Health Disparities
Residential Segregation, Housing, and Adverse Birth Outcomes Among Black Birthing People: The Case of South Carolina (1989-2020). Kristi Allgood* Kristi Allgood Annie Ro Yammei Xie Catherine VanderWoude Nancy Fleischer
Racialized legal residential segregation has been a barrier to homeownership for Black families in the US. This study aims to estimate an association between county-level Black:White (B:W) ratios in housing measures and adverse birth outcomes. Data on singleton, live births among Black birthing people between 1989 and 2020 in South Carolina (SC, n=527,577) were collected from birth certificates. County-level housing measures (B:W ratio of homeownership and home loan denials) were log transformed and standardized. Homeownership and area-level covariates (percent of residents below the poverty level and urban status) were obtained from the US Census Bureau while mortgage denials were from the Home Mortgage Disclosure Act. Unadjusted and adjusted mixed effects models with a random intercept were used to estimate the association between B:W disparities in housing measures and low birthweight (LBW) and preterm birth (PTB), separately. Among babies born to Black birthing people, about 12% were LBW and 12% were PTB. For the exposure measures, on average, Black people were 35% less likely to own a home and were about 2 times more likely to have a home loan denied than White people across SC counties. For every standard deviation increase in the proportion of White residents who owned a home relative to Black residents, the odds for LBW increased by 3% in the adjusted model (aOR: 1.03, CI: 1.1, 1.06). Similar results were observed for PTB (aOR: 1.05, CI: 1.03, 1.08). B:W disparities in home loan denial were not associated with LBW in any model and marginally associated with PTB (aOR was 1.01, CI: 1.00, 1.02). Identifying policy solutions to promote Black homeownership may protect against LBW.