African American Unemployment and the Disparity in Periviable Births

Ralph Catalano,Alison Gemmill,Katherine Saxton,Collette N Ncube,Deborah Karasek,Tim Bruckner,Gary M Shaw,Joan A Casey,Holly Elser

doi:10.1007/s40615-021-01022-7

Abstract

Periviable infants (i.e., born before 26 complete weeks of gestation) represent fewer than .5% of births in the US but account for 40% of infant mortality and 20% of billed hospital obstetric costs. African American women contribute about 14% of live births in the US, but these include nearly a third of the country’s periviable births. Consistent with theory and with periviable births among other race/ethnicity groups, males predominate among African American periviable births in stressed populations. We test the hypothesis that the disparity in periviable male births among African American and non-Hispanic white populations responds to the African American unemployment rate because that indicator not only traces, but also contributes to, the prevalence of stress in the population. We use time-series methods that control for autocorrelation including secular trends, seasonality, and the tendency to remain elevated or depressed after high or low values. The racial disparity in male periviable birth increases by 4.45% for each percentage point increase in the unemployment rate of African Americans above its expected value. We infer that unemployment—a population stressor over which our institutions exercise considerable control—affects the disparity between African American and non-Hispanic white periviable births in the US.

Highlights

Infants born before 26 complete weeks of gestation, who represent fewer than .5% of births in the US, account for approximately 40% of the nation’s infant mortality [1]
Results from steps 1 and 2 appear graphically in Figs. 1 and 2. The points in these figures show the logged odds ratio of male and female periviable births yielded by conception cohorts conceived by African American and non-Hispanic white mothers in the 228 months beginning January 1998 and ending December 2016
The difference between the observed and expected African American unemployment rates serves as our independent variable and shows the influence of the Great Recession in late 2008 and in 2009

Summary

Introduction

Infants born before 26 complete weeks of gestation, who represent fewer than .5% of births in the US, account for approximately 40% of the nation’s infant mortality [1]. One novel approach views the majority of periviable births as post 20th week spontaneous abortions averted through medical intervention [7, 8]. Small for gestational age, but otherwise “normal,” males predominate among spontaneous abortions as they do among periviable births [9, 11, 17] Much literature attributes this selection in utero against small males to mechanisms, conserved by natural selection, that historically averted maternal investment in offspring with low likelihood of surviving in environments threatening to frail infants small males [14]. Small for gestational age and male sex remain among the strongest predictors of which infants die in stressful environments [17,18,19]

Methods

Results

Conclusion