Neighborhood Racial/Ethnic Composition and Birth Outcomes Among Asian American Women in Texas

Background/Purpose: From 1992 to 2018, Asian Americans residing in the United States had an estimated 251,278 preterm births. This group’s prevalence of preterm birth is 9%, a rate comparable to Non-Hispanic Whites. However, among all groups, Asian American women are at increased risk for preterm outcomes because they have the highest average age as first-time mothers. Additionally, the prevalence of low birth weight among this population is the second highest (9%) after Blacks (14%).

Previous research suggests that individual-level factors may not fully explain the underlying cause of ethnic disparities in birth outcomes; neighborhood factors may also play a role. The ethnic density hypothesis postulates that living in neighborhoods with high proportions of one’s own racial/ethnic group can be beneficial to minority groups’ birth outcomes. While Asians tend to live in metro areas, we decided to conduct our study in Texas where the representation of the Asian population differs from other large states. For example, in Houston, which has the highest proportion of Asian Americans in Texas, they make up only 6.7% of the population. In the New York and Sacramento metro areas they make up nearly 10% and 11%, respectively, while proportions in San Francisco and San Diego are even higher. Using data from the state of Texas, we examined the extent to which neighborhood-level Asian American population composition explains Asian American mothers’ birth outcomes.

Methods: Individual-level data came from birth certificate data for singleton births from 2009-2011. Neighborhood level, census track data came from the 2010 Texas census and the American Community Survey (ACS). The dependent variables were preterm births (< 37 weeks) and low birth weight births (birth weight less than 2,500 grams). Asian American composition was measured based on 2010 Census distributions. We estimated multilevel generalized logistic regression models to examine the relationship between neighborhood Asian American composition and each dependent variable using an unadjusted model and a model adjusted for individual and neighborhood level covariates.

Results: Living in neighborhoods with a one standard deviation higher concentration of Asian residents compared to the mean was associated with 10% lower odds of preterm birth outcome (OR=0.90, CI=0.86, 0.93). After adjusting for individual level covariates, neighborhood-level population density, and neighborhood poverty rates, the odds were 4% lower (OR=0.96, CI= 0.93, 1.00). Living in neighborhoods with a one standard deviation higher concentration of Asian residents compared to the mean was associated with 6% lower odds of low birth weight in the unadjusted model (OR=0.94, CI=0.91, 0.98). After adjustment for individual and neighborhood level covariates, the odds were 4% lower (OR=0.96, CI=0.93, 1.00).

Conclusions and Implications: We found that living in predominantly Asian American neighborhoods in Texas had a protective effect on Asian American birth outcomes. Further research is needed to examine the mechanisms explaining the beneficial factors associated with living in neighborhoods with residents from a similar racial group. Critical to this research will be analyses that examine different Asian ethnic subgroups. Such information can help inform culturally responsive interventions.