Spatial Variation in Preterm Birth and Risk Factors in Five Counties Around Atlanta, GA Öffentlichkeit
Largen, Angela Lynn (2013)
Abstract
Background: Preterm birth is a major contributor to infant morbidity and mortality and is a continuing burden in the US despite modern medical care. Many risk factors are implicated in the progression of preterm birth. Health interventions exist for some of these factors, and identifying spatial regions containing high proportions of women with these modifiable risk factors can inform targeted interventions to those regions. Objective: The aim of this study was to identify areas with distinct spatial variation in preterm birth within the five core counties around Atlanta, and determine the relative contribution of significant modifiable risk factors in these areas. Additionally, this study will ascertain if differences exist between African-American women and white women in spatial patterns of preterm birth and risk factors. Methods: Birth data from the Georgia Birth File was obtained for 2005-2007. Preterm birth prevalence was smoothed using spatial Empirical Bayes by census tract, and areas with distinct spatial variation of preterm birth were selected. Regions were identified for distinctly low and high preterm birth prevalence among all women, black women only, and white women only. Attributable risks for modifiable factors were calculated to determine their relative contribution to preterm birth by area. Results: Differences were found in locations of high and low prevalence areas for white and black women. For the area of high preterm birth in all women, attributable risk values were greatest for short interpregnancy interval (4.6%), tobacco use (3.3%), and pregnancy associated hypertension (1.3%). In the high prevalence area for black women, the greatest attributable risk was due to short interpregnancy interval (5.1%), tobacco use (3.2%), and advanced maternal age (2.6%). In the area of high prevalence for white women only, short interpregnancy interval (9.5%) and eclampsia (1.4%) had the greatest attributable risk. Conclusion: This study highlights the existence of spatial variation of preterm birth within the five counties around Atlanta, and that contributions of modifiable risk factors to preterm birth vary by location and by race. These findings suggest health interventions should be targeted at specific risk factors in defined locations to have the greatest impact on preterm birth prevention.
Table of Contents
1. INTRODUCTION ................................................................................................................1 2. LITERATURE REVIEW 2.1 Preterm Birth Risk Factor Overview.............................................................................4 2.2 Risk Factors During Pregnancy.....................................................................................4 2.3 Maternal Risk Factors Prior to Pregnancy.....................................................................6 2.4 Demographic and Socioeconomic Factors.....................................................................7 2.5 Spatial Analysis and Preterm Birth................................................................................9 3. METHODS 3.1 Study Population..........................................................................................................11 3.2 Variable Selection........................................................................................................11 3.3 Selection of Areas for Analysis...................................................................................12 3.4 Statistical Analysis.......................................................................................................13 4. RESULTS 4.1 Descriptive statistics for the total study population.....................................................16 (all race/ethnicities, African-American only, and white only) 4.2 Logistic regression models for overall populations.....................................................17 4.3 Areas of spatially distinct prevalence rates: Combined race and ethnicity groups......18 4.4 Areas of spatially distinct prevalence rates: Non-Hispanic black mothers only.........20 4.5 Areas of spatially distinct prevalence rates: Non-Hispanic white mothers only.........21 4.6 Multiple imputation results: Combined race and ethnicity groups..............................23 5. DISCUSSION 5.1 Comparing the entire study area to hot spots...............................................................25 5.2 Prevalence and risk factors in black women compared to white women....................25 5.3 Multiple imputation vs. complete case analysis..........................................................27 5.4 Strengths......................................................................................................................28 5.5 Limitations...................................................................................................................28 REFERENCES...............................................................................................................................30 TABLES.........................................................................................................................................37 FIGURES........................................................................................................................................50
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