Racial Residential Segregation and Racial Disparities in Stillbirth in the United States

Authors

• AD Williams
• ME Wallace
• CJ Nobles
• P Mendola

Abstract

Background: Although stillbirth rates are declining, US black women experience two-fold higher rates of stillbirth compared to US white women. Structural racism, including black-white racial residential segregation, is a key determinant of US racial health disparities. It is unclear whether current and/or persistent racial residential segregation is associated with black-white stillbirth disparities. Methods: We examined 49,969 black and 71,785 white births from the Consortium on Safe Labor (2002-2008). We measured black-white segregation using the dissimilarity index (the differential distribution of racial/ethnic groups within a geographic area) and the isolation index (the probability that a member of one racial group will interact with a member of the same racial group), categorized into population-based tertiles: high, moderate, low. Current segregation was based on birth year segregation. Persistent segregation was measured by comparing 1990 segregation to birth year segregation. Stillbirth was fetal death =23 weeks gestation reported in medical records. Hierarchical logistic regression models estimated race-specific associations between current and persistent segregation and stillbirth; high levels of current and persistent segregation were the reference category. We estimated number of fewer stillbirths attributable to decreasing segregation using the population attributable fraction. Results: For current segregation, low segregation was more beneficial to blacks (Dissimilarity Odds Ratio [OR]: 0.43 95% Confidence Interval [95% CI]: 0.29, 0.63; Isolation OR: 0.25 95% CI: 0.16, 0.41) than whites (Dissimilarity OR: 1.42 95% CI: 0.77, 2.59; Isolation OR: 0.33 95% CI: 0.21, 0.53). For persistent segregation, decreasing segregation was also more beneficial to blacks (Dissimilarity OR: 0.53 95% CI: 0.32, 0.89; Isolation OR: 0.19 95% CI: 0.10, 0.38) than whites (Dissimilarity OR: 0.75 95% CI: 0.41, 1.37; Isolation OR: 0.82 95% CI: 0.46, 1.48). Approximately 900 stillbirths among blacks could be prevented annually by decreasing segregation. Conclusions: Low and decreasing levels of segregation were associated with reduced odds of stillbirth, with blacks benefitting more than whites. Despite decreasing levels of segregation, the black-white disparity in stillbirth remains. These findings suggest reducing structural racism, like segregation, can improve health outcomes for blacks, and could potentially reduce persistent racial health disparities.

Scientific Focus Area: Social and Behavioral Sciences

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