{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T05:32:23Z","timestamp":1775280743802,"version":"3.50.1"},"reference-count":42,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T00:00:00Z","timestamp":1736121600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2024,11,23]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Preterm birth (PTB) and small-for-gestational-age (SGA) disproportionately affect women who are Black or Asian. Structural racism produces health inequalities. Identifying latent socioeconomic classes may help to understand the role socioeconomic position (SEP) plays in this inequality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We included women from the baseline survey of the UK-based Millennium Cohort Study who had a live singleton pregnancy and gave birth from 1 September 2000 to 11 January 2002. Relative risks (RR) with 95% confidence intervals (CI) for PTB and SGA were estimated for ethnic groups compared with women who were white, with adjustment for SEP. Latent SEP classes were then identified using diverse prospective socioeconomic data. Mediation of health inequality via SEP and latent SEP class was tested.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 17\u2009701 included women, 6.7% (95% CI 6.2%, 7.1%) experienced PTB and 7.0% (6.5%, 7.5%) SGA. We found evidence that the association between ethnic groups and PTB was mediated by latent SEP class for women who were Bangladeshi, Black African, Black Caribbean and Pakistani, with indirect \u2018effects\u2019 of RR 1.08 (1.01, 1.16), 1.07 (1.01, 1.14), 1.06 (1.00, 1.12) and 1.06 (1.00, 1.13), respectively, relative to White. When using the simple measures of maternal education, household income and marital status, we found no evidence of mediation except for a potential protective effect among Indian women, relative to White. We found similar evidence for SGA, with indirect effects through latent SEP class of RR 1.35 (1.19, 1.52), 1.32 (1.17, 1.48), 1.26 (1.12, 1.41), 1.27 (1.13, 1.42), respectively. When using the simple measures, we found evidence of mediation only among Black African and Black Caribbean women, with RR 1.16 (1.04, 1.30) and 1.12 (1.00, 1.26), respectively, relative to White.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The determinants of inequality appeared to differ by ethnicity. We demonstrated the mediating role of individual-level SEP and a role for latent class analysis to interpret complex combinations of socioeconomic data.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jech-2023-220996","type":"journal-article","created":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T13:20:43Z","timestamp":1736169643000},"page":"397-403","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Ethnic group, socioeconomic position and pregnancy outcome: a mediation model through latent class"],"prefix":"10.1136","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2967-0406","authenticated-orcid":false,"given":"Ian","family":"Henderson","sequence":"first","affiliation":[{"name":"University of Warwick Warwick Medical School, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siobhan","family":"Quenby","sequence":"additional","affiliation":[{"name":"University of Warwick Warwick Medical School, Coventry, UK"},{"name":"Biomedical Research Unit in Reproductive Health, University Hospital Coventry, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,1,6]]},"reference":[{"key":"2025100521333001000_79.6.397.1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0036-1586502"},{"key":"2025100521333001000_79.6.397.2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1326988"},{"key":"2025100521333001000_79.6.397.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)01595-6"},{"key":"2025100521333001000_79.6.397.4","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-3016.1999.00174.x"},{"key":"2025100521333001000_79.6.397.5","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-028227","article-title":"Joint contribution of socioeconomic circumstances and ethnic group to variations in preterm birth, neonatal mortality and infant mortality in England and Wales: a population-based retrospective cohort study using routine data from 2006 to 2012","volume":"9","author":"Opondo","year":"2019","journal-title":"BMJ Open"},{"key":"2025100521333001000_79.6.397.6","doi-asserted-by":"crossref","DOI":"10.3389\/frph.2021.684207","article-title":"Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes","volume":"3","author":"Braveman","year":"2021","journal-title":"Front Reprod Health"},{"key":"2025100521333001000_79.6.397.7","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2014-205387"},{"key":"2025100521333001000_79.6.397.8","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-049075","article-title":"Association between neighbourhood deprivation, fetal growth, small-for-gestational age and preterm birth: a population-based prospective cohort study","volume":"11","author":"Gootjes","year":"2021","journal-title":"BMJ Open"},{"key":"2025100521333001000_79.6.397.9","doi-asserted-by":"publisher","DOI":"10.1038\/pr.2014.122"},{"key":"2025100521333001000_79.6.397.10","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-022-13438-9"},{"key":"2025100521333001000_79.6.397.11","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-020-03035-w"},{"key":"2025100521333001000_79.6.397.12","doi-asserted-by":"crossref","DOI":"10.1186\/1475-9276-12-28","article-title":"Contribution of socioeconomic status to the risk of small for gestational age infants--a population-based study of 1,390,165 singleton live births in Finland","volume":"12","author":"R\u00e4is\u00e4nen","year":"2013","journal-title":"Int J Equity Health"},{"key":"2025100521333001000_79.6.397.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2010.05.012"},{"key":"2025100521333001000_79.6.397.14","doi-asserted-by":"publisher","DOI":"10.1111\/ppe.12186"},{"key":"2025100521333001000_79.6.397.15","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2018-316486"},{"key":"2025100521333001000_79.6.397.16","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyu001"},{"key":"2025100521333001000_79.6.397.17","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3016.2007.00902.x"},{"key":"2025100521333001000_79.6.397.18","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60932-6"},{"key":"2025100521333001000_79.6.397.19","doi-asserted-by":"publisher","DOI":"10.1177\/1536867X1101100306"},{"key":"2025100521333001000_79.6.397.20","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000000105"},{"key":"2025100521333001000_79.6.397.21","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-032315-021402"},{"key":"2025100521333001000_79.6.397.22","doi-asserted-by":"publisher","DOI":"10.1002\/sim.8929"},{"key":"2025100521333001000_79.6.397.23","doi-asserted-by":"publisher","DOI":"10.1515\/em-2012-0010"},{"key":"2025100521333001000_79.6.397.24","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-14-835","article-title":"Using latent class analysis to develop a model of the relationship between socioeconomic position and ethnicity: cross-sectional analyses from a multi-ethnic birth cohort study","volume":"14","author":"Fairley","year":"2014","journal-title":"BMC Public Health"},{"key":"2025100521333001000_79.6.397.25","doi-asserted-by":"crossref","DOI":"10.1289\/EHP490","article-title":"Decomposition Analysis of Black-White Disparities in Birth Outcomes: The Relative Contribution of Air Pollution and Social Factors in California","volume":"125","author":"Benmarhnia","year":"2017","journal-title":"Environ Health Perspect"},{"key":"2025100521333001000_79.6.397.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2018.01.012"},{"key":"2025100521333001000_79.6.397.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2019.07.007"},{"key":"2025100521333001000_79.6.397.28","doi-asserted-by":"publisher","DOI":"10.1111\/ppe.12585"},{"key":"2025100521333001000_79.6.397.29","unstructured":"Babalola G , Maguire D . What are health inequalities? 2020 Available: https:\/\/www.kingsfund.org.uk\/publications\/what-are-health-inequalities"},{"key":"2025100521333001000_79.6.397.30","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2022.100608"},{"key":"2025100521333001000_79.6.397.31","unstructured":"Psarros A . Mothers\u2019 voices report. 2018. Available: https:\/\/www.maternityaction.org.uk\/wp-content\/uploads\/MothersVoices2018-FINAL.pdf"},{"key":"2025100521333001000_79.6.397.32","unstructured":"Birthrights . Systemic racism, not broken bodies: an inquiry into racial injustice and human rights in uk maternity care. 2018. Available: https:\/\/www.birthrights.org.uk\/wp-content\/uploads\/2022\/05\/Birthrights-inquiry-systemic-racism_exec-summary_May-22-web.pdf"},{"key":"2025100521333001000_79.6.397.33","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-040218-043750"},{"key":"2025100521333001000_79.6.397.34","unstructured":"Bharj KK , Salway S . Addressing ethnic inequalities in maternity service experiences and outcomes: responding to women\u2019s needs and preferences: a race equality foundation briefing paper 2008. 2008 Available: https:\/\/raceequalityfoundation.org.uk\/wp-content\/uploads\/2022\/10\/health-brief11.pdf"},{"key":"2025100521333001000_79.6.397.35","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2021-064547","article-title":"Interventions to prevent spontaneous preterm birth in women with singleton pregnancy who are at high risk: systematic review and network meta-analysis","volume":"376","author":"Care","year":"2022","journal-title":"BMJ"},{"key":"2025100521333001000_79.6.397.36","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwaa054"},{"key":"2025100521333001000_79.6.397.37","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-017-1232-9"},{"key":"2025100521333001000_79.6.397.38","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2015-009044","article-title":"Models of antenatal care to reduce and prevent preterm birth: a systematic review and meta-analysis","volume":"6","author":"Fernandez Turienzo","year":"2016","journal-title":"BMJ Open"},{"key":"2025100521333001000_79.6.397.39","doi-asserted-by":"crossref","unstructured":"Kawachi I , Glymour MM AM . Socioeconomic status and health. In: KI BL , MM G , eds. Social epidemiology. Oxford: Oxford University Press, 2014.","DOI":"10.1093\/med\/9780195377903.003.0002"},{"key":"2025100521333001000_79.6.397.40","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2022.11.005"},{"key":"2025100521333001000_79.6.397.41","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2011.03.007"},{"key":"2025100521333001000_79.6.397.42","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyi029"}],"container-title":["Journal of Epidemiology and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jech-2023-220996","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T04:33:40Z","timestamp":1759725220000},"score":1,"resource":{"primary":{"URL":"https:\/\/jech.bmj.com\/lookup\/doi\/10.1136\/jech-2023-220996"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,6]]},"references-count":42,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,5,9]]},"published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1136\/jech-2023-220996"],"URL":"https:\/\/doi.org\/10.1136\/jech-2023-220996","relation":{},"ISSN":["0143-005X","1470-2738"],"issn-type":[{"value":"0143-005X","type":"print"},{"value":"1470-2738","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,6]]}}}