The Mediating Role of Social and Environmental Determinants of Health in the Association Between Race and Preterm Birth Risk.

Objective: To evaluate the mediating role of social and environmental determinants of health (SEDH) in the relationship between self-identified race and preterm birth risk. Methods: Data on birth outcomes and five broad domains of SEDH were obtained from the Pregnancy, Race, Environment, Genes study, a prospective cohort of pregnant women (50% Black American) in Richmond, Virginia. Configural consistency across racial groups for SEDH domains assessed via multiple indicators was evaluated using unidimensional confirmatory factor models. Mediation models tested the extent to which individual variables/constructs and broader SEDH domains accounted for the association between self-identified race and gestational age at delivery (GAD). Results: Economic Stability, Education, Health/Health Care, and Social/Community Context showed evidence of mediation through one or more specific subdimensions. Education and Economic Stability fully mediated the association between race and GAD, indexed by maternal educational attainment and current job duration, respectively. In contrast, consideration of Social/Community Context exposed an even larger association between race and GAD. Conclusions: This study highlights the role of specific and broader SEDH domains in the association between race and spontaneous preterm birth (PTB) risk. Findings underscore the significant impact of educational access and economic security on reproductive outcomes.