Multidimensional structural racism predicts birth outcomes for Black and White Minnesotans

Objective The objective of this study is to determine the linkage between multidimensional structural racism typologies and preterm birth (PTB), low birthweight (LBW), and small-for-gestational-age (SGA) birth among infants of White, US-born Black, and foreign-born Black pregnant people in Minnesota. Data Sources The measures of structural racism were based on the 2017 American Community Survey 5-year estimates and the 2017 jail incarceration data from the Vera Institute of Justice. Birth outcomes of infants born in 2018 were based on birth records from the Minnesota Department of Health. Study Design We conducted a latent class analysis to identify multidimensional structural racism typologies in 2017 and related these typologies to birth outcomes of pregnant people who gave birth in Minnesota in 2018 using Vermunt's 3-step approach. Racial group-specific age-adjusted risks of PTB, LBW, and SGA by structural racism typologies were estimated. Data Collection Study data were from public sources. Principal Findings Our analysis identified three multidimensional structural racism typologies in Minnesota in 2017. These typologies can have high structural racism in some dimensions but low in others. The interactive patterns among various dimensions cannot simply be classified as "high" (i.e., high structural racism in all dimensions), "medium," or "low." The risks of PTB, LBW, and SGA for US-born Black pregnant Minnesotans were always higher than for their White counterparts regardless of the typologies in which they lived during pregnancy. Furthermore, these excess risks among US-born Black pregnant people did not vary significantly across the typologies. We did not find clear patterns when comparing the predicted risks for infants of US- and foreign-born Black pregnant people. Conclusion Multidimensional structural racism increases the risks of adverse birth outcomes for US-born Black Minnesotans. Policy interventions to dismantle structural racism and eliminate birth inequities must be multi-sectoral as changes in one or a few dimensions, but not all, will unlikely reduce birth inequities.