Abstract
The purpose of this study was to determine whether housing age in combination with neighborhood poverty, as a proxy for fetal exposure to heavy metal lead, is associated with adverse birth outcomes. We linked population-level birth certificate data for Black, Hispanic, White and Other women, stratified by nativity, from 2009–2011 in Texas (n = 1,040,642) to census the tract-level median housing age/poverty level from the American Community Survey, 2007–2011. Tracts with median housing age values before 1975 with a poverty level of 20% or more were considered to be neighborhoods with a high risk of exposure to deteriorating lead-based paint. We estimated multilevel models to examine the relationship between neighborhood housing age/poverty level and each dependent variable (preterm birth, low birth weight, small-for-gestational age). The odds of adverse birth outcomes were significantly higher for mothers living in high-poverty neighborhoods with median housing built before the lead-based paint ban. Increased awareness of—and improved methods of alleviating— ubiquitous lead-based paint exposure in Texas may be necessary interventions for positive developmental trajectories of children. Allocating federal funds for place-based interventions, including universal lead paint mitigation, in older, high-poverty neighborhoods may reduce the disproportionate risk of adverse birth outcomes.
Highlights
IntroductionNegative birth outcomes in the United States of America are common and consequential
About 39% of the women started prenatal care after the first trimester or had no prenatal care, 66% of them lived in neighborhoods classified as urban, about 32% of them lived in neighborhoods where the median age of housing was before 1975, about 39% of them lived in neighborhoods where the poverty level was 20% or higher, and about 20% of them lived in neighborhoods where the median age of housing was before 1975 and the poverty level was 20% or higher (Table 1)
This study adds to the evidence that housing age in combination with neighborhood poverty is still a significant predictor of adverse birth outcomes; areas with older median housing ages and high poverty appear to be most at risk of these birth disparities
Summary
Negative birth outcomes in the United States of America are common and consequential. In 2018, 1 out of every 10 infants was born preterm (less than 37 weeks), and 1 in 12 exhibited low birth weights [1]. And low birth weights have been linked to a number of harmful states in the later lives of children, such as altered cardiovascular and kidney function, increased risks of social and psychological problems, and higher odds of a diagnosis of cerebral palsy, and early births are the leading cause of perinatal mortality [2,3,4]. Texas performed near the national average at producing healthy babies, with a preterm birth rate of 11% in 2018 and a low-birth-weight rate of 8.3%. For its similarity to the U.S.A. as a whole, as well as its large size both in land and population, we use geographic data on Texas that may be representative of the U.S.A
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