Effects of Socioeconomic and Racial Residential Segregation on Preterm Birth: A Cautionary Tale of Structural Confounding
Abstract
Confounding associated with social stratification or other selection processes has been called structural confounding. In the presence of structural confounding, certain covariate strata will contain only subjects who could never be exposed, a violation of the positivity or experimental treatment effect assumption. Thus, structural confounding can prohibit the exchangeability necessary for meaningful causal contrasts across levels of exposure. The authors explored the presence and magnitude of structural confounding by estimating the independent effects of neighborhood deprivation and neighborhood racial composition (segregation) on rates of preterm birth in Wake and Durham counties, North Carolina (1999-2001). Tabular analyses and random-intercept fixed-slope multilevel logistic models portrayed different structural realities in these counties. The multilevel modeling results suggested some nonsignificant effect of residence in tracts with high levels of socioeconomic deprivation or racial residential segregation on adjusted odds of preterm birth for white and black women living in these counties, and the confidence limit ratios indicated fairly consistent levels of precision around the estimates. The results of the tabular analysis, however, suggested that many of these regression modeling findings were off-support and based on no actual data. The implications for statistical and public health inference, in the presence of no data, are considered.
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In an observational study where exchangeability is achieved by matching or conditioning on covariates, intervention groups may be created whose members in practice have no chance of receiving the treatment, and the meaning of treatment effects estimated in this way is unclear.
“In an observational study, where exchangeability may be achieved by a method such as matching or by conditioning on covariates, intervention groups may be created whose members in practice have no chance of receiving the treatment (55). The meaning of treatment effects estimated in this way is unclear.”
From Natural Experiments: An Overview of Methods, Approaches, and Contributions to Public Health Intervention Research (2017) · cites this paper as [55]
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- Authors
- Messer, L. C., Oakes, J. M., & Mason, S.
- Affiliations
- Duke University (US)
- Corresponding author
- Messer, L. C.
- Venue
- American Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-02-05
- Volume
- 171
- Issue
- 6
- Pages
- 664-673
- ISSN
- 0002-9262 (ISSN-L)
- 1476-6256
- OpenAlex
- W2167350702
- Cited by
- 161
- References
- 36
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 5 · 2023: 2 · 2022: 6 · 2021: 15 · 2020: 8 · 2019: 13 · 2018: 8 · 2017: 11 · 2016: 9 · 2015: 9 · 2014: 13 · 2013: 14 · 2012: 13
- FWCI
- 17.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Minnesota
- Health Resources and Services Administration
- Duke Global Health Institute, Duke University
- University of North Carolina at Chapel Hill
- Maternal and Child Health Bureau
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Social Sciences › Sociology and Political Science › Urban, Neighborhood, and Segregation Studies
- Keywords
- preterm birth, residential segregation, neighborhood disadvantage, racial segregation, neighborhood racial composition, exchangeability, positivity assumption, multilevel logistic regression, Black women, Wake County, North Carolina, Durham County, North Carolina
- MeSH terms
- Adult, Black or African American, Data Interpretation, Statistical, Female, Humans, North Carolina, Pregnancy, Registries, Residence Characteristics, Socioeconomic Factors, Sociology, Medical, Confounding Factors, Epidemiologic, Logistic Models, Censuses, White People, Premature Birth, Health Status Disparities, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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