Health Disparities
Association between neighborhood segregation and fecundability in a cohort of Black women Chen Sheng* Chen Sheng Yvette C. Cozier Sharonda M. Lovett Brittney Francis Mary D. Willis Wendy Kuohung Jacqueline Hicks Junenette L. Peters Lauren A. Wise Amelia K. Wesselink
Background: In the US, approximately 15% of couples experience infertility. Emerging research indicates that residential segregation can shape reproductive outcomes. However, there are few studies investigating the effects of residential segregation on fecundability (per-cycle probability of conception).
Methods: We used data collected during 1995-2011 from the Black Women’s Health Study (BWHS), a prospective study of U.S. Black women who enrolled in 1995. Biennial health questionnaires from 1995-2011 contained questions on reproductive outcomes including births and miscarriages. A supplemental module in 2011 asked participants to report on each pregnancy resulting in a birth, including whether the pregnancy was planned and how many months it took to conceive. We collected additional data on unsuccessful pregnancy attempts. We used residential address data to calculate census tract level Index of Concentration at the Extremes (ICE). We defined ICErace+income, which reflects combined racial and economic segregation, as the number of non-Hispanic White individuals earning ≥$100,000/year to the number of non-Hispanic Black individuals earning <$25,000/year within a census tract. We implemented proportional probabilities regression models with generalized estimating equations to estimate fecundability ratios (FR) and 95% CI, adjusted for age, calendar year, geographic region, early life SES and educational attainment.
Result: The analysis included 2,857 planned pregnancy attempts from 2,183 participants. Compared with the highest quintile ICErace+income (most privileged), the adjusted FR (95% CI) for quintiles 1-4 were 0.93 (95% CI: 0.82-1.06), 0.93 (95% CI: 0.82-1.05), 1.02 (95% CI: 0.90-1.15), and 0.99 (95% CI: 0.88-1.11), respectively.
Conclusion: In this prospective cohort study, there was no strong association of combined racial and economic segregation with fecundability among Black women.