Abstract
Purpose
To evaluate whether ZIP-code level neighborhood socioeconomic status (SES) is associated with adverse pregnancy outcomes.
Methods
A retrospective study of 2009–2014 Oregon Health and Science University (OHSU) births with maternal ZIP codes in one of 89 Portland metropolitan area ZIP codes. Deliveries with ZIP codes outside of the Portland metro area were excluded. Deliveries were stratified by SES based on ZIP code median household income: low (below 10th percentile), medium (11th–89th percentile), and high (above 90th percentile). Univariate analysis and multivariable logistic regression with medium SES as the reference group evaluated perinatal outcomes and strength of association between SES and adverse events.
Results
This study included 8118 deliveries with 1654 (20%) classified as low SES, 5856 (72%) medium SES, and 608 (8%) high SES. The low SES group was more likely to be younger, have a higher maternal BMI, have increased tobacco use, identify as Hispanic or Black, and less likely to have private insurance. Low SES was associated with a significantly increased risk of preeclampsia (RR 1.23 95% CI 1.01–1.49), but this was no longer significant after adjusting for confounders (aRR 1.23 95% CI .971–1.55). High SES was negatively associated with gestational diabetes mellitus (GDM), even after adjusting for confounders (aRR 0.710, 95% CI 0.507–0.995).
Conclusion
In the Portland metropolitan area, high SES was associated with a lower risk of GDM. Low SES was associated with a higher risk of preeclampsia before accounting for covariates. ZIP code-based risk assessment may be a useful indicator in detecting healthcare disparities.
Significance
Low socioeconomic status (SES) is associated with adverse pregnancy outcomes. However, literature exploring neighborhood SES and pregnancy outcomes, particularly using Neighborhood Socioeconomic Status and Perinatal Outcomes ZIP code as a SES surrogate, is limited. Our study suggests that even within a single metropolitan area living in a ZIP-code in the lowest 10th percentile SES is associated with preeclampsia. However, this association is no longer significant after adjusting for confounders such as BMI and tobacco use, suggesting these lifestyle factors may be playing a role in preeclampsia in low SES populations. Understanding this relationship may help guide counseling for this vulnerable population.
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Data Availability (data transparency)
Data was abstracted from patient EHR and is managed in a departmental RedCap database.
Code Availability (software application or custom code)
The code used for statistical analysis in STATA was written by Dr. Amy Valent.
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Acknowledgements
The authors would like to thank Brandon Sawyer for assistance with acquisition of Portland, OR Census data.
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Study design and data collection were performed by Deepraj Pawar, Minhazur Sarker and Amy Valent. The first draft of the manuscript was written by Deepraj Pawar and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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This work was accepted as an abstract and presented as a poster at American College of Obstetricians and Gynecologists Virtual Conference on October 30–31, 2020 Acknowledgements: The authors would like to thank Brandon Sawyer for assistance with acquisition of Portland, OR Census data.
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Pawar, D.K., Sarker, M., Caughey, A.B. et al. Influence of Neighborhood Socioeconomic Status on Adverse Outcomes in Pregnancy. Matern Child Health J 27, 1401–1406 (2023). https://doi.org/10.1007/s10995-023-03701-9
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DOI: https://doi.org/10.1007/s10995-023-03701-9