261053 Using GIS to Examine the Relationship of Maternal Race and Neighborhood Racial Segregation with Birth Outcomes

Sunday, October 28, 2012

Catherine L. Kothari, MA , PhD Program in Interdisciplinary Health Sciences, Western Michigan University, Kalamazoo, MI
Amy B. Curtis, PhD, MPH , Interdisciplinary Health Studies, Western Michigan University, Kalamazoo, MI
Luz Carmen Sweezy, MA , MPA , Healthy Babies Healthy Start, Kalamazoo Health & Community Services Department, Kalamazoo, MI
Annie Wendt, MPH , Epidemiology, Kalamazoo Health & Community Services Department, Kalamazoo, MI
Background: Racial disparities in birth outcomes have been shown to vary widely, and are thought to be closely linked to a community's racial segregation. This study utilized GIS to define racially segregated neighborhoods and examine the association of race and racial segregation with birth outcomes at the individual maternal level as well as the neighborhood,tract level. Methods: This was a secondary data analysis of Kalamazoo County 2008 birth certificate data. Birth records were geo-coded and spatially linked to census tracts. Pearson Chi Square and correlation tests were conducted for maternal race (Black/White) and racial segregation (below/above the county mean Black residents). Regression analyses was then completed for each of the four birth outcome variables (infant death, VLBW, LBW and prematurity). Results: Kalamazoo County census tracts varied widely in racial composition, from 0.1% to 85.4% Black residents, with twenty meeting the racial segregation criteria. Racially segregated tracts had statistically significantly higher vacant housing, lower home-owner-occupied housing, higher poverty and lower high-school-graduation rates. Births in these neighborhoods, regardless of maternal race, were less likely to have early or adequate prenatal care. Regression models identified the following factors associated with poor birth outcomes: HS graduation at the tract level, and maternal race, prenatal smoking, STI and inadequate maternal weight gain at the individual level. Conclusions: Being a Black individual was strongly and independently related to poor birth outcomes; while at the tract level, results suggested an indirect relationship mediated by neighborhood impoverishment, educational attainment and prenatal healthcare resources.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Diversity and culture
Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health or related research

Learning Objectives:
1. Differentiate between individual-level maternal risk factors and neighborhood-level risk factors 2. List three methods for measuring racial segregation 3. Describe how GIS was used to illustrate and analyze the relationship of racial segregation and birth outcomes 4. Discuss the relative association of maternal race and neighborhood racial segregation with birth outcomes in the study community

Keywords: Birth Outcomes, Geographic Information Systems

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have conducted the GIS and statistical analysis for this study, have published peer-reviewed articles related to maternal health, and have conducted evaluations of public health programs including Healthy Start.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.