An Exploration of the Intergenerational Persistence of Health and Social Status Contributing to Racial Disparities in Birth Outcomes in South Carolina

University Of Michigan At Ann Arbor, Ann Arbor MI

Investigators

Abstract

PROJECT SUMMARY/ABSTRACT Racial disparities in adverse birth outcomes such as preterm birth and low birth weight have persisted for generations in the United States. In attempts to explain birth outcomes and disparities, researchers have identified a mother’s own birth outcome as a strong predictor of her infant’s later birth outcome, yet the strength of this intergenerational health association has been measured as stronger for Black women than White women in the United States. This racial difference signals a potential etiology: since race is a social, not a biological, construct, disparities must be attributable not to racial differences in inherited genetic predisposition, but instead to racial differences in the persistence of social risk factors across generations. Understanding of this potential mechanism requires adoption of a life course approach, which involves measurement of exposures across the life course of a mother. One such measurement could be her change in socioeconomic position over time, which can be conceptualized as social mobility. Social mobility is important to study because it may both be differentially attainable but also differentially impactful on health for Black and White women because of structural racism, or the systemic reinforcement of racial inequality. Few studies have adopted longitudinal exposures like social mobility, instead focusing on the impact of exposures during pregnancy on birth outcomes. This proposal will address knowledge gaps by leveraging a unique multigenerational dataset of maternally linked birth certificates from 1989-2020 in South Carolina. Specifically, this proposal hypothesizes that racial disparities in social mobility may explain measured racial disparities in the intergenerational association of birth outcomes. Aim 1 will examine the intergenerational association between maternal and infant birth outcomes and differences in the association by race. Aim 2 will evaluate differences in social mobility trajectories by race and determine the association between social mobility and adverse birth outcomes, including differences by race. Aim 3 will determine how accounting for social mobility trajectories, in addition to generation-specific risk factors, affects racial disparities in the intergenerational association of birth outcomes. This fellowship will provide the PI with mentorship and rigorous methodological and clinical training in social epidemiology, sociology, and obstetrics and gynecology at a highly ranked and well supported institution. Long-term, this fellowship will prepare the PI to investigate the structural and social etiologies of health inequities in her future career as an independent physician-scientist.