Low Birth Weight, Maternal Age, and County Economic Status in the Appalachian Region Open Access

Abstract

Introduction: The effects of area deprivation on perinatal outcomes in the Appalachian region have not been well studied. This analysis assessed the relationship between county economic status and low birth weight (LBW), hypothesizing that there would be a pattern of accelerated aging contrasting low economic status and high economic status counties, which would be supportive of the weathering hypothesis.

Methods: Appalachian Regional Commission county economic status labels were applied to the National Vital Statistics System natality file for births in the Appalachian region between 2006 and 2011. The outcome of interest was births weighing <2,500 grams, and predictors included maternal age, race, parity, adequacy of prenatal care use, education, and smoking. General estimating equations models were used to account for repeated county measures. The estimated age-specific risks of LBW were depicted graphically to better understand the relationship with county status.

Results: Women in low income counties were younger, had lower educational attainment, and a greater proportion smoked than women in high income counties. The relationship between county economic status and low birth weight varied by race and ethnicity. When controlling for smoking, women in low income counties had decreased odds of low birth weight compared to women in high income counties, OR 0.71 (95% CI 0.53-0.94). Among women living in low economic status counties had the lowest risk of LBW at age 28, while women living in high income counties had the lowest risk of LBW at age 32.

Discussion & Conclusions: Smoking is an important predictor of low birth weight among Appalachian women in low economic status counties, where smoking was more common than in high economic status counties. The age-specific risks of LBW are suggestive of a pattern of accelerated aging in women from low economic status counties as compared to women in high economic status counties. Accelerated aging leads to an increased risk of low birth weight as women age, and may be associated with limited educational or career opportunities. The results of this analysis support the weathering hypothesis as a function of county economic status in the Appalachian region.

Table of Contents

Introduction

Review of the Literature. 4

Accelerated Aging. 4

The Weathering Hypothesis. 5

Health in Appalachia. 6

Relevance of Births to Adolescents. 9

Low Birth Weight as an Indicator of Maternal Health. 10

Gaps in the Literature. 12

Methods. 13

Study Population. 13

Data Sources and Predictors of Interest 13

Data Preparation. 14

Data Analysis. 16

Results. 18

Descriptive Statistics. 18

Models. 19

Age-specific Risk of Low Birth Weight 21

Discussion. 24

Demographics. 24

Models. 26

Age-Specific Risk of Low Birth Weight 28

Strengths and Weaknesses. 32

Conclusions. 34

Tables. 35

References. 45

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Low birth weight Accelerated aging Weathering hypothesis Appalachia
Committee Chair / Thesis Advisor	Kramer, Michael R, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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