Pregnant blacks are at higher risk, Kaiser Permanente study finds
Neighborhood segregation caused by systemic racism against Black Americans may be linked to depression and anxiety during pregnancy, according to new research from Kaiser Permanente. of study Published in JAMA Health Forum.
Kaiser Permanente Research Division researchers analyzed the concentration of a racial or ethnic group within an area, categorized as high, medium, or low residential segregation. Researchers found that living in highly segregated areas was associated with higher rates of depression and anxiety among pregnant patients of various races and ethnicities receiving care through Kaiser Permanente Northern California (KPNC). We investigated whether it was associated with an increase in incidence.
They found that for black people, living in highly segregated areas was associated with higher odds of depression and anxiety during pregnancy. However, for Asian, Hispanic, and white pregnant patients, higher residential segregation was associated with lower odds of depression and anxiety.
“Our study examines residential segregation, a pathway of structural racism, and provides evidence of how these factors are associated with negative health outcomes in Black populations.” said co-lead author and DOR researcher Kendria Kelly-Taylor, Ph.D. “These findings support a growing body of literature demonstrating that racial residential segregation is associated with health disparities between black and white Americans.”
The effects of residential segregation may vary by race and ethnicity, the authors said. Racial residential segregation is a byproduct of practices, policies, and laws that limit economic investment through race-based housing and zoning regulations, creates racial inequality by limiting economic and educational opportunities, and They said they are stepping up. The authors also acknowledged that racial and ethnic groups may cohabit with each other for more proactive reasons, such as seeking support from the community or others with similar backgrounds.
Although this study did not explore the reasons for the disparate effects of residential isolation on mental health during pregnancy, the findings do provide an important signal that neighborhood economic conditions influence well-being. Provided.
“What we’ve identified is part of a more complex story,” Kelly Taylor said. “We looked at the forces of structural racism that have shaped and influenced communities over the years. We are beginning to answer the question of how we can conduct studies of the factors and their effects.”
Additional factors that may be considered in future studies include each racial/ethnic subgroup, nativity (US-born vs. non-US-born), immigration status, and length of residence in the neighborhood. he said.
“This type of analysis is critical to developing public policies that benefit pregnant people and preventing depression and anxiety during pregnancy,” said Lindsay Avalos, a DOR researcher and lead author. said Dr. MPH. “These large social factors need to be investigated to develop policies and interventions to ensure the health and well-being of mothers and families.”
Researchers examined the records of 201,115 KPNC patients who became pregnant between 2014 and 2019 and self-identified as Asian, Black, Hispanic, or White. Participants’ addresses were linked to census tract-level population estimates. The researchers categorized neighborhoods using commonly used measures of racial discrimination, and found that by race or ethnicity, low versus moderate racial discrimination, and low racial discrimination and high racial discrimination were compared separately.
They found that diagnoses of depression and anxiety were highest among black pregnant women (18.3% and 18.4%, respectively). This was followed by whites (16.0%, 18.2%), Hispanics (13.0%, 14.4%), and Asians (5.7%, 6.4%).
Asians and blacks were more likely to live in highly segregated areas. High racial residential segregation was associated with 25% higher odds of prenatal depression and 14% higher odds of prenatal anxiety among blacks.
In contrast, higher racial residential segregation was associated with lower odds of prenatal depression and anxiety among Asians and Hispanics and lower odds of depression among whites.
The study also highlighted that blacks living in highly segregated areas are less likely to have a college degree and more likely to have Medicaid health insurance. “The negative economic impacts of long-standing practices of systemic racism, such as racial residential segregation, can offset the economic impact. [any] “Protective cultural and social factors stemming from living within the same race, especially for Black pregnant people,” the authors write.
High racial residential segregation relative to whites appears to provide protection against depression during pregnancy. Economic poverty was also lower in these regions.
The authors said they focused on mental health diagnosis during pregnancy because pregnancy is a particularly vulnerable time in life. “Pregnancy is a vulnerable time and health conditions experienced during this time can have long-term effects on the well-being of both mother and child,” said Kelly Taylor. “And these effects can affect health for generations.”
The research team plans to continue investigating how structural mechanisms influence mental health during pregnancy, said co-lead author Dr. Sylvia Badon, a research scientist at DOR. “We will explore some of the mechanisms of these relationships and how they differ across racial and ethnic groups, taking into account the interaction between socio-economic context and socio-cultural ties. We plan to dig deeper and look at the potential for mitigating the negative mental health effects of living in sparsely populated areas, “an economic opportunity,” Badon said.
This study was funded by a Kaiser Permanente Community Health Policy and Disparities Research Grant and the National Institute of Child Health and Human Development.
Additional co-authors are Wendy T. Dyer, Ph.D., Alex Asera, MPH, Huyun Dong MPH, Tess Baker, Nerissa Nance, Charles Quesenberry, Ph.D., and Kelly Young-Wolff, Ph.D., MPH, in the Department of Research. Mibhali Bhalala, M.D., Kathryn Erickson-Ridout, M.D., Ph.D., of The Permanente Medical Group; and Dr. Chiari N. Kershaw of Northwestern University Feinberg School of Medicine.
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About Kaiser Permanente Research Department
Kaiser Permanente’s Research Division conducts, publishes, and disseminates epidemiology and health services research to improve the health and health care of Kaiser Permanente members and society as a whole. We aim to understand the determinants of disease and health and improve the quality and cost-effectiveness of healthcare. Currently, DOR’s more than 600 staff members are working on more than 450 epidemiology and health services research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow @KPDOR.
