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TABLE 4-2 Preterm Birth Rates (percent) by Maternal Race-Ethnicity and Educational Attainment, 1998 to 2000

Educational Attainmenta

Non-Hispanic African Americans

Non-Hispanic Whites

Asians-Pacific Islanders

American Indians

Hispanics

<8

19.6

11.0

11.5

14.8

10.7

8–12

16.8

9.9

10.5

11.8

10.4

13–15

14.5

8.3

9.1

9.9

9.3

≥16

12.8

7.0

7.5

9.4

8.4

aEducational attainment indicates the number of years of school completed.

SOURCE: NCHS data for U.S. birth cohorts from 1998 to 2000.

behaviors, stress, infections, and genetics (reviewed by Lu and Halfon [2003]).

Conventional wisdom often regards race as a proxy for socioeconomic condition, and some believe that socioeconomic factors (often measured in terms of educational attainment, household income, or occupational status) explain differences in preterm birth rates by race. African American women, on average, are more socioeconomically disadvantaged than non-Hispanic white women (Oliver and Shapiro, 1995), and a poorer socioeconomic condition is associated with an increased risk for preterm birth. However, in most studies the differences in preterm birth rates (McGrady et al., 1992), birth weights (Collins and Hawkes, 1997; Shiono et al., 1997), and infant mortality rates (Schoendorf et al., 1992) between African American and white women persisted after adjustment for (measured) socioeconomic differences. Furthermore, socioeconomic condition does not confer equal protection across racial-ethnic groups, as shown in Table 4-2.

For example, although within each racial-ethnic group the risk of preterm birth decreases with an increasing level of educational attainment, African American women with more than 16 years of education still have substantially higher preterm birth rates than non-Hispanic white women with less than 9 years of education. Although it is possible that the residual disparities result from misclassification error, measurement error, aggregation bias, or some unmeasured aspect of socioeconomic condition (Kaufman et al., 1997), these studies suggest that differences in socioeconomic conditions cannot fully account for racial disparities in preterm birth rates.

Another popular explanation holds maternal risk behaviors responsible for the racial disparities in preterm birth, such as smoking or drug use. However, several studies have found, albeit by self-report, that proportion-



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