Neighborhood deprivation and racial differences in in vitro fertilization outcomes

Abstract

BACKGROUNDThere are significant racial disparities in in vitro fertilization outcomes, which are poorly explained by individual-level characteristics. Environmental factors such as neighborhood-level socioeconomic factors may contribute to disparities in in vitro fertilization outcomes; however, few studies have directly addressed this research question in a large, racially diverse cohort. OBJECTIVETo investigate whether neighborhood deprivation is associated with differences in in vitro fertilization outcomes. STUDY DESIGNOur retrospective cohort study included 1110 patients who underwent 2254 autologous in vitro fertilization cycles between 2014 and 2019 at an academic fertility center in the Southeastern United States. Neighborhood deprivation was estimated using the neighborhood deprivation index, a composite variable measuring community levels of material capital based off poverty, occupation, housing, and education domains. Using multivariable log-binomial generalized estimating equations with cluster weighting, risk ratios (RR) and 95% confidence intervals (CI) were estimated for cycle cancellation, miscarriage (defined as spontaneous pregnancy loss before twenty weeks after a confirmed intrauterine gestation), and live birth according to patient neighborhood deprivation index. RESULTSThere were positive associations between increasing neighborhood deprivation index (indicating worsening neighborhood deprivation) and body mass index, as well as increasing prevalence of tubal and uterine factor infertility diagnoses. The crude probability of live birth per cycle was lower in Black (24%) versus White patients (32%) and the crude probability of miscarriage per clinical pregnancy was elevated in Black (22%) as compared to White patients (12%). After adjustment, neighborhood deprivation index was not significantly associated with risk of cycle cancellation or live birth. Results were consistent when analyses were stratified by race. CONCLUSIONOur research demonstrates racial disparities between Black and White women in the incidence of miscarriage and live birth following in vitro fertilization. While level of neighborhood deprivation was closely related to race, it did not have strong associations with in vitro fertilization outcomes in our population as a whole or within strata of race.