Upward or Downward Mobility: Longitudinal residential trajectories and risk for preterm birth Open Access

Abstract

Background: Many studies have been conducted on the potential effect of neighborhood deprivation on preterm birth and how this effect varies throughout the life-course. Most of these have been cross-sectional. We investigated the preterm birth risk associated with moving to a lower or higher deprivation neighborhood compared to staying in the same neighborhood through a longitudinal study design. We hypothesized that a decrease in deprivation exposure through upward mobility would be associated with reduced preterm birth risk while an increase in deprivation through downward mobility would result in increased risk.

Methods: A retrospective cohort was constructed through linking sibling birth records to 170,865 mothers living in the Atlanta area between 1994 and 2007. The residential addresses were geo-coded and linked to Census measures of neighborhood deprivation, creating a partial adult exposure history preceding the second birth. Fixed-effects multi-level regression modeling was performed to draw comparisons between women who shared a neighborhood at the baseline measurement.

Results: Moving to a lower deprivation neighborhood was associated with a decrease in preterm birth risk (OR=0.93, 95% confidence interval 0.88, 0.98) while moving to a higher deprivation neighborhood was associated with an increase in preterm birth risk (OR=1.15, 95%CI 1.09, 1.21), controlling for maternal race, education, and age. The magnitudes of the associations depended on maternal age at baseline, the time between baseline and follow-up births, and the preterm status of the baseline birth. Null associations between mobility trajectories and baseline preterm birth were found, providing some evidence that selection factors alone do not account for the association between neighborhood deprivation and preterm birth.

Conclusions: Longitudinal measures of residential mobility and consequent changes in deprivation lend support to a causal association between neighborhood deprivation and preterm birth. Residential mobility trajectories are a tool to improve our understanding of neighborhood effects throughout the life-course.

Table of Contents

Table of Contents

Introduction.................................................4

Theory and Conceptual Models........................9

Literature Review........................................17

Methods....................................................37
Results......................................................58 Discussion..................................................86 Reference.................................................104

Appendix A: Modeling Process.......................123

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
Keyword	Preterm birth Social mobility Neighborhood effects Neighborhood deprivation Residential mobility
Committee Chair / Thesis Advisor	Kramer, Michael R, Emory University
Partnering Agencies	Georgia state or local health department

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