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Health Equity/Community Health

Poster Session 3

(682) Neighborhood, race, or both? Impact on maternal and neonatal adverse outcomes

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective: Area deprivation index (ADI) is a measure that identifies neighborhoods experiencing socioeconomic disadvantage by considering factors independent of race such as income and education. We tested the hypothesis that patients living in deprived neighborhoods are at increased risk of adverse pregnancy outcomes and that this association is modified by race due to exposure to racism.  

Study Design: This is a secondary analysis of a prospective cohort study of singleton pregnancies at our academic center from 2017 to 2020. The parent study excluded non-English speaking patients and IVF pregnancies. The primary outcome for this analysis was composite adverse obstetric outcomes. The secondary outcome was composite neonatal adverse outcomes (Table). These outcomes were compared between patients with low ADI (< 75th percentile, representing affluence/ prosperity) and high ADI (≥75th percentile with cutoff of ADI≥9, adversity/ deprivation). Stratified analysis by race (Black vs. White), and interaction testing of ADI and race were performed.  

Results: Of 1260 birthing people, 1029 had ADI data for analysis. The median ADI for the cohort was 7 (IQR 3-9).  Patients with high ADI were more likely to have composite adverse obstetric outcomes compared to those with lower ADI (aRR 1.17, 95%CI [1.02, 1.33]). There was no difference in composite neonatal adverse outcomes. After stratifying by race, there was no difference in risk of adverse outcomes in Black patients with low ADI vs. Black patients with high ADI. However, the p-value for interaction between race, ADI, and composite adverse obstetric outcome was significant (p=0.001) demonstrating that the association between ADI and adverse outcomes is modified by race, where Black patients are at higher risk than White patients.

Conclusion: More than half of patients living in deprived neighborhoods experience an adverse pregnancy outcome. Race modifies this risk where Black patients in deprived neighborhoods are at higher risk than White patients. Our results suggest that factors other than socioeconomics alone, such as systemic racism, contribute to adverse outcomes.