Black-White Disparities in Preterm Birth May 13, 2009Posted by awooley in Disparities.
Tags: health disparities, infant mortality, minority health, preterm birth, weathering hypothesis
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In the last 50 years, infant mortality rates in the United States have declined. However, disparities in infant morality rates across racial and ethnic groups persist. Black infants are more than twice as likely to die in their first year of life than their white counterparts (CDC 2000 and CDC 2008). Preterm birth (birth prior to 37 weeks gestation) is a major contributor to infant mortality disparities. These black-white disparities in preterm birth persist with increasing socioeconomic status, suggesting that this disparity is not due to socioeconomic position. Black college-educated women have higher rates of PTB than their white college-educated counterparts (Schoendorf et al., 1992). Attempts to increase access to prenatal care and offer intensive prenatal case management have not influenced these disparities.
Could it be that racism-associated stress, a form of psychosocial stress, encountered long before conception may increase the risk of preterm delivery and begin to explain this disparity? Sociologist Arline Geronimus posits that experiences of discrimination, rather than socioeconomic position, may explain women’s health inequalities among black women, particularly those residing in high poverty urban areas. Geronimus introduced the concept of the “weathering hypothesis,” whereby the body exhibits consequences of and responses to chronic exposure to social, economic and political exclusion arising from racial discrimination. Psychosocial stress resulting from these cumulative experiences may prematurely age or weather the reproductive system, contributing to the increasing the risk of poor birth outcomes among older black women. Moreover, in utero exposure to a deteriorated environment results in a generational transfer of the weathering process (Geronimus, 1992 and Geronimus, 2001). Considering this weathering framework, it seems that interventions to address these disparities must begin prior to conception to improve the mental and physical health of women and girls of color to counteract the bio-psychosocial consequences of racial discrimination.
Centers for Disease Control and Prevention. Office of Minority Health and Health Disparities. Fact Sheet: Eliminate Disparities in Infant Mortality. http://www.cdc.gov/omhd/AMH/factsheets/infant.htm Accessed 9 Feb 2009.
Centers for Disease Control and Prevention. Healthy People 2010: Understanding and improving health (2nd Edition). Nov 2000. http://www.healthypeople.gov/Document/html/uih/uih_2.htm#goals Accessed 9 Feb 2009.
Geronimus AT. The weathering hypothesis and the health of African-American women and infants: evidence and speculations. Ethnicity and Disease. 1992; 2(3): 207-221.
Geronimus AT. Understanding and eliminating racial inequalities in women’s health in
The United States: The role of the weathering conceptual framework. JAMWA 2001; 56: 133-136
Schoendorf K.C., Hogue C.J.R., Kleinman J.C., Rowley D. Mortality among infants of black as compared with white college-educated parents. New England Journal of Medicine 1992; 326: 1522-1526.