Intergenerational Transmission of Health: The Role of Neighborhood Contextual Environment

Background: Pregnant and postpartum women and their infants living in Chicago are disparately exposed to neighborhood violence, segregation, and adverse social and physical conditions, which produce intergenerational disadvantage and health inequities. Black women experience alarmingly high maternal mortality and morbidity and bear a disproportionate burden of death and are nearly three times as likely to die within one year of pregnancy as White women. Children born to these women also experience the deleterious effects of structural racism. Our study uses innovative statistical methods to construct a structural racism index and contributes to new knowledge about the impact of structural racism on maternal-infant dyads.

Methods: Data for this study were from the Electronic Health Records of 2,215 maternal-infant dyads who received care between 2015-2023 at an urban academic medical center in Chicago, IL. Measures included demographics, medical care (hospital, office, emergency department visits), maternal health and mental health conditions (ICD-10 codes, labs) and infant health (gestational age, birthweight, ICD-10 codes, labs). A structural racism index composite measure was created using: median household income, educational attainment, employment, occupation by industry, voter registration, voter turnout, household size, percent renter occupied, and arrest and crime data. Residential addresses were geocoded. Employing spatial analysis techniques, indicators were integrated at the census tract level. We analyzed data using linear regression models and ArcGIS.

Results: The dyads were predominantly Non-Hispanic Black (52.5%), followed by Hispanic (31.2%) and Non-Hispanic White (6.5%). The most prevalent maternal chronic conditions were hypertension, obesity, and diabetes/prediabetes. Of the mothers, 21.9% had none of the chronic conditions, whereas 39.7% had one chronic condition, 33.3% had two, and 4.9% had all three chronic conditions. Of the mothers, 22.6% were diagnosed with at least one mental health disorder. For infants, the mean gestational age was 38.53 weeks (SD=2.04), which is full-term. Of the births, 11.8% were preterm and 11.3% of infants were classified as low birth weight. A substantial of infants (30.3%) required neonatal intensive care unit admission. Mothers with chronic conditions were significantly more likely to have infants with low birth weight and a fetal demise compared with mothers without chronic conditions. Analysis of neighborhood structural racism index data indicated that dyads resided in areas with consistently higher levels of disadvantage compared to Cook County (the county where Chicago is located). The overall structural racism index was higher in neighborhoods where dyads lived (mean=0.50) compared to the Cook County average (mean=0.40), indicating greater exposure to structural racism. Mental health disorders, obesity, hypertension, and infant emergency department visits were all associated with living in neighborhoods with high violent crime rates.

Implications: Our findings suggest that harmful neighborhood exposures and structural racism may produce a sequela of consequences for mother and her child. To address disparities in health, we need robust evidence that informs our efforts to address structural racism and neighborhood conditions to support optimal health and mental health for mothers and their infants.