Structural gendered racism – the “totality of interconnectedness between structural racism and sexism” – is conceptualized as a fundamental cause of the persistent preterm birth inequities experienced by Black and Indigenous people in the United States. Our objective was to develop a state-level latent class measure of structural gendered racism and examine its association with preterm birth among all singleton live births in the US in 2019. Using previously-validated inequity indicators between White men and Black women across 9 domains (education, employment, poverty, homeownership, health insurance, segregation, voting, political representation, incarceration), we conducted a latent profile analysis to identify a latent categorical variable with number of classes that have similar values on the observed continuous input variables. Racialized group-stratified multilevel modified Poisson regression models with robust variance and random effects for state assessed the association between state-level classes and preterm birth. We found four distinct latent classes that were all characterized by higher levels of disadvantage for Black women and advantages for White men, but the magnitude of that difference varied by latent class. We found preterm birth risk among Black birthing people was higher across all state-level latent classes compared to White birthing people, and there was some variation of preterm birth risk across classes among Black but not White birthing people. These findings further emphasize the importance of understanding and interrogating the system and the need for multifaceted policy solutions.

中文翻译：

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美国的结构性性别种族主义和早产不平等

结构性性别种族主义——“结构性种族主义和性别歧视之间相互关联的总体”——被概念化为美国黑人和原住民持续存在早产不平等的根本原因。我们的目标是制定一个州级结构性性别种族主义的潜在阶级衡量标准，并研究其与 2019 年美国所有单胎活产儿中早产的关系。使用先前验证的跨 9 个领域的白人男性和黑人女性之间的不平等指标（教育、就业、贫困、住房所有权、健康保险、种族隔离、投票、政治代表、监禁），我们进行了潜在概况分析，以识别潜在分类变量，其中包含在观察到的连续输入变量上具有相似值的类别数量。种族化群体分层多级修正泊松回归模型具有稳健的方差和州随机效应，评估了州级类别与早产之间的关联。我们发现了四个不同的潜在类别，其特征都是黑人女性处于较高的劣势而白人男性处于优势，但这种差异的程度因潜在类别而异。我们发现，与白人出生的人相比，所有州级潜在阶层的黑人出生的人的早产风险都较高，而且黑人出生的人（而非白人出生的人）的早产风险在不同阶层之间存在一些差异。这些发现进一步强调了理解和质疑该体系的重要性以及多方面政策解决方案的必要性。