Investigating the association between small-area violent crime and preterm birth in Atlanta, GA: 1998-2006 Public

Abstract

Background: Preterm birth causes considerable morbidity and mortality among children
in the United States, but the risk of preterm birth is not fully explained by individual
maternal risk factors. There is some evidence that living in a high crime
neighborhood may contribute to an increased risk of preterm birth.
Methods: We used multilevel logistic regression to investigate the association between
both census tract and census block group violent crime rate on the probability of
preterm birth, controlling for potential individual and neighborhood-level
confounders. We restricted our analysis to births within the City of Atlanta, GA in
the years 1998-2006.
Results: Preterm births comprised 13.1% of 50,665 births in Atlanta. Violent crime rates
at the block group level showed statistically significant interaction with maternal
age. The odds of preterm birth among women in the highest two violent crime
quartiles were increased compared to women in the lowest violent crime quartile
among women 30 years and older; there was no association between living in the
highest block group crime quartiles and preterm birth compared to living in the
lowest crime quartile among women younger than 30. There was no significant
interaction between tract-level violent crime and age category; all women living in
any but the lowest crime quartile showed an increased odds of preterm birth
compared to women living in the lowest crime quartile.
Discussion: There is evidence of an association between living in a high-crime area and
an increased risk of preterm birth, when considering violent crime rate at either the
block group scale or the tract scale.

Table of Contents

Table of Contents


Introduction 1
Methods 5
Results 9
Discussion 15
Future Directions 19
References 20
Table 1: Demographics and health characteristics of infants and mothers of
infants born at term and preterm in Atlanta, GA, 1998-2006 22
Table 2: Distribution of all births in spatially-smoothed block group violent
crime rate quartiles of Atlanta, GA, 1998-2006 24
Table 3: The odds of preterm birth of women in medium, high, and very
high spatially-smoothed block group crime quartiles compared to women in
the lowest crime quartiles, stratified by age category 27
Table 4: The odds of preterm birth of women in all maternal age categories
and all spatially-smoothed block group crime quartiles compared to women
aged 30-34 in the lowest crime quartile. 28
Table 5: Odds of preterm birth of women in medium, high, and very high
spatially-smoothed tract crime quartiles compared to women in the lowest
crime quartiles as calculated by three models 29
Figure 1: Violent crime rate in Atlanta, GA by type of crime: 1989-2009. 30
Figure 2: Distribution of spatially smoothed block-group level violent
crime rate quartiles in Atlanta, GA: 1998, 2002, and 2006. 31
Figure 3: Distribution of poverty in Atlanta, GA, represented as the percent
of people in each census tract below the poverty line: 1998, 2002, and 2006. 32
Figure 4: Distribution of tract-level deprivation indices in Atlanta, GA:
1998, 2002, and 2006. 33
Figure 5: Distribution of spatially-smoothed block group preterm birth rates
in Atlanta, GA: 1998-2006. 34
Figure 6: Number of births per spatially-smoothed block-group violent
crime quartile in Atlanta, GA: 1998-2006. 35
Figure 7: Adjusted odds ratios comparing odds of preterm birth in the a) 4th
spatially-smooth block group crime quartile, the b) 3rd spatially-smooth
block group crime quartile, and the c) 2nd spatially-smooth block group
crime quartile with the 1st spatially-smooth block group crime quartile
between age categories in Atlanta, GA, 1998-2006. 36

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Mot-clé	violent crime preterm birth
Committee Chair / Thesis Advisor	Kramer, Michael R, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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