United States.
Lara J. Cushing, Department of Environmental Health Sciences, University of California Los Angeles, Los Angeles, CA, United States.
Dana Dabelea, Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
Anne L. Dunlop, Emory University School of Medicine, Atlanta, GA, United States.
Stephanie Eick, Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, United States.
Amy J. Elliott, Avera Research Institute, Sioux Falls, SD, United States.
Tali Felson, Department of Obstetrics, Gynecology, and Reproductive Sciences, UCSF Program on Reproductive Health and the Environment, San Francisco, CA, United States.
Sarah Geiger, Department of Health and Kinesiology, University of Illinois at Urbana-Champaign, Urbana, IL, United States.
Frank D. Gilliland, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, United States.
Tamarra James-Todd, Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, United States.
Linda G. Kahn, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, United States.
Matt Kasman, Economic Studies, Brookings Institution, Washington, DC, United States.
Jordan R. Kuiper, Department of Environmental and Occupational Health, The George Washington University Milken Institute School of Public Health, Washington, DC, United States.
Bennett Leventhal, Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, United States.
Maristella Lucchini, Department of Psychiatry, Columbia University, New York, NY, United States.
Morgan Nelson, Avera Research Institute, Sioux Falls, SD, United States.
Gwendolyn Norman, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, United States.
Chaela Nutor, Department of Psychology, Emory University, Atlanta, GA, United States.
T Michael O'Shea, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, United States.
Amy M. Padula, Department of Obstetrics, Gynecology, and Reproductive Sciences, UCSF Program on Reproductive Health and the Environment, San Francisco, CA, United States.
Susan L. Schantz, Beckman Institute, University of Illinois Urbana-Champaign, Urbana, IL, United States.
Shilpi S. Mehta-Lee, Department of Obstetrics and Gynecology, NYU Langone Health, Brooklyn, NY, United States.

Document Type

Journal Article

Publication Date

10-20-2025

Journal

American journal of epidemiology

DOI

10.1093/aje/kwaf224

Keywords

disparities; perinatal health; preterm birth; social determinants of health; structural racism

Abstract

Our objective was to examine the role of structural racism and economic disadvantage in perinatal health inequities using the Environmental influences on Child Health Outcomes Cohort. Participants' addresses were linked to area-level measures of life expectancy, education, unemployment, health insurance, jail rate, segregation, and housing cost burden. We created absolute measures to represent economic disadvantage and relative measures comparing values for Black or Latinx people to White people in the same area to represent structural racism. We used quantile G-computation to estimate the effects of a one-quartile increase in all exposures simultaneously on fetal growth and gestational age measures. A one-quartile increase in economic disadvantage was associated with a reduction in birthweight [(-25.65 grams, 95% CI (-45.83, -5.48)], but not gestational age [-0.02 weeks, 95% CI (-0.13, 0.09)]. With a one-quartile increase in Latinx-White structural racism, we observed reductions in birthweight [-80.83, 95% CI (-143.42, -18.23)) among Latinx participants. A one-quartile increase in Black-White structural racism was weakly associated with lower birthweight among Black participants [-15.70, 95% CI (-82.89, 51.48)] but was associated with higher birthweight among White participants [57.47, 95% CI (13.26, 101.67)]. Our findings suggest co-occurring forms of structural inequity likely influence racialized disparities in fetal growth outcomes.

Department

Environmental and Occupational Health

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