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

BMC Public Health
Renee MehraJeannette R Ickovics

Abstract

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. 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. 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 ...Continue Reading

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Citations

Feb 7, 2020·Paediatric and Perinatal Epidemiology·Martina A SteurerLaura L Jelliffe-Pawlowski
Jul 3, 2021·International Journal of Environmental Research and Public Health·Allison A AppletonLawrence M Schell
Sep 26, 2021·American Journal of Obstetrics & Gynecology MFM·Stephanie A FisherEmily S Miller

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Methods Mentioned

BETA
cesarean section

Software Mentioned

SAS
Mplus

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