Structural Racism and Risk of SARS-CoV-2 in Pregnancy: A Local Population Analysis

Abstract

Background: Structural racism leads to adverse health outcomes, as highlighted by inequities in COVID-19 infections. We characterized black/white disparities among pregnant women with SARS-CoV-2 in a county with some of the most extreme health disparities in the U.S.Methods: This was a retrospective cohort study using data collected as part of public health surveillance.Findings: One hundred and sixty-two women submitted information to the surveillance team from March to October 2020. 81 (50%) were Black, 67 (41%) White, 9 (0.05%) Hispanic, 2 (0·01%) Asian; and three did not self-identify with any particular race. More than half who supplied occupational information (n=132) were essential workers as classified by the CDC definition (55%, n=73). Black women were younger (p=0.0062), more likely to be obese (p=0·052), and more likely to identify an occupational contact as exposing them to SARS-CoV-2 (p=0·020). Non-black women were more likely to work from home (p=0·018) and indicate a personal or household contact as their exposure (p=0·020). Occupation was a risk factor for severe symptoms (aOR 4·487, p = 0·037). Most black women lived in areas with median income Interpretation: Many pregnant women infected by SARS-CoV-2 are essential workers. Black women are more likely than white counterparts to have occupational exposure as the presumed source for their infection. These vocational exposures and limitations in controlling risk could be related to lower socio-economic status, resulting from a long history of structural racism.Funding: NoneDeclaration of Interests: NoneEthics Approval Statement: This study was approved by the institutional review board of University Hospitals Cleveland Medical Center.