Neighborhood Deprivation and Preterm Birth among Non-Hispanic Black and White Women in Eight Geographic Areas in the United States

Abstract

Disparities in preterm birth by race and ethnic group have been demonstrated in the United States. Recent research has focused on the impact of neighborhood context on racial disparities in pregnancy outcomes. The authors utilized vital-record birth certificate data and US Census data from eight geographic areas in four states (Maryland, Michigan, North Carolina, and Pennsylvania) to examine the relation between neighborhood deprivation and preterm birth among non-Hispanic White and Black women. The years covered by the data varied by site and ranged from 1995 to 2001. Results were adjusted for maternal age and education, and specific attention was paid to racial and geographic differences in the relation between neighborhood deprivation and preterm birth. Preterm birth rates were higher for non-Hispanic Blacks (10.42-15.97%) than for non-Hispanic Whites (5.77-9.13%), and neighborhood deprivation index values varied substantially across the eight areas. A significant association was found between neighborhood deprivation and risk of preterm birth; for the first quintile of the deprivation index versus the fifth, the adjusted summary odds ratio was 1.57 (95% confidence interval: 1.41, 1.74) for non-Hispanic Whites and 1.15 (95% confidence interval: 1.08, 1.23) for non-Hispanic Blacks. In this study, deprivation at the neighborhood level was significantly associated with increased risk of preterm birth among both non-Hispanic White women and non-Hispanic Black women.

Neighborhood Inequalities in Adverse Pregnancy Outcomes in an Urban Setting in Spain: A Multilevel Approach

“…At the contextual level, recent studies have found that more disadvantaged neighborhoods, measured in terms of poverty, 6 unemployment, 7 income, 8 compound deprivation index, 9 or violent crime rate, 10 have higher prevalence of adverse pregnancy outcomes; also, mothers residing in such neighborhoods have higher individual risk of presenting an adverse pregnancy outcome. 11,12 Neighborhood socioeconomic level is the result of macro-level structural factors including economic aspects, migration, discrimination, political decisions, and public policies 13 thus constituting a key area of health inequalities research. 14 In Spain, immigration (from developing countries) is a fairly recent phenomenon.…”

Neighborhood Socioeconomic Status in Relation to Preterm Birth in a U.S. Cohort of Black Women

“…Our results overall do not support the positive findings from some previous studies that assessed preterm birth in relation to neighborhood deprivation as a summary variable among AfricanAmerican women in different geographic regions. [16][17][18][19] O'Campo et al 16 presented a summary odds ratio of 1.15 (95 % CI, 1.08, 1.23) for Non-Hispanic Black women comparing the highest versus lowest quintile of neighborhood deprivation using data from four states. The authors also examined effect estimates for Non-Hispanic Black women across eight study areas and reported that six of the eight area-specific odds ratios, ranging from 0.88 to 1.40, were not statistically significant.…”

“…7,8 Several studies have examined the association of neighborhood socioeconomic characteristics with preterm birth. [9][10][11][12][13][14][15][16][17][18][19] All except one 14 found statistically significant associations with at least one neighborhood-level indicator after adjustment for individual-level factors. Although many studies have assessed neighborhood characteristics as single variables, [9][10][11][12][13][14][15] the complexities of neighborhood SES may be better captured by a summary variable comprised of multiple area-level factors.…”

“…20 In four large studies based on vital statistic birth records, a summary variable of neighborhood deprivation was significantly associated with increased risk of preterm birth among women of various races/ethnicities. [16][17][18][19] Although all previous studies except for a Canadian report 15 included Black women, it is unclear whether the association between neighborhood deprivation and preterm birth is present for particular subgroups of Black women, such as well-educated women. It is possible that higher levels of personal educational attainment buffer adverse effects of neighborhood deprivation on birth outcomes in Black women.…”

Adverse social determinants and risk for congenital anomalies

“…In general, poverty indices measure the proportion of families within a defined geographical unit with a combination of circumstances indicating fewer resources or a great need of basic services, or both. 2 Different studies have studied familiar and regional adverse social determinants in relation to perinatal outcome, such as neonatal mortality, 3 low birth weight 4 and prematurity, 5 but not in relation to congenital anomalies. Among the few reported causes on this issue, a low maternal socioeconomic level (SEL) has been associated with a higher risk of having a newborn infant with cleft lip, 6,9 neural tube defects, 7 and heart diseases.…”