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BMC Public Health
Published in: BMC Public Health 1/2009

Open Access 01-12-2009 | Research article

The joint influence of area income, income inequality, and immigrant density on adverse birth outcomes: a population-based study

Authors: Nathalie Auger, Julie Giraud, Mark Daniel

Published in: BMC Public Health | Issue 1/2009

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Abstract

Background

The association between area characteristics and birth outcomes is modified by race. Whether such associations vary according to social class indicators beyond race has not been assessed.

Methods

This study evaluated effect modification by maternal birthplace and education of the relationship between neighbourhood characteristics and birth outcomes of newborns from 1999–2003 in the province of Québec, Canada (N = 353,120 births). Areas (N = 143) were defined as administrative local health service delivery districts. Multi-level logistic regression was used to model the association between three area characteristics (median household income, immigrant density and income inequality) and the two outcomes preterm birth (PTB) and small-for-gestational age (SGA) birth. Effect modification by social class indicators was evaluated in analyses stratified according to maternal birthplace and education.

Results

Relative to the lowest tertile, high median household income was associated with SGA birth among Canadian-born mothers (odds ratio (OR) 1.13, 95% confidence interval (CI) 1.06, 1.20) and mothers with high school education or less (OR 1.13, 95% CI 1.02, 1.24). Associations between median household income and PTB were weaker. Relative to the highest tertile, low immigrant density was associated with a lower odds of PTB among foreign-born mothers (OR 0.79, 95% CI 0.63, 1.00) but a higher odds of PTB among Canadian-born mothers (OR 1.14, 95% CI 1.07, 1.21). Associations with income inequality were weak or absent.

Conclusion

The association between area factors and birth outcomes is modified by maternal birthplace and education. Studies have found that race interacts in a similar manner. Public health policies focussed on perinatal health must consider the interaction between individual and area characteristics.
Literature
1.
Ahern J, Pickett KE, Selvin S, Abrams B: Preterm birth among African American and white women: a multilevel analysis of socioeconomic characteristics and cigarette smoking. J Epidemiol Community Health. 2003, 57: 606-611. 10.1136/jech.57.8.606.CrossRefPubMedPubMedCentral
2.
Janghorbani M, Stenhouse E, Millward A, Jones RB: Neighborhood deprivation and preterm birth in Plymouth, UK. J Matern Fetal Neonatal Med. 2006, 19: 85-91. 10.1080/14767050500363428.CrossRefPubMed
3.
Luo ZC, Kierans WJ, Wilkins R, Liston RM, Mohamed J, Kramer MS: Disparities in birth outcomes by neighborhood income: temporal trends in rural and urban areas, british columbia. Epidemiology. 2004, 15: 679-686. 10.1097/01.ede.0000142149.34095.88.CrossRefPubMed
4.
Luo ZC, Wilkins R, Kramer MS: Effect of neighbourhood income and maternal education on birth outcomes: a population-based study. CMAJ. 2006, 174: 1415-1420.CrossRefPubMedPubMedCentral
5.
Masi CM, Hawkley LC, Piotrowski ZH, Pickett KE: Neighborhood economic disadvantage, violent crime, group density, and pregnancy outcomes in a diverse, urban population. Soc Sci Med. 2007, 65: 2440-2457. 10.1016/j.socscimed.2007.07.014.CrossRefPubMed
6.
O'Campo P, Burke JG, Culhane J, Elo IT, Eyster J, Holzman C, et al: Neighborhood deprivation and preterm birth among non-Hispanic Black and White women in eight geographic areas in the United States. Am J Epidemiol. 2008, 167: 155-163. 10.1093/aje/kwm277.CrossRefPubMed
7.
Urquia ML, Frank JW, Glazier RH, Moineddin R: Birth outcomes by neighbourhood income and recent immigration in Toronto. Health Rep. 2007, 18: 21-30.PubMed
8.
Messer LC, Vinikoor LC, Laraia BA, Kaufman JS, Eyster J, Holzman C, et al: Socioeconomic domains and associations with preterm birth. Soc Sci Med. 2008, 67: 1247-1257. 10.1016/j.socscimed.2008.06.009.CrossRefPubMed
9.
Buka SL, Brennan RT, Rich-Edwards JW, Raudenbush SW, Earls F: Neighborhood support and the birth weight of urban infants. Am J Epidemiol. 2003, 157: 1-8. 10.1093/aje/kwf170.CrossRefPubMed
10.
Krieger N, Chen JT, Waterman PD, Soobader MJ, Subramanian SV, Carson R: Choosing area based socioeconomic measures to monitor social inequalities in low birth weight and childhood lead poisoning: The Public Health Disparities Geocoding Project (US). J Epidemiol Community Health. 2003, 57: 186-199. 10.1136/jech.57.3.186.CrossRefPubMedPubMedCentral
11.
O'Campo P, Xue X, Wang MC, Caughy M: Neighborhood risk factors for low birthweight in Baltimore: a multilevel analysis. Am J Public Health. 1997, 87: 1113-1118. 10.2105/AJPH.87.7.1113.CrossRefPubMedPubMedCentral
12.
Pearl M, Braveman P, Abrams B: The relationship of neighborhood socioeconomic characteristics to birthweight among 5 ethnic groups in California. Am J Public Health. 2001, 91: 1808-1814. 10.2105/AJPH.91.11.1808.CrossRefPubMedPubMedCentral
13.
Rauh VA, Andrews HF, Garfinkel RS: The contribution of maternal age to racial disparities in birthweight: a multilevel perspective. Am J Public Health. 2001, 91: 1815-1824. 10.2105/AJPH.91.11.1815.CrossRefPubMedPubMedCentral
14.
Roberts EM: Neighborhood social environments and the distribution of low birthweight in Chicago. Am J Public Health. 1997, 87: 597-603. 10.2105/AJPH.87.4.597.CrossRefPubMedPubMedCentral
15.
Baker AN, Hellerstedt WL: Residential racial concentration and birth outcomes by nativity: do neighbors matter?. J Natl Med Assoc. 2006, 98: 172-180.PubMedPubMedCentral
16.
Bell JF, Zimmerman FJ, Almgren GR, Mayer JD, Huebner CE: Birth outcomes among urban African-American women: a multilevel analysis of the role of racial residential segregation. Soc Sci Med. 2006, 63: 3030-3045. 10.1016/j.socscimed.2006.08.011.CrossRefPubMed
17.
Mason SM, Messer LC, Laraia BA, Mendola P: Segregation and preterm birth: The effects of neighborhood racial composition in North Carolina. Health Place. 2009, 15: 1-9. 10.1016/j.healthplace.2008.01.007.CrossRefPubMed
18.
Osypuk TL, Acevedo-Garcia D: Are racial disparities in preterm birth larger in hypersegregated areas?. Am J Epidemiol. 2008, 167: 1295-1304. 10.1093/aje/kwn043.CrossRefPubMed
19.
Pickett KE, Collins JW, Masi CM, Wilkinson RG: The effects of racial density and income incongruity on pregnancy outcomes. Soc Sci Med. 2005, 60: 2229-2238.CrossRefPubMed
20.
Grady SC: Racial disparities in low birthweight and the contribution of residential segregation: a multilevel analysis. Soc Sci Med. 2006, 63: 3013-3029. 10.1016/j.socscimed.2006.08.017.CrossRefPubMed
21.
Grady SC, Ramirez IJ: Mediating medical risk factors in the residential segregation and low birthweight relationship by race in New York City. Health Place. 2008, 14: 661-677. 10.1016/j.healthplace.2007.10.011.CrossRefPubMed
22.
Auger N, Daniel M, Platt RW, Wu Y, Luo ZC, Choiniere R: Association between perceived security of the neighbourhood and small-for-gestational-age birth. Paediatr Perinat Epidemiol. 2008, 22: 467-477. 10.1111/j.1365-3016.2008.00959.x.CrossRefPubMed
23.
Huynh M, Parker JD, Harper S, Pamuk E, Schoendorf KC: Contextual effect of income inequality on birth outcomes. Int J Epidemiol. 2005, 34: 888-895. 10.1093/ije/dyi092.CrossRefPubMed
24.
O'Campo P, Caughy MO: Measures of residential community contexts. Methods in Social Epidemiology. Edited by: Oakes JM, Kaufman JS. 2008, San Francisco: John Wiley & Sons
25.
Subramanian SV, Kawachi I: Commentary: Chasing the elusive null–the story of income inequality and health. Int J Epidemiol. 2007, 36: 596-599. 10.1093/ije/dym102.CrossRefPubMed
26.
Spencer N: The effect of income inequality and macro-level social policy on infant mortality and low birthweight in developed countries–a preliminary systematic review. Child Care Health Dev. 2004, 30: 699-709. 10.1111/j.1365-2214.2004.00485.x.CrossRefPubMed
27.
Wilkinson RG, Pickett KE: Income inequality and population health: a review and explanation of the evidence. Soc Sci Med. 2006, 62: 1768-1784. 10.1016/j.socscimed.2005.08.036.CrossRefPubMed
28.
Reagan PB, Salsberry PJ: Race and ethnic differences in determinants of preterm birth in the USA: broadening the social context. Soc Sci Med. 2005, 60: 2217-2228.CrossRefPubMed
29.
Kaufman JS: Commentary: Income inequality and reproductive outcomes–that model is best which models the least. Int J Epidemiol. 2005, 34: 896-897. 10.1093/ije/dyi116.CrossRefPubMed
30.
31.
Kramer MS, Platt RW, Wen SW, Joseph KS, Allen A, Abrahamowicz M, et al: A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics. 2001, 108: E35-10.1542/peds.108.2.e35.CrossRefPubMed
32.
Wilcox AJ: On the importance–and the unimportance–of birthweight. Int J Epidemiol. 2001, 30: 1233-1241. 10.1093/ije/30.6.1233.CrossRefPubMed
33.
Richard L, Pineault R, D'Amour D, Brodeur JM, Seguin L, Latour R, et al: The diversity of prevention and health promotion services offered by Quebec Community Health Centres: a study of infant and toddler programmes. Health Soc Care Community. 2005, 13: 399-408. 10.1111/j.1365-2524.2005.00576.x.CrossRefPubMed
34.
Philibert MD, Pampalon R, Hamel D, Thouez JP, Loiselle CG: Material and social deprivation and health and social services utilisation in Quebec: a local-scale evaluation system. Soc Sci Med. 2007, 64: 1651-1664. 10.1016/j.socscimed.2006.12.010.CrossRefPubMed
35.
Gauvin L, Robitaille E, Riva M, McLaren L, Dassa C, Potvin L: Conceptualizing and operationalizing neighbourhoods: the conundrum of identifying territorial units. Can J Public Health. 2007, 98 (Suppl 1): S18-S26.PubMed
36.
Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M: A United States national reference for fetal growth. Obstet Gynecol. 1996, 87: 163-168. 10.1016/0029-7844(95)00386-X.CrossRefPubMed
37.
De Maio FG: Income inequality measures. J Epidemiol Community Health. 2007, 61: 849-852. 10.1136/jech.2006.052894.CrossRefPubMed
38.
Goldstein H: Multilevel Statistical Models. 1999, London: Institute of Education, Multilevel Models Project
39.
Hanley JA, Negassa A, Edwardes MD, Forrester JE: Statistical analysis of correlated data using generalized estimating equations: an orientation. Am J Epidemiol. 2003, 157: 364-375. 10.1093/aje/kwf215.CrossRefPubMed
40.
Ahern J, Galea S, Hubbard A, Midanik L, Syme SL: "Culture of drinking" and individual problems with alcohol use. Am J Epidemiol. 2008, 167: 1041-1049. 10.1093/aje/kwn022.CrossRefPubMed
41.
Merlo J, Chaix B, Ohlsson H, Beckman A, Johnell K, Hjerpe P, et al: A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena. J Epidemiol Community Health. 2006, 60: 290-297. 10.1136/jech.2004.029454.CrossRefPubMedPubMedCentral
42.
Heagerty PJ, Zeger SL: Marginalized multilevel models and likelihood inference (with discussion). Statistical Science. 2000, 15: 1-26.
43.
Witte JS, Greenland S, Kim LL, Arab L: Multilevel modeling in epidemiology with GLIMMIX. Epidemiology. 2000, 11: 684-688. 10.1097/00001648-200011000-00012.CrossRefPubMed
44.
Dole N, Savitz DA, Hertz-Picciotto I, Siega-Riz AM, McMahon MJ, Buekens P: Maternal stress and preterm birth. Am J Epidemiol. 2003, 157: 14-24. 10.1093/aje/kwf176.CrossRefPubMed
45.
Dole N, Savitz DA, Siega-Riz AM, Hertz-Picciotto I, McMahon MJ, Buekens P: Psychosocial factors and preterm birth among African American and White women in central North Carolina. Am J Public Health. 2004, 94: 1358-1365. 10.2105/AJPH.94.8.1358.CrossRefPubMedPubMedCentral
46.
Dejin-Karlsson E, Hanson BS, Ostergren PO, Sjoberg NO, Marsal K: Does passive smoking in early pregnancy increase the risk of small-for-gestational-age infants?. Am J Public Health. 1998, 88: 1523-1527. 10.2105/AJPH.88.10.1523.CrossRefPubMedPubMedCentral
47.
Dejin-Karlsson E, Ostergren PO: Psychosocial factors, lifestyle, and fetal growth: the added value of both pre- and post-natal assessments. Eur J Public Health. 2003, 13: 210-217. 10.1093/eurpub/13.3.210.CrossRefPubMed
48.
Frohlich KL, Potvin L: Transcending the known in public health practice: the inequality paradox: the population approach and vulnerable populations. Am J Public Health. 2008, 98: 216-221. 10.2105/AJPH.2007.114777.CrossRefPubMedPubMedCentral
49.
Auger N, Luo ZC, Platt RW, Daniel M: Do mother's education and foreign born status interact to influence birth outcomes? Clarifying the epidemiological paradox and the healthy migrant effect. J Epidemiol Community Health. 2008, 62: 402-409. 10.1136/jech.2007.064535.CrossRefPubMed
50.
Halpern D: Minorities and mental health. Soc Sci Med. 1993, 36: 597-607. 10.1016/0277-9536(93)90056-A.CrossRefPubMed
51.
Osler M, Christensen U, Due P, Lund R, Andersen I, Diderichsen F, et al: Income inequality and ischaemic heart disease in Danish men and women. Int J Epidemiol. 2003, 32: 375-380. 10.1093/ije/dyg074.CrossRefPubMed
52.
Wen M, Browning CR, Cagney KA: Poverty, affluence, and income inequality: neighborhood economic structure and its implications for health. Soc Sci Med. 2003, 57: 843-860. 10.1016/S0277-9536(02)00457-4.CrossRefPubMed
53.
Kravdal Ø: Does income inequality really influence individual mortality? Results from a 'fixed-effects analysis' where constant unobserved municipality characteristics are controlled. Demographic Research. 2008, 18: 205-232. 10.4054/DemRes.2008.18.7.CrossRef
54.
Hou F, Myles J: Neighbourhood inequality, neighbourhood affluence and population health. Soc Sci Med. 2005, 60: 1557-1569. 10.1016/j.socscimed.2004.08.033.CrossRefPubMed
55.
Sanmartin C, Ross NA, Tremblay S, Wolfson M, Dunn JR, Lynch J: Labour market income inequality and mortality in North American metropolitan areas. J Epidemiol Community Health. 2003, 57: 792-797. 10.1136/jech.57.10.792.CrossRefPubMedPubMedCentral
56.
Lynch JW, Smith GD, Kaplan GA, House JS: Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions. BMJ. 2000, 320: 1200-1204. 10.1136/bmj.320.7243.1200.CrossRefPubMedPubMedCentral
57.
Kahn RS, Wise PH, Kennedy BP, Kawachi I: State income inequality, household income, and maternal mental and physical health: cross sectional national survey. BMJ. 2000, 321: 1311-1315. 10.1136/bmj.321.7272.1311.CrossRefPubMedPubMedCentral
58.
Lochner K, Pamuk E, Makuc D, Kennedy BP, Kawachi I: State-level income inequality and individual mortality risk: a prospective, multilevel study. Am J Public Health. 2001, 91: 385-391. 10.2105/AJPH.91.3.385.CrossRefPubMedPubMedCentral
59.
Subramanian SV, Kawachi I: Whose health is affected by income inequality? A multilevel interaction analysis of contemporaneous and lagged effects of state income inequality on individual self-rated health in the United States. Health Place. 2006, 12: 141-156. 10.1016/j.healthplace.2004.11.001.CrossRefPubMed
60.
Lynch J, Harper S, Kaplan GA, Davey SG: Associations between income inequality and mortality among US states: the importance of time period and source of income data. Am J Public Health. 2005, 95: 1424-1430. 10.2105/AJPH.2004.048439.CrossRefPubMedPubMedCentral
61.
Oliver LN, Hayes MV: Does choice of spatial unit matter for estimating small-area disparities in health and place effects in the Vancouver Census Metropolitan Area?. Can J Public Health. 2007, 98 (Suppl 1): S27-S34.PubMed
Metadata
Title
The joint influence of area income, income inequality, and immigrant density on adverse birth outcomes: a population-based study
Authors
Nathalie Auger
Julie Giraud
Mark Daniel
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2009
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-9-237

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