Abstract

BackgroundAlthough socio-economic factors have been identified as one of the most important groups of neighbourhood-level risks affecting birth outcomes, uncertainties still exist concerning the pathways through which they are transferred to individual risk factors. This poses a challenge for setting priorities and developing appropriate community-oriented public health interventions and planning guidelines to reduce the level of adverse birth outcomes.MethodThis study examines potential direct and mediated pathways through which neighbourhood-level socio-economic determinants exert their impacts on adverse birth outcomes. Two hypothesized models, namely the materialist and psycho-social models, and their corresponding pathways are tested using a binary-outcome multilevel mediation analysis. Live birth data, including adverse birth outcomes and person-level exposure variables, were obtained from three public health units in the province of Ontario, Canada. Corresponding neighbourhood-level socio-economic, psycho-social and living condition variables were extracted or constructed from the 2001 Canadian Census and the first three cycles (2001, 2003, and 2005) of the Canadian Community Health Surveys.ResultsNeighbourhood-level socio-economic-related risks are found to have direct effects on low birth weight and preterm birth. In addition, 20-30% of the total effects are contributed by indirect effects mediated through person-level risks. There is evidence of four person-level pathways, namely through individual socio-economic status, psycho-social stress, maternal health, and health behaviours, with all being simultaneously at work. Psycho-social pathways and buffering social capital-related variables are found to have more impact on low birth weight than on preterm birth.ConclusionThe evidence supports both the materialist and psycho-social conceptualizations and the pathways that describe them, although the magnitude of the former is greater than the latter.

Highlights

  • Socio-economic factors have been identified as one of the most important groups of neighbourhood-level risks affecting birth outcomes, uncertainties still exist concerning the pathways through which they are transferred to individual risk factors

  • Many of the identified person-level risk variables for maternal health, behaviour, social and financial support, psycho-social, and genetic aspects shown in Table 3 are the same for low birth weight (LBW) and preterm birth (PTB), with some minor variations

  • To identify these unique aspects and to control for multicollinearity, orthogonal risk factors were constructed separately for LBW and PTB based on their corresponding identified person-level risk variables

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Summary

Introduction

Socio-economic factors have been identified as one of the most important groups of neighbourhood-level risks affecting birth outcomes, uncertainties still exist concerning the pathways through which they are transferred to individual risk factors This poses a challenge for setting priorities and developing appropriate community-oriented public health interventions and planning guidelines to reduce the level of adverse birth outcomes. Despite this knowledge, there is a general lack of understanding of the mechanisms that transfer neighbourhoodlevel social and environmental conditions to individual instances of adverse birth outcomes. There is a general lack of understanding of the mechanisms that transfer neighbourhoodlevel social and environmental conditions to individual instances of adverse birth outcomes This poses a challenge for setting priorities and developing appropriate public health programs and policies, especially for community health interventions. Two models can be used to disentangle these complex processes

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