Preterm birth, neighborhood deprivation, and first grade educational attainment: An analysis of multiplicative interaction and spatial heterogeneity Público

Nelson, Lauren Noffsinger (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/g445cd39f?locale=es
Published

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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