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Public Health/Global Health

Poster Session 2

(518) Association between neighborhood poverty and adverse birth outcomes

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Community-level factors, including neighborhood deprivation, have been associated with adverse birth outcomes. Our objective was to evaluate the association between area poverty and birth outcomes in a large cohort of diverse birthing persons residing in a metropolitan area in the Midwest.

Study Design: This was a retrospective study of birthing persons delivering at one large metropolitan health system, including a large academic medical center and eight community hospitals, from 1/2018-7/2023. The primary exposure was area poverty rate which was identified by matching patient zip codes at delivery hospitalization to the American Community Survey Zip Code Tabulation Area (ZCTA) data. The ZCTA data were coded for percentage of households living at or below the federal poverty level and categorized as < 5%, 5-9.9%, 10-19.9%, or ≥20%. Outcomes included adverse maternal and neonatal outcomes. Multivariable models controlled for sociodemographic and comorbidity differences.

Results: Our cohort included 84,512 deliveries with 48.5% who lived in areas with < 5% poverty, 30.3% who lived in areas with 5-9.9% poverty, 16.4% who lived in areas with 10-19.9% poverty, and 4.7% who lived in areas with ≥20% poverty. Of birthing persons living in areas with the highest poverty rates, 98% delivered at the academic hospital. On adjusted analyses, living in an area with poverty rates ≥20% was significantly associated with increased risk of hypertensive disorders of pregnancy (aIRR 1.33, 95% CI 1.17-1.51), complication after vaginal birth (aOR 1.15, 95% CI 1.03-1.28) and cesarean birth (aIRR 1.16, 95% CI 1.01-1.34), preterm birth (aIRR 1.14, 95% CI 1.01-1.27), low birth weight (aIRR 1.20, 95% CI 1.06-1.36), and admission to the neonatal intensive care unit (aIRR 1.44, 95% CI 1.30-1.60, Table).

Conclusion: Neighborhood poverty was independently associated with adverse maternal and neonatal outcomes, even after accounting for other adverse social determinants of health. Findings are relevant as health systems seek to develop quality initiatives and community interventions to improve outcomes for vulnerable populations.