Publications [#378349] of Hedwig E. Lee

Papers Published

1. Das, A; Casey, JA; Gemmill, A; Catalano, R; Lee, H; Stolte, A; Bustos, B; Bruckner, TA, Dynamic changes in place-based measures of structural racism and preterm birth in the USA., Journal of epidemiology and community health, vol. 78 no. 9 (August, 2024), pp. 550-555 [doi]
   (last updated on 2026/01/15)

   Abstract:
   

   Background

   Structurally racist systems, ideologies and processes generate and reinforce inequities among minoritised racial/ethnic groups. Prior cross-sectional literature finds that place-based structural racism, such as the Index of Concentration at the Extremes (ICE), correlates with higher infant morbidity and mortality. We move beyond cross-sectional approaches and examine whether a decline in place-based structural racism over time coincides with a reduced risk of preterm birth across the USA.

   Methods

   We used as the outcome count of preterm births overall and among non-Hispanic (NH) black and NH white populations across three epochs (1998-2002, 2006-2010, 2014-2018) in 1160 US counties. For our measure of structural racism, we used ICE race/income county measures from the US Census Bureau. County-level fixed effects Poisson models include a population offset (number of live births) and adjust for epoch indicators, per cent poverty and mean maternal age within counties.

   Results

   An SD increase in ICE (0.11) over time corresponds with a 0.6% reduced risk of preterm birth overall (incidence rate ratio (IRR): 0.994, 95% CI 0.990, 0.998), a 0.6% decrease in preterm risk among NH black births (IRR: 0.994, 95% CI 0.989, 0.999) and a 0.4% decrease among NH white births (IRR: 0.996, 95% CI 0.992, 0.999).

   Conclusions

   Movement away from county-level concentrated NH black poverty preceded reductions in preterm risk, especially among NH black populations. Our longitudinal design strengthens inference that place-based reductions in structural racism may improve perinatal health. These improvements, however, do not appear sufficient to redress large disparities.