Measures of Structural Racism and Black-White Disparity in Stillbirth Rates in New York City, 2009-2018: A Population-Based Cross-Sectional Study

Abstract

Objective: To explore associations between measures of structural racism and stillbirth.

Design: Population-based cross-sectional.

Setting: New York City (NYC), USA.

Population: All non-Hispanic Black and White singleton births 2009-2018.

Methods: We modelled associations between measures of structural racism (Indices of Dissimilarity, Isolation and Concentration at the Extremes [ICE] and an Educational Inequity Ratio) and stillbirth. For indicators with evidence of interaction with race, we estimated odds ratios for stillbirth separately in 221 925 Black and 325 058 White births.

Outcome measure: Stillbirth (fetal death at 20+ completed gestational weeks).

Results: The stillbirth rate (per 1000 total births) was 13.8 in Black and 4.7 in White births. For Black mothers, residence in privileged versus disadvantaged PUMAs (Public Use Microdata Areas) (ICE Quintile 5 vs. 1) was associated with 54% greater odds of stillbirth (95% confidence interval, CI, 1.11, 2.14), and residence in more versus less isolated PUMAs (Isolation Tertile 3 vs. 1) was associated with 36% lower odds of stillbirth (95% CI 0.51, 0.82). There were no associations between measures of structural racism and stillbirth in White births.

Conclusions: ICE and Isolation were associated with stillbirth in Black but not White births, but associations were not in the expected direction, raising questions about whether and how these measures represent structural racism. NYC stillbirths comprise about 4% of the USA's stillbirths but 15% of all Black stillbirths. Hence, reductions in racial disparities in stillbirth rates in NYC will also contribute to national public health.

Keywords: inequity; racial disparity; stillbirth; structural racism.