Neighborhood Deprivation and Preterm Birth in a North Carolina Birth Cohort

Abstract

Background: Residing in deprived areas can have health impacts beyond individual level deprivation and may increase vulnerabilities to other exposures. Adverse pregnancy outcomes, including preterm birth, have previously been associated with various indicators of area-level deprivation. Methods: We examined associations between neighborhood deprivation and preterm birth in the North Carolina birth registry cohort from 2006 - 2011 (n=653,887). The neighborhood deprivation index (NDI) was developed at the census tract level using principle components analysis with American Community Survey 5-year estimates representing 5 socio-demographic domains: income/poverty, education, employment, housing, and occupation. Risk ratios (RR) (95% confidence intervals) were estimated using multilevel (random-intercept) binomial regression models adjusted for individual-level gestational parent race/ethnicity, marital status, Medicaid status, and age; race-stratified models were also examined. Results: The adjusted RR for preterm birth for each standard deviation increase in NDI in the unstratified analysis was 1.07 (1.06, 1.08). RRs in race-stratified analyses were highest for white parents (1.11 (1.09, 1.13)), followed by black (1.05 (1.04, 1.07) and Hispanic parents (1.03 (1.00, 1.05)). Conclusions: Increases in neighborhood deprivation were associated with increased risk of preterm birth, while the magnitude of association differed by race/ethnicity. In the future, we will explore interactions between neighborhood deprivation and environmental exposures, such as air pollution. The views expressed in this abstract are those of the authors and do not necessarily represent views or policies of the U.S. Environmental Protection Agency.