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BMC Public Health. 2019 Feb 27;19(1):236. doi: 10.1186/s12889-019-6533-7.

Area-level deprivation and preterm birth: results from a national, commercially-insured population.

Author information

1
Yale School of Public Health, PO Box 208034, New Haven, CT, 06520-8034, USA. renee.mehra@yale.edu.
2
Yale School of Public Health, PO Box 208034, New Haven, CT, 06520-8034, USA.
3
Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Boston, MA, 02114, USA.
4
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, PO Box 208063, New Haven, CT, 06520, USA.
5
Health Care Cost Institute, 1100 G Street NW, Suite 600, Washington, DC, 20005, USA.
6
Medtronic, 950 F Street NW, Suite 500, Washington, DC, 20004, USA.
7
Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA.
8
Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
9
Yale-NUS College, 20 College Avenue West #03-401, Singapore, 138529, Singapore.

Abstract

BACKGROUND:

Area-level deprivation is associated with multiple adverse birth outcomes. Few studies have examined the mediating pathways through which area-level deprivation affects these outcomes. The objective of this study was to investigate the association between area-level deprivation and preterm birth, and examine the mediating effects of maternal medical, behavioural, and psychosocial factors.

METHODS:

We conducted a retrospective cohort study using national, commercial health insurance claims data from 2011, obtained from the Health Care Cost Institute. Area-level deprivation was derived from principal components methods using ZIP code-level data. Multilevel structural equation modeling was used to examine mediating effects.

RESULTS:

In total, 138,487 women with a live singleton birth residing in 14,577 ZIP codes throughout the United States were included. Overall, 5.7% of women had a preterm birth. In fully adjusted generalized estimation equation models, compared to women in the lowest quartile of area-level deprivation, odds of preterm birth increased by 9.6% among women in the second highest quartile (odds ratio (OR) 1.096; 95% confidence interval (CI) 1.021, 1.176), by 11.3% in the third highest quartile (OR 1.113; 95% CI 1.035, 1.195), and by 24.9% in the highest quartile (OR 1.249; 95% CI 1.165, 1.339). Hypertension and infection moderately mediated this association.

CONCLUSIONS:

Even among commercially-insured women, area-level deprivation was associated with increased risk of preterm birth. Similar to individual socioeconomic status, area-level deprivation does not have a threshold effect. Implementation of policies to reduce area-level deprivation, and the screening and treatment of maternal mediators may be associated with a lower risk of preterm birth.

KEYWORDS:

Area-level deprivation; Commercially-insured; Mediating pathways; Preterm birth

PMID:
30813938
PMCID:
PMC6391769
DOI:
10.1186/s12889-019-6533-7
[Indexed for MEDLINE]
Free PMC Article

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