Area-level deprivation and preterm birth: results from a national, commercially-insured population

Abstract

Background: Area-level deprivation is associated with multiple adverse birth outcomes. Few studies have examined the mediating pathways through which area-level deprivation affects these outcomes. The objective of this study was to investigate the association between area-level deprivation and preterm birth, and examine the mediating effects of maternal medical, behavioural, and psychosocial factors. Methods: We conducted a retrospective cohort study using national, commercial health insurance claims data from 2011, obtained from the Health Care Cost Institute. Area-level deprivation was derived from principal components methods using ZIP code-level data. Multilevel structural equation modeling was used to examine mediating effects. Results: In total, 138,487 women with a live singleton birth residing in 14,577 ZIP codes throughout the United States were included. Overall, 5.7% of women had a preterm birth. In fully adjusted generalized estimation equation models, compared to women in the lowest quartile of area-level deprivation, odds of preterm birth increased by 9.6% among women in the second highest quartile (odds ratio (OR) 1.096; 95% confidence interval (CI) 1.021, 1.176), by 11.3% in the third highest quartile (OR 1.113; 95% CI 1.035, 1.195), and by 24.9% in the highest quartile (OR 1.249; 95% CI 1.165, 1.339). Hypertension and infection moderately mediated this association. Conclusions: Even among commercially-insured women, area-level deprivation was associated with increased risk of preterm birth. Similar to individual socioeconomic status, area-level deprivation does not have a threshold effect. Implementation of policies to reduce area-level deprivation, and the screening and treatment of maternal mediators may be associated with a lower risk of preterm birth.

Cohort study of respiratory hospital admissions, air quality and sociodemographic factors in preterm infants born in California

“…For example, neighbourhood deprivation is associated with incidence of preterm birth. 11,12 In children, socioeconomic deprivation assessed at a household level or using area-based socioeconomic indexes correlates with childhood mortality. 13 Less is known about the associations of SES on health outcomes in preterm infants.…”

“…Socioeconomic factors have been associated with worse health outcomes in adult and paediatric populations. For example, neighbourhood deprivation is associated with incidence of preterm birth . In children, socioeconomic deprivation assessed at a household level or using area‐based socioeconomic indexes correlates with childhood mortality .…”

How does area-level deprivation depress an individual’s self-rated health and life satisfaction? Evidence from a nationwide population-based survey in Japan

“…It is well known that area-level socioeconomic conditions have a contextual association with an individual's health outcomes [1][2][3]. Many studies have indicated that area-level deprivation, which re ects various aspects of an area's socioeconomic positions, can affect the health outcomes of its residents, including mortality [4][5][6][7], morbidity [8][9][10][11], mental health [12,13], poor birth outcomes [14][15][16], and health risk behavior [17,18]. The impact of area-level deprivation on health matters for not only public health policies but also macroeconomic and social policies, which are committed to income redistribution, labor market regulations, and other issues related to social welfare.…”

“…Regarding the association between area-level deprivation and health, two issues have remained to be addressed. First, the impact on self-rated health (SRH), which represents overall health conditions [27,28], or subjective well-being (SWB), which is often expressed by life satisfaction (LS) [29,30], has been relatively understudied, compared to the impact of area-level deprivation on mortality, morbidity, or other speci c health outcomes [4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Meanwhile, many studies have examined the association between arealevel income inequality or poverty and an individual's SRH or SWB [31][32][33].…”

“…Second, the factors that may mediate the impact of area-level deprivation on SRH and LS need to be more addressed. Speci c factors such as the availability of alcohol, the physical environment, and maternal health have been found to mediate the impact of neighborhood deprivation on alcohol consumption, some health biomarkers, and preterm birth, respectively [34,35,16]. In the case of the impact on SRH and SWB, health behavior and/or interactions with neighbors/friends, both of which are well known to affect them [36][37][38][39], could be potential mediators.…”