Preterm birth, neighborhood deprivation, and first grade educational attainment: An analysis of multiplicative interaction and spatial heterogeneity Öffentlichkeit
Nelson, Lauren Noffsinger (2013)
Abstract
Objectives
Early childhood development is important for school readiness and
educational attainment and has a lasting affect on health. There is
evidence that both preterm birth and neighborhood deprivation are
independently associated with school readiness and educational
attainment, however there has been little examination of their
combined effect. This analysis assessed for multiplicative
interaction and spatial heterogeneity of the influence of preterm
birth and neighborhood deprivation on the risk of failing the math
portion of the Georgia Criterion-Referenced Competency Test (CRCT)
in first grade.
Methods
Data is from the Georgia Birth to School Cohort. Birth and
standardized test records were linked for 97,747 children born from
1998 to 2002 in the five core counties of Atlanta. Interaction was
assessed using multivariable logistic regression and spatial
heterogeneity was assessed using geographically weighted regression
(GWR).
Results
The logistic regression models indicated that when adjusting for
maternal age, marital status, education level, race, child sex,
insurance status, smoking during pregnancy, and quality of prenatal
care, there was evidence of significant interaction between preterm
birth and neighborhood deprivation. For those who were born preterm
(less than 37 weeks gestation), there was no significant effect of
deprivation on the risk of failing the math portion of the CRCT
(aRR: 1.00, 95% CI: 0.97, 1.04). For those born at term, there was
a significant effect of deprivation on failing (aRR: 1.04, 95% CI:
1.02, 1.06). The GWR suggests that there is spatial heterogeneity
in the relationship between preterm birth, neighborhood
deprivation, and failure of the math CRCT. Among preterm births,
deprivation appeared to have a larger effect in the northwest and
eastern areas of the region. Among term births, deprivation had a
greater effect in the northeast and in parts of the northwest and
south.
Conclusion
This analysis provides evidence of significant multiplicative
interaction and substantial spatial heterogeneity of preterm birth
and neighborhood deprivation when predicting risk of failing the
math portion of the CRCT in first grade. Further research should
establish these spatial differences to better target interventions
that aim to improve early childhood development.
Table of Contents
Table of Contents
Literature Review 1
Methods 19
Results 27
Discussion 32
Strengths and Limitations 36
Future Directions 40
References 42
Tables 53
Table 1. Descriptive statistics of the birth to school cohort before and after excluding observations with missing variables 53
Table 2. Descriptive statistics by preterm and deprivation status 55
Table 3. Bivariate associations of all variables with outcome and exposures 57
Table 4. No-interaction multivariable logistic regression models of risk of failing the math portion of the CRCT in first grade 59
Table 5. Interaction multivariable logistic regression models of risk of failing the math portion of the CRCT in first grade 61
Table 6. Interaction multivariable logistic regression models stratified by race 63
Table 7. Results of geographically weighted regression. Median and interquartile range of odds ratios for failing the math portion of the CRCT 65
Figures 67
Figure 1. Median odds ratios of failing the math CRCT in first grade for a one standard deviation increase in neighborhood deprivation index among preterm births (left) and term births (right) 67
Figure 2. Median odds ratios of failing the math CRCT in first grade for a one standard deviation increase in neighborhood deprivation index among preterm births (left) and term births (right), adjusted for maternal age, maternal race, maternal marital status, child sex, maternal education, insurance status, smoking status during pregnancy, and Kotelchuck index 68
Appendix 69
IRB Letter 69
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