14 Living in an area with high social vulnerability during pregnancy is associated with preterm birth

Abstract

We sought to determine if women living in census tracts with high levels of social vulnerability have increased odds of preterm birth (PTB). This was a retrospective cohort study of women carrying non-anomalous singleton or twin gestations identified from electronic medical record data from a large university health system, 2014-2020. Women at high-risk for spontaneous and/or medically indicated PTB were included in a 1:2 ratio with randomly selected low-risk controls. Each woman’s home address was geocoded and assigned to a census tract, and then linked at the census tract level to the CDC’s Social Vulnerability Index (SVI). The SVI integrates 15 census variables to produce composite scores across 4 major domains (socioeconomic, household composition & disability, minority status & language, and housing type & transportation) in addition to an overall composite SVI score. Higher scores indicate greater social vulnerability. The primary outcome was PTB <37 wks; secondary outcomes were PTB <34 and <28 wks. Data were analyzed using chi2, t-test, and logistic regression. 50,998 women met inclusion criteria; 8.6% delivered < 37, 2.8% < 34, and 1.0% < 28 wks. Population characteristics are shown in the Table. Women delivering preterm < 37, < 34, and < 28 wks were more likely to live in an area with a higher overall SVI and higher social vulnerability in each SVI domain (Table). In regression models, the aOR of PTB increased as the overall SVI and social vulnerabilities in each domain increased; these effects were greatest at the earliest GAs (Figure). The association between PTB and SVI were largest for domains 1 (socioeconomic – which includes poverty, unemployment, education) and 2 (household composition & disability – which includes single-parent households and individuals < 17 or > 65 living in the household). Census-tract level social vulnerabilities in a woman’s area of residence during pregnancy are associated with PTB <37, <34, and <28 weeks’ gestation. Supporting communities to reduce these specific social vulnerabilities has the potential to reduce prematurity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)