Abstract
IntroductionNeighbourhood level deprivation has been shown to influence adverse perinatal outcomes independent of individual level socioeconomic status (SES) in countries with high income inequality, such as the United States. The present study evaluates whether municipality level deprivation defined based on education (proportion of inhabitants with university level education), income (mean income per capita) and unemployment were associated with the prevalence of preterm birth (<37 weeks) and small for gestational age (SGA, birth weight <2 standard deviations) after adjustment for individual level socio-demographics (age, parity, prior preterm births, smoking during pregnancy and SES defined based on maternal occupation at birth) in Finland.MethodsThe study design was cross-sectional. The data gathered from the Medical Birth Register included all singleton births (n = 345,952) in 2005–2010. We fitted Generalized Estimating Equations (GEE) models to account for correlation of preterm birth and SGA clustering within municipality.ResultsOf all the women with singleton pregnancies, 4.5% (n = 15,615) gave birth preterm and 3.8% (n = 13,111) of their newborns were classified as SGA. Individual level SES and smoking were important risk factors for each outcome in adjusted models. Controlling for individual level factors, women living in intermediate and high unemployment class municipalities were 6.0% (adjusted odds ratio (aOR) = 1.06; 95% confidence interval (CI) 1.01-1.12) and 13.0% (aOR = 1.13; 95% CI 1.06-1.20), respectively, more likely to give birth to an SGA newborn than women living in low unemployment class municipalities.ConclusionsAfter adjustment for individual level socio-demographics, the prevalence of SGA was around 6-13% higher in municipalities with an intermediate or high unemployment rate than municipalities with the lowest unemployment rate. The results suggested that the unemployment rate has an important public health effect with clinical implications since SGA is associated with a higher risk of adverse long-term health outcomes.
Highlights
Neighbourhood level deprivation has been shown to influence adverse perinatal outcomes independent of individual level socioeconomic status (SES) in countries with high income inequality, such as the United States
In total, 4.5% (n = 15,615) of all the included women with singleton pregnancies gave birth preterm (
The prevalence of SGA varied significantly only by municipality unemployment classes; giving birth to a SGA newborn was more frequent in the most deprived municipalities defined based on unemployment
Summary
Neighbourhood level deprivation has been shown to influence adverse perinatal outcomes independent of individual level socioeconomic status (SES) in countries with high income inequality, such as the United States. We have identified only three previous studies in European populations, which test for the association between neighbourhood level deprivation and adverse perinatal outcomes while controlling for individual level SES and behaviours. Two previous studies with small random samples from the Netherlands reported inconsistent results; neighbourhood level deprivation was an independent risk factor for giving birth to a small for gestational age (SGA) newborn (birth weight below 10th percentile of birth weight standard), [6] and a greater prevalence of adverse perinatal outcomes in deprived neighbourhoods was explained by individual level characteristics [7].
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