Abstract
BackgroundThe association between area characteristics and birth outcomes is modified by race. Whether such associations vary according to social class indicators beyond race has not been assessed.MethodsThis study evaluated effect modification by maternal birthplace and education of the relationship between neighbourhood characteristics and birth outcomes of newborns from 1999–2003 in the province of Québec, Canada (N = 353,120 births). Areas (N = 143) were defined as administrative local health service delivery districts. Multi-level logistic regression was used to model the association between three area characteristics (median household income, immigrant density and income inequality) and the two outcomes preterm birth (PTB) and small-for-gestational age (SGA) birth. Effect modification by social class indicators was evaluated in analyses stratified according to maternal birthplace and education.ResultsRelative to the lowest tertile, high median household income was associated with SGA birth among Canadian-born mothers (odds ratio (OR) 1.13, 95% confidence interval (CI) 1.06, 1.20) and mothers with high school education or less (OR 1.13, 95% CI 1.02, 1.24). Associations between median household income and PTB were weaker. Relative to the highest tertile, low immigrant density was associated with a lower odds of PTB among foreign-born mothers (OR 0.79, 95% CI 0.63, 1.00) but a higher odds of PTB among Canadian-born mothers (OR 1.14, 95% CI 1.07, 1.21). Associations with income inequality were weak or absent.ConclusionThe association between area factors and birth outcomes is modified by maternal birthplace and education. Studies have found that race interacts in a similar manner. Public health policies focussed on perinatal health must consider the interaction between individual and area characteristics.
Highlights
The association between area characteristics and birth outcomes is modified by race
We evaluated whether the relationship between area characteristics and these birth outcomes was modified by two social markers, maternal birthplace and education
We examined a fused version of local community service center (CLSC) provided by the health ministry (N = 147) to ensure areas were sufficiently large for the calculation of income inequality [mean population 51,564; mean births 2,469]
Summary
The association between area characteristics and birth outcomes is modified by race. Whether such associations vary according to social class indicators beyond race has not been assessed. Some studies have focussed on neighbourhood segregation and gestational age [15,16,17,18,19] or birthweight [15,16,19,20,21], but the evidence is conflicting. Studies demonstrate both protective [16,19] and unfavourable [15,16,17,18,20,21,22] associations with birth outcomes. A small number of studies have found that area deprivation interacts with race [5,6,8,20]
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