Do work characteristics mediate ethnic disparities in birth outcomes? Evidence from a birth dataset

To assess racial/ethnic differences in the association between psychosocial work characteristics and birth outcomes, we analyzed maternal occupation and birth outcomes from Connecticut in 2000. Work characteristics were imputed to maternal occupation recorded for 26,408 singleton births, using scores for work substantive complexity (SC) derived from O*NET. Adjusted odds ratios (aOR) for small-for-gestational-age (SGA) and low birthweight (LBW) were estimated separately by race/ethnicity using logistic regression controlling for age, previous delivery, prenatal care, tobacco use, and education. LBW was independently associated with low SC in Blacks (aOR 1.8, 95% CI 1.0-3.0) but not in Whites or Hispanics. A gradient of risk for LBW and SGA with lower SC was seen when Blacks were compared with Whites, even adjusted for education. For Black mothers in high SC work, the aOR for LBW, contrasted with Whites, was 1.6 (0.99–2.5); for Blacks in low SC work, aOR was 2.3 (1.8–2.9). Contrasts in risk were greater at equivalent educational levels; for college graduates, the aOR for LBW in Blacks compared to Whites was 2.2 (1.6-3.2) even after adjustment for work SC. Compared to Whites, lower proportions of Black college graduates are in high SC jobs (43.0%, vs 59.6% in Whites) with higher representation of Blacks in low SC work in all educational strata. These data suggest that gradients in birth outcome by education may be mediated by ability to obtain work consistent with educational attainment, and that education/work mismatch may play a role in racial disparities in birth outcomes.