Gene Environment Interactions

Because the constellation of socioenvironmental variables known to affect the risk of pre-term birth is not equitably distributed across racial-ethnic groups, the interaction of these factors with genetic predispositions may also produce highly disparate clinical outcomes. As discussed in the previous section, this area needs to be further investigated.

In summary, the question of whether genetics explains a substantial proportion of health disparities in preterm birth, is largely unanswered. It is anticipated that as populations increasingly become admixed (that is, as populations increasingly comprise couples of different ancestries), race and ethnicity will become even more inaccurate proxies for health risk. Without discounting self-identified race or ethnicity as a variable correlated with health, researchers must move beyond these weak and imperfect relationships. We need to understand not only what is downstream from race or ethnicity, but also upstream factors that explain how and why a racial-ethnic groups' disparity exists in health or disease. Such information may shed light on the pathways and mechanisms explaining why race-ethnicity are associated with health or disease. Furthermore, future genetic epidemiological studies need to employ advanced methodology in dealing with admixed populations (see section on Methodological Issues below).

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