County Socioeconomic Deprivation and Preterm Birth Risk Between White and Black Mothers in Georgia, USA

County Socioeconomic Deprivation and Preterm Birth Risk Between White and Black Mothers in Georgia, USA

Wei Tu (Georgia Southern University, USA)
DOI: 10.4018/978-1-7998-2351-3.ch008

Abstract

Past studies have reported the association between living in a socioeconomically deprived neighborhood and elevated preterm births (PtB) risk after adjusting certain individual level confounders. This article examined the association between county-level deprivation and PtB risk of three stratified racial groups, white, black, and the others. The author built two level random intercept logistic regression models using 112,589 single live births retrieved from vital statistics record in Georgia, USA in 2010. Although county level deprivation was found to be insignificant for PtB risk for the entire study population, it had a significant yet modest effect on magnifying the PtB risk of black women (The odds ratio (OR) = 1.063,95% CI = 1.02, 1.12). In addition, the Median Odds Ratio (MOR) (1.229) indicated a weak neighborhood effect on PtB risk and the Interval Odds Ratio (IOR)-80% (0.68-1.49) suggested large unaccounted county-level heterogeneity. Future research will include more confounders at both levels in analysis as well as addressing the uncertain geographic context problem (UGCoP).
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Introduction

Preterm births (PtB) are births occurring earlier than the 37th week gestation. As a significant health issue, PtB is closely associated with infant mortality, infant morbidity, and numerous childhood developmental disabilities (Callaghan, MacDorman, Rasmussen, Qin, & Lackritz, 2006; Goldenberg, Culhane, Iams, & Romero, 2008; Shapiro-Mendoza & Lackritz, 2012). Many previous studies have shown that pregnant women, particularly black women, living in more socioeconomically deprived neighborhoods had been at an elevated risk of adverse birth outcomes including PtB, after adjusting for individual socioeconomic status (SES) (Ma et al., 2015; Messer et al., 2006; Tu, Tu, & Tedders, 2014). However, the reported relationship between neighborhood deprivation and PtB risk among racial and/or ethnic groups has not always been consistent. Some studies found little difference among ethnic groups (Elo et al., 2009) while some reported a stronger effect on the non-Hispanic white group (Cubbin et al., 2008; O'Campo et al., 2008). Further, other studies found the greatest magnitude of an association among Hispanic Caribbean women (Janevic et al., 2010).

Although past research has rather consistently shown that neighborhood SES has a moderate-weak but statistically significant effect on health outcomes (Pickett & Pearl, 2001; Robert, 1999; Subramanian, Kim, & Kawachi, 2002), important challenges such as the definition of neighborhoods and identification of relevant neighborhood characteristics are also acknowledged (A.V. Diez Roux, 2001; Kwan, 2012a). Overall, scholars agree that risk factors at the individual and the neighborhood level may jointly influence specific health outcomes (Marmot, 1998). Thus, knowledge about the association between health risks and the neighborhood SES may provide valuable insights to formulate innovative approaches for community level interventions. In some instances, neighborhood SES may be viewed as an upstream effect in the causal pathway influencing health outcomes (Adler & Newman, 2002; Bharmal, Derose, Felician, & Weden, 2015). The biological and behavioral characteristics of downstream individuals may then be affected by neighborhood level SES, consequently influencing health outcomes such as PtB. For instance, pregnant women residing in neighborhoods with high SES are more likely to have better access to higher quality prenatal care services, lower exposure to stress and environmental pollution, and more pleasant built environment, thereby resulting in a decreased risk of PtB (Meng, Thompson, & Hall, 2013).

In the State of Georgia, the raw PtB rates in 2015 for white, black, and all other racial groups were 9.3% (total case = 7003), 13.7% (total case = 6165), and 8.8% (total case = 954), respectively (Georgia Department of Public Health, 2016a). While the PtB rates of the white group and the others group have met or exceeded the Healthy People 2020 goal of 11.4% and even a more ambitious target rate of 9.6% set by the March of Dimes (2016), the rate of black group has not. So, there was an obvious disparity in PtB rate between black and the other two racial groups.

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