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Social Determinants of Health and Birth Outcome Disparities

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Social Determinants of Health and Birth Outcome Disparities Gail C. Christopher, D.N. June 2007 Courage to Love: Infant Mortality Commission 2005 2007 Co-Chairs ... – PowerPoint PPT presentation

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Title: Social Determinants of Health and Birth Outcome Disparities


1
Social Determinants of Health and Birth Outcome
Disparities
  • Gail C. Christopher, D.N.
  • June 2007

2
Courage to Love Infant Mortality Commission
  • 2005 2007
  • Co-Chairs Reverend Dr. Ronald David Barbara
    Nelson, In partnership with UCLA UMICH.

3
  • U.S. Ranks 28th
  • African American rates were twice as high and
    rising.

4
  • Focusing on prenatal care in our public health
    policy prescription for infant mortality
    disparities ignores the socioeconomic context in
    which women live, medicalizes a problem that is
    socially and historically complex, and thus
    contributes to the illusion that there is a
    medical policy bullet that can provide a
    comprehensive and efficacious solution
  • Frisch Lantz 1999

5
  • Disparities in health, education, employment, and
    wealth, along with persistent residential
    segregation, are vestiges of a long history of
    oppression and denial of fundamental human
    rights. The legacy of racial injustice shadows
    this nation and African American Communities in
    the form of persistent infant mortality
    disparities. True healing must emerge through
    acknowledgement, reconciliation, and amelioration
    of the inequalities that continue to
    disproportionately burden African Americans and
    other people of color
  • Christopher, 2005

6
Black women are at increased risk for adverse
birth outcomes
  • Ectopic pregnancy
  • Spontaneous abortion
  • Cesarean delivery
  • Preterm birth
  • Low birth weight
  • Birth defects
  • Infant death
  • Maternal death from pregnancy-related
    complications

Reveiwed by S. Gennaro, Am J Obstet Gyneco 192,
S310, 2005
7
How Could Environmental Chemicals Contribute to
Disparities?
  • Different exposures to environmental chemicals
  • Different genetic susceptibility to environmental
    chemicals
  • Different acquired modifications of
    susceptibility to environmental chemicals

Interactions
8
Differences in Exposure
  • The Center for Disease Control (CDC) conducts
    biomonitoring of US population exposure to
    environmental chemicals
  • Measure chemicals or their metabolites in blood
    or urine of participants in the National Health
    Nutrition Examination Survey (NHANES)
  • The Third Report on Human Exposure to
    Environmental Chamicals presents data on 148
    chemicals for years 2001-2002

(http//www.cdc.gov/exposurereport/)
9
NHANES Results on Racial Differences in Exposure
Blacks have higher levels of certain chemicals or
their metabolites than Whites
  • p,p-DDE (DDT metabolite)
  • Phthalates (certain monoester metabolites)
  • Organochlorine pesticides (2,5-dichlorophenol,
    2,4,6-trichlorophenol)
  • Lead (urine)
  • Mercury in blood but not urine
  • Cotinine (nicotine metabolite)

10
Blood mercury is higher in Black women of
reproductive age compared with women of other
racial identities
NHANES 1999-2000 and 2001-2002
From Centers for Disease Control and Prevention.
Third National Report on Human Exposure to
Environmental Chemicals. Atlanta (GA) CDC, 2005.
  • Among females aged 16-49 years, non-Hispanic
    Blacks had higher levels than non-Hispanic Whites
    and Mexican-American females.
  • Racial differences not observed for urinary
    mercury.

11
2,4,6-Trichorophenol is higher in non-pregnant
Black women of reproductive age compared with
women of other racial identities
Analysis of NHANES data
  • Use as a wood preservative was discontinued in
    1970s in USA
  • Is a metabolite of the insecticide lindane, which
    is used as pharmaceutical treatment for lice
    scabies
  • Measured in urine

Data analysis by L. Kobeissi and J. Meeker
12
Focus on Preterm Birth
From Martin et al., Births Final data for 2004.
National vital statistics reports, 55 (1). 2006.
  • There has been a steady increase in preterm birth
    over the past two decades

13
Environmental Justice Living with pollution
  • Living near sources of air pollution increases
    risk of preterm birth
  • Petroleum refinery plants (Lin et al., 2001 Yang
    et al., 2004)
  • Petrochemical industrial complexes (Yang, Chang,
    et al., 2002 Yang, Chiu, et al., 2002)
  • Industrial districts including petrochemical,
    petroleum, steel, and shipbuilding industries
    (Tsai et al., 2003)

http//www.demographia.com/db-fuji.htm
14
Living in regions with high sulfur dioxide and
particulate air pollution increases risk of
preterm birth
  • Living near sulfur dioxide and particulate
    pollution sources
  • Highways (Wilhelm and Ritz, 2003 Yang et al.,
  • 2003 Ponce et al., 2005 Wilhelm and Ritz,
    2005)
  • Coal-burning power plant (Mohorovic, 2004)
  • Increased risk is concentration-dependent (Liu et
    al., 2003 Bobak, 2000 Xu et al., 1995)
  • Not all studies found an association (Sagiv et
    al., 2005 Landgren, 1996)

http//www.fotosearch.com/GSH143/gs033008/
http//www.ens-newswire.com/ens/jun2002/200
15
Minority women are more likely to live in areas
of high air pollution
  • Minority populations are more likely to live in
    areas with higher air pollution in the USA
    (Brown, 1995 Silbergeld and Patrick, 2005)
  • Pregnant women of minority race are more likely
    to live in areas of higher air pollution in the
    USA (Ponce et al., 2005 Woodruff et al., 2003)
  • Black women living in areas of high
    traffic-related air pollution have an additional
    increased risk for delivering preterm (Ponce et
    al., 2005)
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