High to low, low to high: neighbourhood socioeconomic trajectories and birth outcomes

Abstract

Abstract Background A growing body of literature has consistently linked neighbourhood socioeconomic status (SES) with adverse birth outcomes. However, the available evidence is based on cross-sectional indicators of neighbourhood SES, which fail to reflect neighbourhoods' dynamic nature. The objective of this study was to explore the relationship between temporal trajectories of neighbourhood socioeconomic change and adverse birth outcomes. Methods The study population consisted of registered singleton births occurred in the Netherlands 2003-2017 between 24 and 41 weeks of gestation (N = 2,335,449). Based on neighbourhood socioeconomic data from The Netherlands Institute for Social Research, we categorized neighbourhoods into longitudinal SES trajectories (e.g. stable, declining, ascending). Multilevel logistic regression models were used to estimate the relationship between neighbourhood SES trajectories and birth outcomes, i.e., preterm birth and small-for-gestational-age (SGA). Results Living in a Stable Low SES neighbourhood was associated with higher odds of preterm birth (OR[CI]=1.10[1.06; 1.14]), and SGA (OR[CI]=1.15[1.12; 1.18]), compared to living in Stable High SES areas. Also, women living in a Declining (Middle to Low SES) neighbourhood had higher odds for preterm birth (OR = 1.08[1.03; 1.14]) and SGA (OR = 1.10 [1.06; 1.15]), compared to Stable High SES areas. Conclusions Women from neighbourhoods with long-term low or declining SES were more likely to experience adverse birth outcomes. Policies aimed at mitigating the effect of long-term neighbourhood disadvantage or preventing neighbourhoods' decline have potential to benefit early life health outcomes. Key messages Women living in long-term low or declining socioeconomic status neighbourhoods were more likely to experience adverse birth outcomes. Our results can provide guidance to policies aimed at improving early life health outcomes.