Injuries/Violence
Racial and ethnic disparities in community violence and its association with maternal and infant health in California Emily Liu* Emily Liu Liu Liu Liu University of California, Berkeley
Structural racism may shape exposure and susceptibility to community violence (CV), contributing to racialized disparities in perinatal health. Few studies have evaluated whether exposure to, and health impacts of, CV vary by race and ethnicity.
We analyzed over 4 million singleton live births in California (2007–2018) using linked hospital discharge, birth, and death records. CV was measured at the ZIP code level and binarized as high (≥50th percentile) versus lower levels. We used targeted maximum likelihood estimation for race-stratified risk differences (per 1000) with perinatal outcomes. The analysis was restricted to ZIP codes with overlapping propensity scores for high community violence.
Exposure to high CV was most common among Black (79.0%), Hispanic (74.1%), American Indian/Alaska Native (73.6%), Native Hawaiian/Pacific Islander (NHPI; 67.7%), and Multiracial (57.3%) pregnant people, compared with White (45.0%) and Asian (36.6%) pregnant people. NHPI pregnant people had among the highest prevalence of gestational diabetes (GDM; 14.3%), hypertensive disorders of pregnancy (HDP; 12.9%), preeclampsia (PE; 6.0%), and preterm birth (PTB; 10.0%), and experienced large risk increases associated with high CV, including GDM (RD 11.11 [95% CI 11.04–11.17]), HDP (RD 24.54 [95% CI 24.48–24.60]), PE (RD 12.25 [95% CI 12.21–12.30]), and PTB (RD 7.15 [95% CI 7.09–7.22]). Black pregnant people had the highest prevalence of HDP (14.6%), PE (6.2%), and PTB (11.0%), with substantial violence-associated risk increases, including HDP (RD 19.35 [95% CI 19.34–19.35]), PE (RD 6.63 [95% CI 6.62–6.63]), and PTB (RD 5.39 [95% CI 5.39–5.40]).
Large racial and ethnic differences in both exposure and susceptibility to CV were observed. NHPI and Black pregnant people appear particularly vulnerable to violence exposure and violence-related perinatal risks, underscoring CV as a potential contributor to persistent health disparities.