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Open Access 01-12-2019 | Premature Birth | Research article

Area-level deprivation and preterm birth: results from a national, commercially-insured population

Authors: Renee Mehra, Fatma M. Shebl, Shayna D. Cunningham, Urania Magriples, Eric Barrette, Carolina Herrera, Katy B. Kozhimannil, Jeannette R. Ickovics

Published in: BMC Public Health | Issue 1/2019

Abstract

Background

Area-level deprivation is associated with multiple adverse birth outcomes. Few studies have examined the mediating pathways through which area-level deprivation affects these outcomes. The objective of this study was to investigate the association between area-level deprivation and preterm birth, and examine the mediating effects of maternal medical, behavioural, and psychosocial factors.

Methods

We conducted a retrospective cohort study using national, commercial health insurance claims data from 2011, obtained from the Health Care Cost Institute. Area-level deprivation was derived from principal components methods using ZIP code-level data. Multilevel structural equation modeling was used to examine mediating effects.

Results

In total, 138,487 women with a live singleton birth residing in 14,577 ZIP codes throughout the United States were included. Overall, 5.7% of women had a preterm birth. In fully adjusted generalized estimation equation models, compared to women in the lowest quartile of area-level deprivation, odds of preterm birth increased by 9.6% among women in the second highest quartile (odds ratio (OR) 1.096; 95% confidence interval (CI) 1.021, 1.176), by 11.3% in the third highest quartile (OR 1.113; 95% CI 1.035, 1.195), and by 24.9% in the highest quartile (OR 1.249; 95% CI 1.165, 1.339). Hypertension and infection moderately mediated this association.

Conclusions

Even among commercially-insured women, area-level deprivation was associated with increased risk of preterm birth. Similar to individual socioeconomic status, area-level deprivation does not have a threshold effect. Implementation of policies to reduce area-level deprivation, and the screening and treatment of maternal mediators may be associated with a lower risk of preterm birth.

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Martin JA, Hamilton BE, Osterman MJ, Curtin SC, Matthews TJ. Births: final data for 2013. Natl Vital Stat Rep. 2015;64(1):1–65.PubMed

Mathews TJ, MacDorman MF, Thoma ME. Infant mortality statistics from the 2013 period linked birth/infant death data set. Natl Vital Stat Rep. 2015;64(9):1–30.

Institute of Medicine. Preterm birth: causes, consequences, and prevention. Washington, DC: The National Academies Press; 2007. https://doi.org/10.17226/11622

Kim D, Saada A. The social determinants of infant mortality and birth outcomes in Western developed nations: a cross-country systematic review. Int J Environ Res Public Health. 2013;10(6):2296–335 https://doi.org/10.3390/ijerph10062296.CrossRef

Messer LC, Laraia BA, Kaufman JS, Eyster J, Holzman C, Culhane J, et al. The development of a standardized neighborhood deprivation index. J Urban Health. 2006;83(6):1041–62 https://doi.org/10.1007/s11524-006-9094-x.CrossRef

Wentz AE, Messer LC, Nguyen T, Boone-Heinonen J. Small and large size for gestational age and neighborhood deprivation measured within increasing proximity to homes. Health Place. 2014;30c:98–106 https://doi.org/10.1016/j.healthplace.2014.08.010.CrossRef

Janevic T, Stein CR, Savitz DA, Kaufman JS, Mason SM, Herring AH. Neighborhood deprivation and adverse birth outcomes among diverse ethnic groups. Ann Epidemiol. 2010;20(6):445–51 https://doi.org/10.1016/j.annepidem.2010.02.010.CrossRef

Ma XG, Fleischer NL, Liu JH, Hardin JW, Zhao G, Liese AD. Neighborhood deprivation and preterm birth: an application of propensity score matching. Ann Epidemiol. 2015;25(2):120–5 https://doi.org/10.1016/j.annepidem.2014.11.021.CrossRef

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(2):155–63 https://doi.org/10.1093/aje/kwm277.CrossRef

10.

Elo IT, Culhane JF, Kohler IV, O'Campo P, Burke JG, Messer LC, et al. Neighbourhood deprivation and small-for-gestational-age term births in the United States. Paediatr Perinat Epidemiol. 2009;23(1):87–96 https://doi.org/10.1111/j.1365-3016.2008.00991.x.CrossRef

11.

Lydon-Rochelle MT, Holt VL, Cardenas V, Nelson JC, Easterling TR, Gardella C, et al. The reporting of pre-existing maternal medical conditions and complications of pregnancy on birth certificates and in hospital discharge data. Am J Obstet Gynecol. 2005;193(1):125–34 https://doi.org/10.1016/j.ajog.2005.02.096.CrossRef

12.

Roohan PJ, Josberger RE, Acar J, Dabir P, Feder HM, Gagliano PJ. Validation of birth certificate data in New York State. J Community Health. 2003;28(5):335–46.CrossRef

13.

Meng G, Thompson ME, Hall GB. Pathways of neighbourhood-level socio-economic determinants of adverse birth outcomes. Int J Health Geogr. 2013;12:32 https://doi.org/10.1186/1476-072x-12-32.CrossRef

14.

Farley TA, Mason K, Rice J, Habel JD, Scribner R, Cohen DA. The relationship between the neighbourhood environment and adverse birth outcomes. Paediatr Perinat Epidemiol. 2006;20(3):188–200 https://doi.org/10.1111/j.1365-3016.2006.00719.x.CrossRef

15.

Clayborne ZM, Giesbrecht GF, Bell RC, Tomfohr-Madsen LM. Relations between neighbourhood socioeconomic status and birth outcomes are mediated by maternal weight. Soc Sci Med. 2017;175:143–51 https://doi.org/10.1016/j.socscimed.2016.12.041.CrossRef

16.

Schempf A, Strobino D, O'Campo P. Neighborhood effects on birthweight: an exploration of psychosocial and behavioral pathways in Baltimore, 1995-1996. Soc Sci Med. 2009;68(1):100–10 https://doi.org/10.1016/j.socscimed.2008.10.006.CrossRef

17.

Culhane JF, Elo IT. Neighborhood context and reproductive health. Am J Obstet Gynecol. 2005;192(5 Suppl):S22–9 https://doi.org/10.1016/j.ajog.2005.01.071.CrossRef

18.

Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: final data for 2017. Natl Vital Stat Rep. 2018;67(8):1–50.PubMed

19.

Health Care Cost Institute. Health Care Cost and Utilization Report: 2011. 2012. https://www.healthcostinstitute.org/images/pdfs/2011-HCCI-Annual-Report.pdf. Accessed 16 Jan 2019.

20.

Cunningham SD, Herrera C, Udo IE, Kozhimannil KB, Barrette E, Magriples U, et al. Maternal medical complexity: impact on prenatal health care spending among women at low risk for cesarean section. Womens Health Issues. 2017;27(5):551–8 https://doi.org/10.1016/j.whi.2017.03.003.CrossRef

21.

Bureau of the Census. Geographic areas reference manual. 1994. https://www.census.gov/geo/reference/garm.html. Accessed 27 Jan 2016.

22.

Kramer MS, Seguin L, Lydon J, Goulet L. Socio-economic disparities in pregnancy outcome: why do the poor fare so poorly? Paediatr Perinat Epidemiol. 2000;14(3):194–210.CrossRef

23.

Xu X, Gariepy A, Lundsberg LS, Sheth SS, Pettker CM, Krumholz HM, et al. Wide variation found in hospital facility costs for maternity stays involving low-risk childbirth. Health Aff (Millwood). 2015;34(7):1212–9 https://doi.org/10.1377/hlthaff.2014.1088.CrossRef

24.

United States Census Bureau. Geographic terms and concepts - core based statistical areas and related statistical areas. https://www.census.gov/geo/reference/gtc/gtc_cbsa.html. Accessed 6 Jan 2019.

25.

Jacquez GM. Current practices in the spatial analysis of cancer: flies in the ointment. Int J Health Geogr. 2004;3(1):22 https://doi.org/10.1186/1476-072x-3-22.CrossRef

26.

Tian N, Goovaerts P, Zhan FB, Wilson JG. Identification of racial disparities in breast cancer mortality: does scale matter? Int J Health Geogr. 2010;9:35 https://doi.org/10.1186/1476-072x-9-35.CrossRef

27.

United States Census Bureau. ACS 2011 (5-year estimates). Prepared by Social Explorer. Accessed 27 Jan 2016.

28.

United States Department of Agriculture. Documentation: 2010 Rural-Urban Commuting Area (RUCA) codes. https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/documentation/. Accessed 12 Feb 2018.

29.

Hall SA, Kaufman JS, Ricketts TC. Defining urban and rural areas in U.S. epidemiologic studies. J Urban Health. 2006;83(2):162–75 https://doi.org/10.1007/s11524-005-9016-3.CrossRef

30.

Center for Rural Health. Temporary ZIP RUCA 3.10 file access. https://ruralhealth.und.edu/ruca. Accessed 12 Feb 2018.

31.

VanderWeele TJ, Ding P. Sensitivity analysis in observational research: introducing the e-value. Ann Intern Med. 2017;167(4):268–74 https://doi.org/10.7326/M16-2607.CrossRef

32.

Preacher KJ, Zyphur MJ, Zhang Z. A general multilevel SEM framework for assessing multilevel mediation. Psychol Methods. 2010;15(3):209–33 https://doi.org/10.1037/a0020141.CrossRef

33.

White JS, Hamad R, Li X, Basu S, Ohlsson H, Sundquist J, et al. Long-term effects of neighbourhood deprivation on diabetes risk: quasi-experimental evidence from a refugee dispersal policy in Sweden. Lancet Diabetes Endocrinol. 2016;4(6):517–24 https://doi.org/10.1016/s2213-8587(16)30009-2.CrossRef

34.

Meijer M, Rohl J, Bloomfield K, Grittner U. Do neighborhoods affect individual mortality? A systematic review and meta-analysis of multilevel studies. Soc Sci Med. 2012;74(8):1204–12 https://doi.org/10.1016/j.socscimed.2011.11.034.CrossRef

35.

Vos AA, Posthumus AG, Bonsel GJ, Steegers EA, Denktas S. Deprived neighborhoods and adverse perinatal outcome: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2014;93(8):727–40 https://doi.org/10.1111/aogs.12430.CrossRef

36.

Marmot M. The health gap: the challenge of an unequal world. London: Bloomsbury Publishing; 2015.

37.

Messer LC, Maxson P, Miranda ML. The urban built environment and associations with women's psychosocial health. J Urban Health. 2013;90(5):857–71 https://doi.org/10.1007/s11524-012-9743-1.CrossRef

38.

Akosa Antwi Y, Ma J, Simon K, Carroll A. Dependent coverage under the ACA and Medicaid coverage for childbirth. N Engl J Med. 2016;374(2):194–6 https://doi.org/10.1056/NEJMc1507847.CrossRef

39.

Daw JR, Sommers BD. Association of the Affordable Care act dependent coverage provision with prenatal care use and birth outcomes. JAMA. 2018;319(6):579–87 https://doi.org/10.1001/jama.2018.0030.CrossRef

40.

Markus AR, Krohe S, Garro N, Gerstein M, Pellegrini C. Examining the association between Medicaid coverage and preterm births using 2010-2013 National Vital Statistics Birth Data. J Child Poverty. 2016:1–16 https://doi.org/10.1080/10796126.2016.1254601.

41.

Schempf AH, Kaufman JS, Messer LC, Mendola P. The neighborhood contribution to black-white perinatal disparities: an example from two North Carolina counties, 1999-2001. Am J Epidemiol. 2011;174(6):744–52 https://doi.org/10.1093/aje/kwr128.CrossRef

42.

Adler NE, Stewart J. Health disparities across the lifespan: meaning, methods, and mechanisms. Ann N Y Acad Sci. 2010;1186:5–23 https://doi.org/10.1111/j.1749-6632.2009.05337.x.CrossRef

43.

Howell EA, Egorova NN, Janevic T, Balbierz A, Zeitlin J, Hebert PL. Severe maternal morbidity among Hispanic women in New York City: investigation of health disparities. Obstet Gynecol. 2017;129(2):285–94 https://doi.org/10.1097/aog.0000000000001864.CrossRef

44.

Krieger N, Waterman P, Chen JT, Soobader MJ, Subramanian SV, Carson R. Zip code caveat: bias due to spatiotemporal mismatches between zip codes and US census-defined geographic areas--the public health disparities geocoding project. Am J Public Health. 2002;92(7):1100–2.CrossRef

45.

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(3):186–99.CrossRef

46.

US Bureau of the Census. ZIP Code™ Tabulation Areas (ZCTAs™). https://www.census.gov/geo/reference/zctas.html. Accessed 4 Jan 2019.

47.

Andrade SE, Scott PE, Davis RL, Li DK, Getahun D, Cheetham TC, et al. Validity of health plan and birth certificate data for pregnancy research. Pharmacoepidemiol Drug Saf. 2013;22(1):7–15 https://doi.org/10.1002/pds.3319.CrossRef

48.

D'Angelo DV, Le B, O'Neil ME, Williams L, Ahluwalia IB, Harrison LL, et al. Patterns of health insurance coverage around the time of pregnancy among women with live-born infants--pregnancy risk assessment monitoring system, 29 states, 2009. MMWR Surveill Summ. 2015;64(4):1–19.PubMed

49.

Bell ML, Belanger K. Review of research on residential mobility during pregnancy: consequences for assessment of prenatal environmental exposures. J Expo Sci Environ Epidemiol. 2012;22(5):429–38 https://doi.org/10.1038/jes.2012.42.CrossRef

50.

Li R, Bauman B, D'Angelo DV, Harrison LL, Warner L, Barfield W, Cox S. Affordable care act-dependent insurance coverage and access to care among young adult women with a recent live birth. Med Care. 2019;57(2):109–14 https://doi.org/10.1097/mlr.0000000000001044.PubMed

Title: Area-level deprivation and preterm birth: results from a national, commercially-insured population
Authors: Renee Mehra
Fatma M. Shebl
Shayna D. Cunningham
Urania Magriples
Eric Barrette
Carolina Herrera
Katy B. Kozhimannil
Jeannette R. Ickovics
Publication date: 01-12-2019
Publisher: BioMed Central
Keyword: Premature Birth
Published in: BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-019-6533-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Area-level deprivation and preterm birth: results from a national, commercially-insured population

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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