The Impact of Economic Segregation on Very Preterm Birth across MSAs in the United States: 2010-2011 Pubblico

Abstract

Background: Being born very preterm (VPT) can negatively impact infant health in many ways, including hearing impairment, developmental delay, and cerebral palsy. Higher risk of VPT has been associated with racial segregation and income inequality, therefore there is some evidence that living in a metropolitan statistical area (MSA) with high economic segregation may contribute to an increased probability of VPT.

Methods: This study used Generalized Estimating Equations to assess the association between the level of economic segregation within an MSA that a mother lives and the probability of her giving birth VPT, controlling for individual risk factors and county level covariates. The study uses live births to mothers over 18 years old in 2010 and 2011 and spans 184 MSAs across the US. The level of economic segregation in an MSA was based on income data from the 2012 national census.

Results: This study suggests that there is an association between economic segregation and the probability of VPT and that the association varies by maternal race/ethnicity, maternal age, and proportion of the non-Hispanic black population in an MSA. Non-Hispanic black women experience nearly a two-fold increase in the probability of VPT when living in an MSA with high economic segregation compared to living in an MSA with low/no economic segregation (Figure 1). However, the level of economic segregation has a minor impact on non-Hispanic white women's probability of VPT (Figure 1). High versus low economic segregation appears to have a stronger relative association with the probability of VPT for mothers in the mid-reproductive age (28 years old) compared to younger (18 years old) and older (35 years old) ages. The association between economic segregation on VPT also appears to increase as the proportion of the MSA that is non-Hispanic black increases, suggesting a relationship between economic segregation and racial segregation.

Discussion: There is evidence that living in a MSA that is economically segregated impacts a mother's probability of giving birth very preterm, particularly for non-Hispanic black mothers. However, this association could potentially be mediated by or entirely due to the correlation between racial segregation and economic segregation.

Table of Contents

Introduction...............................................1

Methods.....................................................10

Results.......................................................15

Discussion..................................................21

Future Directions........................................25

Tables 0abc: Demographics and Risk Factors for Mothers with Live Births in MSAs across the U.S. by Quintiles of Economic Segregation .........................................................26

Table 1: Demographics and Risk Factors for Mothers with Infants Born to Very Preterm, Preterm, and Term...................................................................................................29

Tables 2abc: OR of VPT by Segregation Indices Adjusting for Individual Covariates.......................................................................................................................................30

Tables 3abc: Model Results for Economic Segregation and Very Preterm Birth Adjusting for all Individual Covariates and Significant Interaction Terms....................................33

Figures 1abc: OR of VPT for Women in MSAs of High Economic Segregation compared to Women in MSAs of Low Economic Segregation by Maternal Age and Maternal Race/Ethnicity.................36

Figure 2. OR of VPT for Women in MSAs of High Segregation Overall compared to Women in MSAs of Low Segregation Overall by Proportion of Non-Hispanic Black Population in the MSA...............................37

Figure 3. Correlation between Race-Specific Economic Segregation and Overall Economic Segregation across MSAs (n=184)..........................................................................38

References......................39

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Parola chiave	Very Preterm Birth Generalized Estimating Equations Economic Segregation
Committee Chair / Thesis Advisor	Kramer, Michael R, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs CDC

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