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The built environment as a mediator in the relationship between racial residential segregation and preterm birth in Durham, North Carolina

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Version 2 2024-06-03, 16:25
Version 1 2023-12-18, 21:38
journal contribution
posted on 2024-06-03, 16:25 authored by J.S. Kaufman, L.C. Messer, Marie Lynn MirandaMarie Lynn Miranda, R. Anthopolos
Background. While racial residential segregation has been associated with preterm birth, few studies have examined mediating pathways, in part because with binary outcomes, indirect effects estimated from multiplicative models generally lack causal interpretation. We develop a method to estimate additive scale natural direct and indirect effects from logistic regression. We then evaluate whether segregation operates through poor quality built environment to affect preterm birth. Methods. To estimate natural direct and indirect effects, we derive risk differences (RDs) from logistic regression coefficients. Birth records (2000-2008) for Durham, North Carolina, were linked to neighborhood-level measures of racial isolation and a composite construct of poor quality built environment. We decomposed the total effect of racial isolation on preterm birth into direct and indirect effects. Results. The adjusted total effect of an interquartile increase in racial isolation on preterm birth was an extra 27 preterm events per 1,000 births (RD=0.027, 95% CI: 0.007, 0.047). With poor quality built environment held at the level it would take under isolation at the 25th percentile, the direct effect of an interquartile increase in isolation was 0.022 (95% CI: -0.001, 0.042). Poor quality built environment accounted for 35% (95% CI: 11, 65) of the total effect. Conclusions. Our methodology facilitates estimation of additive-scale natural effects with binary outcomes. In this study, the total effect of racial segregation on preterm birth was partially mediated by poor quality built environment

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