African-American Women's Early-Life Exposure to Neighborhood Mortgage Discrimination and Preterm Birth Rates: A Population-Based Study.

Objective: To determine the extent to which African-American women's early-life residence in urban neighborhoods with mortgage discrimination (compared to neighborhoods without mortgage discrimination) is associated with preterm birth (< 37 weeks, PTB).

Methods: Stratified and multivariable binominal regression analyses were performed on a Chicago transgenerational dataset of African-American women (born 1989-1991) and their infants (born 2005-2017) with appended Home Mortgage Disclosure Act and Index of Concentration at the Extremes (ICE) data.

Results: In mortgage discriminated neighborhoods, the proportion of non-Hispanic White residents exceeded that of neighborhoods without mortgage discrimination: 84% vs. 31%, p < 0.01. Additionally, mean ICE_{race/ethnicity} for mortgage discriminated neighborhoods equaled 0.78 (0.64-0.91) confirming the greater concentrations of non-Hispanic White populations. African-American women (n = 735) with early-life residence in mortgage discriminated neighborhoods had a PTB rate of 15.8% compared to 13.1% for those (n = 23,369) with early-life residence in non-mortgage discriminated neighborhoods; RR = 1.20 (1.01, 1.43). The adjusted (controlling for trimester of prenatal care usage and cigarette smoking) RR of early (< 34 weeks), late (34-36 weeks), and total PTB for African-American women with early-life residence in mortgage (compared to non-mortgage discriminated) neighborhoods equaled 1.60 (1.20, 2.14), 1.18 (0.92,1.53), and 1.31 (1.09,1.57), respectively. The subgroup of African-American women (n = 536) with early-life residence in mortgage discriminated neighborhoods and adulthood residence in non-mortgage discriminated neighborhoods had an early PTB rate of 8.0% versus 5.1% for those (n = 20,298) with a lifelong residence in non-mortgage discriminated neighborhoods; RR = 1.58 (1.18, 2.12).

Conclusions: Urban African-American women's early-life residence in predominately non-Hispanic White, mortgage discriminated neighborhoods is associated with an increased risk of PTB, particularly its' early component, independent of adulthood risk status.