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SOCIODEMOGRAPHIC DOAMINS OF DEPRIVATION AND PRETERM BIRTH
Citation:
MESSNER, L., L. VINIKOOR, J. S. KAUFMAN, AND B. LARAIA. SOCIODEMOGRAPHIC DOAMINS OF DEPRIVATION AND PRETERM BIRTH. Presented at American Public Health Association Annual Meeting, Phildelphia, PA, December 11 - 14, 2005.
Description:
Background. Neighborhood-level deprivation has long been associated with adverse outcomes, including preterm birth (PTB), as observed in the authors' previous work using a composite deprivation index. Area disadvantage is multifaceted comprising income, employment, education and other sociodemographic domains, but is often estimated using single census variables. Objective: Assess the independent contribution of neighborhood deprivation domains in multilevel models for dichotomized (birth < 37 weeks gestational age) PTB. Methods. Geocoded 1999-2001 vital records (n=28,226 births) and 2000 US Census data (n=105 census tracts) for Wake County NC were analyzed using race-stratified multilevel random effects logistic regression models. Using census data representing a priori defined domains, principal components analysis (PCA) produced indices estimating poverty (n=6 variables), education (n=3), housing (n=6), employment (n=3), occupation (n=4) and residential stability (n=3); index alphas ranged 0.74-0.96. Single domain quartiles were modeled. Findings. In maternal age and education adjusted models, tract poverty, education and occupation domains were associated with PTB odds for non-Hispanic (NH) white women; Odds Ratios (OR) (95% Confidence Intervals [CI]) = 1.3 (1.0, 1.6), 1.4 (1.1, 1.7) and 0.7 (0.6, 0.8), respectively. Among NH black women, tract poverty [OR=1.6 (1.2, 2.3)] and residential stability [OR=1.3 (1.0, 1.6)] were associated with PTB odds. For black and white NH women, tract housing and employment domains were unassociated with PTB. Conclusion: Different deprivation domains appear associated with PTB odds for NH white and black women, a finding with important policy implications for PTB reduction efforts in this country. Results for other MODE-PTD sites will be discussed.
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