Published online March 2, 2009
PEDIATRICS Vol. 123 No. 3 March 2009, pp. e438-e445 (doi:10.1542/peds.2008-1634)
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ARTICLE

Explaining the Low Risk of Preterm Birth Among Arab Americans in the United States: An Analysis of 617451 Births

Abdulrahman M. El-Sayed, BSa,b and Sandro Galea, MD, MPH, DrPHa,c,d

a Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
b Medical Scientist Training Program, University of Michigan Medical School, Ann Arbor, Michigan
c Institute for Social Research, University of Michigan, Ann Arbor, Michigan
d Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York

OBJECTIVES. Arab Americans have a lower risk for preterm birth than white Americans. We assessed factors that may contribute to the association between ethnicity and preterm birth risk in Michigan, the state with the largest concentration of Arab Americans in the United States. Factors assessed as potential contributors to the ethnicity/preterm birth risk association were maternal age, parity, education, marital status, tobacco use, and maternal birthplace.

METHODS. Data were collected about all births in Michigan between 2000 and 2005. Stratified analyses, trivariate analyses, and manual stepwise logistic regression model building were used to assess potential contributors to the ethnicity/preterm birth risk association.

RESULTS. Arab ethnicity was associated with lower preterm birth risk compared with non-Arab white subjects in the unadjusted model. Maternal birthplace inside or outside the United States explained 0.17 of the difference in preterm birth risk between Arab ethnicity and non-Arab white mothers; ethnic differences in marital status and tobacco use explained less of the observed ethnic difference in preterm birth risk. In the final model adjusted for all explanatory variables, Arab ethnicity was no longer associated with preterm birth risk.

CONCLUSIONS. Maternal birthplace, marital status, and tobacco use may contribute to the preterm birth risk difference between Arab ethnicity and non-Arab white mothers. Additional work is needed to consider the mechanisms relating factors such as maternal birthplace and marital status to ethnic differences in preterm birth risk.

Key Words: Arab American • ethnicity • preterm birth • birth outcomes

Abbreviations: PTB—preterm birth • AE—Arab ethnicity • NAW—non-Arab white • SES—socioeconomic status • OR—odds ratio • CI—confidence interval

Accepted Nov 13, 2008.


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