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EXPOSURE TO AREA-LEVEL PRETERM BIRTH DISPARITY AND EFFECTS ON BIRTH OUTCOMES
Citation:
MESSER, L. C., J. S. KAUFMAN, B. A. LARAIA, AND P. MENDOLA. EXPOSURE TO AREA-LEVEL PRETERM BIRTH DISPARITY AND EFFECTS ON BIRTH OUTCOMES. Presented at Society for Epidemiologic Research, Boston, MA, June 19 - 22, 2007.
Impact/Purpose:
Explore black–white disparity in preterm birth
Description:
Black–white disparity in preterm birth (PTB) is persistent and not explained by individual factors. Given that exposure to inequality is associated with increased risk of adverse health, we examined PTB risk (birth <37 weeks gestational age) explained by living in U.S. census tracts with disparate PTB outcomes for Whites and Blacks. Geocoded birth records for Wake County NC from 1999-2001 were used to calculate PTB proportions for each woman (her block PTB count divided by her block birth count, excluding her birth outcome); PTB disparity was defined for each blockgroup [(block Black PTB proportion)–(block White PTB proportion)]. Conditional logistic models, fixed at the tract level, were adjusted for maternal age and education. Fewer white women lived in tracts with high (20.9%) and very high PTB disparity (24.3%), compared with black women (28.7 and 34.3%, respectively). For white women, living in tracts with high and very high PTB disparity was associated with increased PTB odds (Adjusted Odds Ratio (AOR)= 2.1, 95% Confidence Interval (CI):1.5, 3.0 and AOR=1.8, CI:1.3, 2.6, respectively). For black women, exposure to high and very high levels was unassociated with increased PTB odds (AOR=1.1, CI:0.7, 1.7; and AOR=0.9, CI:0.6, 1.3, respectively). Neighborhood fixed effects models are a useful analytic tool because they condition on measured and unmeasured community attributes shared by area residents that may influence birth outcomes. While Whites are less likely than blacks to live in the most disparate tracts, their exposure to disparity is associated with PTB; this association is not observed for Blacks. Further work will explore area-level correlates of PTB disparity that may help explain these findings. This is an abstract or a proposed presentation and does not necessarily reflect EPA policy.