Resilience as a potential modifier of racial inequities in preterm birth

Authors

Allyson M. Redhunt, Maine Medical Center
Rachel Ledyard, Division of Neonatology, Children's Hospital of Pennsylvania, Philadelphia, PA.
Ai-Ris Y. Collier, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
Michele R. Hacker, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA.
Heather H. Burris, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA

Document Type

Article

Publication Date

4-21-2023

Institution/Department

Obstetrics & Gynecology

Journal Title

Annals of epidemiology

Abstract

PURPOSE: In the United States, preterm birth is 55% more common among Black compared to White individuals and psychosocial stressors may contribute. Resilience is associated with improved health outcomes outside of pregnancy. However, whether resilience modifies preterm birth inequity is unknown. We hypothesized that high resilience would reduce inequities in preterm birth risk. METHODS: This study analyzes data from 535 pregnancies among Black (n=101, 19%) and White (n=434, 81%) participants from the Spontaneous Prematurity and Epigenetics of the Cervix prospective cohort. Participants completed the Connor-Davidson Resilience Scale. We calculated risk ratios (RR) for preterm birth among Black compared to White participants, stratified by resilience tertiles, to test for effect measure modification. RESULTS: Among those in the lowest resilience tertile, there were 6 (20.7%) preterm births among Black and 7 (4.9%) among White participants (RR: 4.26; 95% confidence interval (CI): 1.53, 11.81). Among those in the highest resilience tertile, there were 8 (18.2%) preterm births among Black and 14 (9.5%) among White participants (RR: 1.92; 95% CI: 0.87, 4.24. Adjusting for education and income, the Black:White RR was 2.00 (95% CI 0.47, 8.64) in the lowest tertile, and 3.49 (95% CI 1.52, 8.01) in the highest tertile. CONCLUSIONS: Black-White preterm birth inequity did not differ among resilience strata and remained significant in the highest tertile. Our findings suggest that high resilience is inadequate to overcome Black:White racial inequity in preterm birth.

Recommended Citation

Redhunt AM, Ledyard R, Collier AY, Hacker MR, Burris HH. Resilience as a potential modifier of racial inequities in preterm birth [published online ahead of print, 2023 Apr 21]. Ann Epidemiol. 2023;S1047-2797(23)00075-3. doi:10.1016/j.annepidem.2023.04.010