A multidimensional tool for quantifying structural racism: Application to adverse pregnancy outcomes in Chicago, Illinois

Authors

Alexa A. Freedman, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, United States. Electronic address: alexa.freedman@northwestern.edu.
Lauren S. Keenan-Devlin, Department of Obstetrics and Gynecology, Endeavor Health, University of Chicago, Pritzker School of Medicine, United States.
Britney P. Smart, Department of Obstetrics and Gynecology, Endeavor Health, United States.
Renee M. Odom-Konja, Department of Obstetrics and Gynecology, Endeavor Health, United States.
Shanti U. Gallivan, Institute for Policy Research, Northwestern University, United States.
Andrew D. Franklin, Advocate Health - MidwestFollow
Amy H. Crockett, Department of Obstetrics and Gynecology, Prisma Health, University of South Carolina School of Medicine, United States.
Linda M. Ernst, Department of Pathology and Laboratory Medicine, Endeavor Health, University of Chicago, Pritzker School of Medicine, United States.
Ann Borders, Department of Obstetrics and Gynecology, Endeavor Health, University of Chicago, Pritzker School of Medicine, United States; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, United States; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, United States.
Gregory E. Miller, Institute for Policy Research, Northwestern University, United States; Department of Psychology, Northwestern University, United States.

Recommended Citation

Freedman AA, Keenan-Devlin LS, Smart BP, et al. A multidimensional tool for quantifying structural racism: Application to adverse pregnancy outcomes in Chicago, Illinois. Soc Sci Med. 2025;372:118013. doi:10.1016/j.socscimed.2025.118013

Abstract

Understanding the relationship between structural racism and health is essential for identifying practice- and policy-based interventions to reduce health inequities. We developed neighborhood-based measures of structural racism and tested their associations with adverse pregnancy outcomes, health outcomes characterized by some of the most pronounced racial inequities. We leveraged electronic health records from 89,410 pregnant patients at six Chicago-area hospitals. Patients were linked with neighborhood exposure to 22 experiences reflective of structural racism based on home address, geocoded to the census tract. Measures were summarized into six domains identified as salient to Black women in the literature: law enforcement, housing, medical, employment, education, and community infrastructure. The primary outcome was preterm birth and models were stratified by race and ethnicity. After adjustment for neighborhood socioeconomic status, Black patients in neighborhoods with unfavorable law enforcement practices and school characteristics were more likely to deliver preterm (law RR: 1.07; 95 % CI: 1.02, 1.12; education RR: 1.08; 95 % CI: 1.03, 1.14). This study developed an approach for quantifying multiple domains of structural racism and illustrated its value in the context of preterm birth risk among Black patients.

Document Type

Article

PubMed ID

40147332