Health Disparities
Associations between the Social Determinants of Health and Preterm Birth in the Diverse Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Faizah Alshehri* Faizah Alshehri Alshehri Alshehri Alshehri Alshehri Alshehri Alshehri Alshehri Alshehri Alshehri Pennsylvania State University
Social determinants of health (SDoH), such as acculturation (language, social and ethnic relations), discrimination, educational attainment, familism, and religiosity, are associated with adverse maternal and infant outcomes, with higher rates among U.S. Hispanic/Latina women compared to non-Hispanic White women. Most studies examine SDoH in isolation rather than their collective influence, which may provide a more accurate estimate of their association with outcomes. We leveraged a diverse community-based cohort—the Hispanic Community Health Study/Study of Latinos—to gather information about pregnancies in the ~6 years between visits 1-2 (2008-11 and 2014-17), resulting in 489 singleton live births with complete information on six pre-pregnancy SDoH and a total of 42 PTBs (<37 weeks, 11.2%). The top two principal components (PCs) of the six SDoH measures explained >50% of variation and had loadings indicative of both acculturation (PC1) and discrimination/education (PC2) related processes. We ran a generalized estimating equation to account for familial clustering with PCs as predictors of PTB, adjusting for seven indicators of Hispanic/Latina background, center, time since visit 1, maternal age at birth, and time in the US/nativity categories. Most births were to women of Mexican (51%) and Puerto Rican (10%) backgrounds. Neither PC was associated with PTB in our logistic regression; however, Puerto Rican background was a significant risk factor for PTB (Odds Ratio=3.56, 95% Confidence Interval= 1.05-12.13). Prior studies have shown persistent disparities in birth outcomes among Puerto Rican women, particularly for PTB. Our results provide a strong foundation for further latent modeling of multiple SDoH and the investigation of bio-psychosocial underpinnings of the observed background-specific effects. Improved understanding of disparities in PTB faced by Hispanic/Latinas, a large and growing demographic group in the US, is important for population precision health