Neighborhood-Level Asian American Composition and Poverty Concentration: Associations with Preterm Birth Among Asian Americans in Texas

Background and Purpose: Preterm birth (PTB), birth before 37 weeks gestation, continues to be a leading cause of infant mortality in the United States. Since individual-level risk factors do not completely explain differences in birth outcomes, researchers have increasingly explored whether broader social and structural elements, including neighborhood context, influence PTB. Although considerable efforts have been made to better understand the associations between neighborhood factors and PTB among Black, Hispanic, and White people, there is a notable lack of empirical work examining this relationship among Asians. While Asian Americans are often viewed as a successful model minority, this "model minority myth" obscures the varying social determinants of health faced by certain groups within this community, including socioeconomic differences and racial discrimination that may impact neighborhood conditions for some more than others. This study examines the relationship between neighborhood Asian American composition, neighborhood poverty, and PTB among Asian Americans in Texas.

Methods: We obtained data from Texas birth records (2005-2020, N=281,553 births by people of Asian race/ethnicity). Using multilevel logistic regression, we examined singleton births for the full sample and for the five largest sub-groups in Texas (Chinese, Filipino, Korean, Asian Indian, Vietnamese), using both unadjusted models and models adjusted for covariates. The main exposure variables are census-tract level Asian American composition and neighborhood poverty concentration (low, medium, high). Covariates include time trend, sociodemographic factors, nativity, having prenatal care in the first trimester or not, and parity.

Results: Among Asians in Texas, the overall prevalence of PTB was 9.4%, with the highest rate among immigrant Filipinos (12.4%) and the lowest among Korean immigrants (6.9%). Overall, residence in neighborhoods with medium Asian concentration was significantly associated with higher odds of PTB compared to residence in areas with high concentrations of Asians (OR: 1.06, CI: 1.00-1.11). Additionally, women living in neighborhoods with high poverty levels had notably increased odds of PTB compared to those in low-poverty areas (OR: 1.06, CI: 1.00-1.11). In models stratified by Asian subgroups, Asian Indian women living in areas with a low concentration of Asians had higher odds of having PTB (OR: 1.22, CI: 1.01-1.47) than those living in areas with a high concentration of Asians. Asian Indian mothers residing in neighborhoods with medium (OR: 1.07, CI: 1.00-1.15) and high poverty levels (OR: 1.12, CI: 1.02-1.23) exhibited higher odds of having PTB than their respective counterparts. No other groups were impacted by the neighborhood exposures.

Conclusions and Implications: Our results indicate that residing in areas with a high concentration of Asians may have a protective effect against the risk of PTB among Asian American women, particularly among Asian Indian mothers. The cultural and social capital present in these ethnic communities could be significant factors to consider when developing targeted health promotion initiatives for this population. Our study also calls for concerted efforts to address systemic and structural barriers in socioeconomically disadvantaged neighborhoods to reduce the risk of PTB among Asian Americans, with a focus on supporting Asian Indian mothers.