Birth of a City: Exploring the Impact of Residential Segregation on Preterm Birth Dynamics in Atlanta’s Newest Cities Restricted; Files Only

Abstract

Introduction: Preterm birth, a leading cause of neonatal morbidity and mortality globally, is significantly influenced by various social factors. The cityhood movement in Atlanta has been characterized by the formation of new municipalities from predominantly white, affluent neighborhoods. The study explores how this movement, reflecting modern-day segregation trends, has impacted preterm birth rates across newly formed and pre-existing cities, specifically focusing on racial and socioeconomic disparities.

Objective: To explore the correlation between the cityhood movement and preterm birth rates in newly incorporated vs. pre-existing or unincorporated areas of Atlanta, further examining the role of racial and socioeconomic factors as potential mediators of the relationship.

Methods: Analyzing data from 497,419 live births in DeKalb and Fulton counties in Atlanta from 2000 to 2020, the study used logistic regression models to assess the association between cityhood status and preterm birth. Key variables included city incorporation status, maternal demographics, and insurance coverage, adjusting for confounders and potential interactions.

Results: Significant disparities were observed between the maternal characteristics and preterm birth rates of pre-existing and newly incorporated cities. Newly incorporated cities primarily had births to non-Hispanic White mothers (53.5%), higher private insurance coverage (58.8%) and lower preterm birth rates (10.2%). In contrast, pre-existing or unincorporated areas saw predominantly non-Hispanic Black mothers (49.4%), higher usage of public insurance or no insurance (29.7%, 52.2%), and increased preterm birth rates (12.5%). Unadjusted logistic regression highlighted a 26% higher odds of preterm birth in pre-existing areas (OR: 1.26, 95% CI: 1.22-1.31). Adjustments for maternal age, race, and marital status revealed significant associations, with non-Hispanic Black and Multiracial mothers experiencing higher odds of preterm birth. Further adjustments and inclusion of city-specific fixed effects confirmed these disparities, and an interaction term between cityhood status and maternal age showed nuanced impacts on preterm birth risk.

Conclusion: This study underscores the need to consider the historical context of the cityhood movement, finding that newly incorporated cities exhibit lower pre-term birth rates and are influenced by factors such as race and socioeconomic status. Future research should pursue longitudinal and qualitative studies to further understand how urban restructuring affects health disparities. 

Table of Contents

Table of Contents

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

Background and Literature Review .................................................................................... 1

Preterm Birth ........................................................................................................... 1

Neighborhoods and Health ...................................................................................... 4

Atlanta’s Cityhood Movement ................................................................................ 5

Methods................................................................................................................................ 7

Population ................................................................................................................ 7

Measures .................................................................................................................. 8

Analysis ................................................................................................................... 8

Results ................................................................................................................................. 9

Descriptive Statistics ............................................................................................... 9

Logistic Regression Models .................................................................................... 11

Discussion ........................................................................................................................... 13

    Descriptive Statistics .............................................................................................. 13

Logistic Regression Models ................................................................................... 15

Conclusion .............................................................................................................. 16

References .......................................................................................................................... 19

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology Health Sciences, Public Health
Keyword	Preterm birth Cityhood Residential segregation
Committee Chair / Thesis Advisor	Michael Kramer, Emory University

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