Dr. Smith Publishes on Adverse Birth Outcomes

Michael Smith, Research Assistant Professor for the Department of Health Services Management and Policy in the East Tennessee State University College of Public Health and Project Director for the Choose Well Evaluation Study, is a co-author of an article in the Maternal and Child Health Journal.  The article, “The South Carolina Multigenerational Linked Birth Dataset: Developing Social Mobility Measures Across Generations to Understand Racial/Ethnic Disparities in Adverse Birth Outcomes in the US South,” describes the creation of a multigenerational linked dataset with social mobility measures for South Carolina as an example for states in the South and other areas of the country. 

Nancy Fleischer of the University of Michigan is lead author of the article.  Additional co-authors include Chelsea Abshire of the University of Michigan, Claire Margerison of Michigan State University, and Daniela Nitcheva of the South Carolina Department of Health and Environmental Control.

The United States has high rates of adverse birth outcomes compared to other developed nations and suffers from long-standing racial/ethnic disparities in these outcomes, particularly in the South.  Social mobility has been linked to birth outcomes, with mixed findings about its importance by race/ethnicity. Multigenerational datasets using population-based birth certificates have been created previously, but new datasets are needed to examine multiple dimensions of social mobility and birth outcomes.

Using unique identifiers, the authors linked birth certificates along the maternal line using SC birth certificate data from 1989 to 2014, and compared the subset of records for which linking was possible with two comparison groups on sociodemographic and birth outcome measures. Of the 1,366,288 singleton birth certificates in SC from 1989 to 2014, the research team linked 103,194, resulting in 61,229 unique three-generation units.

Mothers and fathers were younger and had lower education, and low birth weight was more common, in the multigenerational linked dataset than in the two comparison groups. Based on the social mobility summary score, only 6.3% of White families were always disadvantaged, compared to 30.4% of Black families and 13.2% of Hispanic families. Moreover, 32.8% of White families were upwardly mobile and 39.1% of Black families were upwardly mobile, but only 29.9% of Hispanic families were upwardly mobile. Overall, this multi-generational social mobility measure indicates that Black families were more likely to begin with a low social score, and also experienced more dynamic changes across the observed generations than White families in South Carolina.

When states are able to link individuals, birth certificate data may be an excellent source for examining population-level relationships between social mobility and adverse birth outcomes. Due to its location in the Deep South, the multigenerational South Carolina dataset may be particularly useful for understanding racial/ethnic difference in social mobility and birth outcomes.