(191) Intersectionality of individual- and neighborhood-level adverse social determinants of health in pregnancy

A secondary analysis from the prospective cohort Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be. Participant home addresses in the first trimester were geocoded at the census-tract level. We compared the overlap in frequency of three individual-level adverse SDOH (low income, low education, and Medicaid insurance) with three validated neighborhood-level  adverse SDOH measures (socioeconomic disadvantage per the highest tertile by the 2015 Area Deprivation Index, food desert by the USDA Food Access Research Atlas, and less walkability by the EPA National Walkability Score).

Results: Of 9,588 nulliparous individuals, individual-level adverse SDOH (low income, low education, and Medicaid insurance) were more prevalent among the 6% (406/7,282) of individuals who lived in a neighborhood with all three adverse SDOH (socioeconomic disadvantage, food desert, and less walkability) (low income: 39%; low education: 44%; Medicaid: 55%) compared with the individuals who lived in neighborhoods with either two (43% of the population: low income: 22%; low education: 27%; Medicaid: 37%) or one adverse neighborhood SDOH (51% of the population: low income: 14%; low education: 17%; Medicaid: 27%) (p< 0.001 for all).

Conclusion:

Among nulliparous individuals, individual-level adverse SDOH factors increased in frequency as individuals lived in neighborhoods with a greater number of neighborhood-level adverse SDOH. Approaches that identify both individual- and neighborhood-level adverse SDOH and relate these to pregnancy outcomes are needed.