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Racial/Ethnic Disparities in Very Preterm Birth and Preterm Birth Before and During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Was the first wave of the coronavirus disease 2019 (COVID-19) pandemic associated with exacerbated racial/ethnic disparities in preterm birth in New York City?

Findings  This cross-sectional study found that racial/ethnic disparities in very preterm birth and preterm birth among 8026 women were similar during the first wave of the COVID-19 pandemic in New York City compared with the same period the year prior.

Meaning  Monitoring of racial/ethnic disparities in adverse birth outcomes as the COVID-19 pandemic continues is warranted.

Abstract

Importance  The coronavirus disease 2019 (COVID-19) pandemic may exacerbate existing racial/ethnic inequities in preterm birth.

Objective  To assess whether racial/ethnic disparities in very preterm birth (VPTB) and preterm birth (PTB) increased during the first wave of the COVID-19 pandemic in New York City.

Design, Setting, and Participants  This cross-sectional study included 8026 Black, Latina, and White women who gave birth during the study period. A difference-in-differences (DID) analysis of Black vs White disparities in VPTB or PTB in a pandemic cohort was compared with a prepandemic cohort by using electronic medical records obtained from 2 hospitals in New York City.

Exposures  Women who delivered from March 28 to July 31, 2020, were considered the pandemic cohort, and women who delivered from March 28 to July 31, 2019, were considered the prepandemic cohort. Reverse transcription–polymerase chain reaction tests for the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were performed using samples obtained via nasopharyngeal swab at the time of admission.

Main Outcomes and Measures  Clinical estimates of gestational age were used to calculate VPTB (<32 weeks) and PTB (<37 weeks). Log binomial regression was performed to estimate Black vs White risk differences, pandemic cohort vs prepandemic cohort risk difference, and an interaction term representing the DID estimator. Covariate-adjusted models included age, insurance, prepregnancy body mass index, and parity.

Results  Of 3834 women in the pandemic cohort, 492 (12.8%) self-identified as Black, 678 (17.7%) as Latina, 2012 (52.5%) as White, 408 (10.6%) as Asian, and 244 (6.4%) as other or unspecified race/ethnicity, with approximately half the women 25 to 34 years of age. The prepandemic cohort comprised 4192 women with similar sociodemographic characteristics. In the prepandemic cohort, VPTB risk was 4.4% (20 of 451) and PTB risk was 14.4% (65 of 451) among Black infants compared with 0.8% (17 of 2188) VPTB risk and 7.1% (156 of 2188) PTB risk among White infants. In the pandemic cohort, VPTB risk was 4.3% (21 of 491) and PTB risk was 13.2% (65 of 491) among Black infants compared with 0.5% (10 of 1994) VPTB risk and 7.0% (240 of 1994) PTB risk among White infants. The DID estimators indicated that no increase in Black vs White disparities were found (DID estimator for VPTB, 0.1 additional cases per 100 [95% CI, −2.5 to 2.8]; DID estimator for PTB, 1.1 fewer case per 100 [95% CI, −5.8 to 3.6]). The results were comparable in covariate-adjusted models when limiting the population to women who tested negative for SARS-CoV-2. No change was detected in Latina vs White PTB disparities during the pandemic.

Conclusions and Relevance  In this cross-sectional study of women who gave birth in New York City during the COVID-19 pandemic, no evidence was found for increased racial/ethnic disparities in PTB, among women who tested positive or tested negative for SARS-CoV-2.

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Article Information

Accepted for Publication: January 23, 2021.

Published: March 17, 2021. doi:10.1001/jamanetworkopen.2021.1816

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Janevic T et al. JAMA Network Open.

Corresponding Author: Teresa Janevic, PhD, MPH, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, PO Box 1077, One Gustave Levy Pl, New York, NY 10029 (teresa.janevic@mountsinai.org).

Author Contributions: Drs Janevic and Glazer had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Janevic, Glazer, Stone, Howell.

Acquisition, analysis, or interpretation of data: Janevic, Glazer, Vieira, Weber, Stern, Bianco, Wagner, Dolan.

Drafting of the manuscript: Janevic, Glazer.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Janevic, Glazer, Weber, Bianco.

Administrative, technical, or material support: Vieira, Stone, Stern, Wagner, Dolan, Howell.

Supervision: Janevic, Stone, Dolan, Howell.

Conflict of Interest Disclosures: Dr Dolan reported receiving grants from the Centers for Disease Control and Prevention during the conduct of the study. No other disclosures were reported.

Funding/Support: This work was supported by the Blavatnik Family Foundation.

Role of the Funder/Sponsor: The Blavatnik Family Foundation had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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