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The Relation of Neighborhood Racial and Income Polarity to Preterm Birth Rates in Chicago

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Abstract

Objectives

To investigate the extent to which spatial social polarization is associated with preterm birth among urban African-American and non-Latinx white women, and whether prenatal care modifies this relationship.

Methods

We performed multilevel logistic regression analyses on a 2013–2017 dataset of Chicago vital records (N = 29,179) with appended Index of Concentration at the Extremes (ICE) values for race and income.

Results

Women who resided in the bottom ICE quintile neighborhoods had a preterm birth rate of 11.5%, compared to 7.3% for those who live in the top ICE quintile areas; adjusted odds ratio (aOR) equaled 1.72 (95% confidence interval [CI] = 1.39, 2.12). This disparity widened for early (< 34 weeks) preterm birth rates, aOR = 2.60 (1.77, 3.81). These associations persisted among women with adequate prenatal care utilization.

Conclusions for Practice

Spatial polarization of race and income in urban African-American and non-Latinx white women’s residential environment is strongly associated with preterm birth rates, even among those who receive adequate prenatal care. These findings highlight the benefit of using ICE to contextualize the impact of urban neighborhood-level characteristics on preterm birth rates.

Significance

To better understand the social determinants of preterm birth, research efforts have shifted from women’s individual-level characteristics toward their exposure to contextual markers. The Index of Concentration at the Extremes (ICE) is a novel measure of spatial social polarization that quantifies the extremes of both privilege and deprivation. Our population-based study adds to the limited published literature on the relation of ICE to preterm birth rates among African-American and non-Latinx white women. We found that the high degree of both racial and income polarization within communities was associated with preterm birth rates even among those who received adequate prenatal care

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Data Availability

The maternal-infant raw data used for this study is not deidentified. The raw data is therefore protected on-site within the City of Chicago Department of Health, requiring clearance to access and analyze.

Code Availability

The code, processed using Statistical Analytic Systems software, is also protected on-site within the City of Chicago Department of Health, requiring clearance to access and analyze.

References

  • Aaronson, D., Hartley, D., & Mazumder, B. (2017). The effects of the 1930s HOLC “Redlining” maps. Chicago: Federal Reserve Bank of Chicago.

    Google Scholar 

  • Bailey, Z. D., Krieger, N., Agenor, M., Graves, J., Linos, N., & Bassett, M. T. (2017). Structural racism and health inequities in the USA: Evidence and interventions. Lancet, 389(10077), 1453–1463.

    Article  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention. (2013). CDC Health Disparities & Inequalities Report, 2013. MMWR Surveil Summ, 62(3), 1–187.

    Google Scholar 

  • Chambers, B. D., Baer, R. J., McLemore, M. R., & Jelliffe-Pawlowski, L. L. (2019). Using Index of Concentration at the Extremes as indicators of structural racism to evaluate the association with preterm birth and infant mortality – California, 2011–2012. Journal of Urban Health, 96(2), 159–170.

    Article  PubMed  Google Scholar 

  • Collins, J. W., & David, R. J. (2009). Racial disparity in low birth weight and infant mortality. Clinics in Perinatology, 36(1), 63–73.

    Article  PubMed  Google Scholar 

  • Collins, J. W., Mariani, A., & Rankin, K. M. (2018). African-American women’s upward economic mobility and small for gestational age births: A population-based study. Maternal and Child Health Journal, 22(8), 1183–1189.

    Article  PubMed  Google Scholar 

  • Collins, J. W., Rankin, K. M., & David, R. J. (2011). African-American women’s upward economic mobility and preterm birth: The effect of fetal programming. American Journal of Public Health, 101(4), 714–719.

    Article  PubMed  PubMed Central  Google Scholar 

  • Collins, J. W., Rankin, K. M., & David, R. J. (2015). Downward economic mobility and preterm birth: An exploratory study of Chicago-born upper class white mothers. Maternal and Child Health Journal, 19(7), 1601–1607.

    Article  PubMed  Google Scholar 

  • Collins, J. W., Wall, S. N., & David, R. J. (1997). Adequacy of prenatal care utilization, maternal ethnicity, and infant birthweight in Chicago. Journal of the National Medical Association, 89(3), 198–203.

    PubMed  PubMed Central  Google Scholar 

  • Cox, R. G., Zhang, L., Zotti, M. E., & Graham, J. (2011). Prenatal care utilization in Mississippi: Racial disparities and implications for unfavorable birth outcomes. Maternal and Child Health Journal, 15(7), 931–942.

    Article  PubMed  Google Scholar 

  • De Smith, M., Goodchild, M. F., & Longley, P. (2006). Geospatial Analysis: A Comprehensive Guide (2nd ed.). Troubador Publishing Ltd.

    Google Scholar 

  • DeFranco, E. A., Lian, M., Muglia, L. J., & Schootman, M. (2008). Area-level poverty and preterm birth risk: A population-based multilevel analysis. BMC Public Health, 8(316), 1–9.

    Google Scholar 

  • Dwyer, R. E. (2010). Poverty, prosperity, and place: The shape of class segregation in the age of extremes. Social Problems, 57, 114–137.

    Article  Google Scholar 

  • Fisher, G. M. (1992). The development and history of the poverty thresholds. Social Security Bulletin, 55(4), 3–14.

    CAS  PubMed  Google Scholar 

  • Huynh, M., Spasojevic, J., Li, W., Maduro, G., Van Wye, G., Waterman, P. D., & Krieger, N. (2018). Spatial social polarization and birth outcomes: Preterm birth and infant mortality – New York City, 2010–14. Scand J Public Health, 46(1), 157–166.

    Article  CAS  PubMed  Google Scholar 

  • Khanani, I., Elam, J., Hearn, R., Jones, C., & Maseru, N. (2010). The impact of prenatal WIC participation on infant mortality and racial disparities. American Journal of Public Health, 100(Suppl 1), S204–S209.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kollmann, T., Marsiglio, S., & Suardi, S. (2018). Racial segregation in the United States since the Great Depression: A dynamic segregation approach. Journal of Housing Economics, 40, 95–116.

    Article  Google Scholar 

  • Kotelchuck, M. (1994). An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. American Journal of Public Health, 84(9), 1414–1420.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kramer, M. S., Demissie, K., Yang, H., Platt, R. W., Sauve, R., & Liston, R. (2000). The contribution of mild and moderate preterm birth to infant mortality. JAMA, 284(7), 843–849.

    Article  CAS  PubMed  Google Scholar 

  • Krieger, N., Waterman, P. D., Spasojevic, J., Li, W., Maduro, G., & Van Wye, G. (2016). Public health monitoring of privilege and deprivation with the Index of Concentration at the Extremes. American Journal of Public Health, 106(2), 256–263.

    Article  PubMed  PubMed Central  Google Scholar 

  • Magowan, B. A., Bain, M., Juszczak, E., & McInneny, K. (2005). Neonatal mortality amongst Scottish preterm singleton births (1985–1994). BJOG, 105(9), 1005–1010.

    Article  Google Scholar 

  • Maldonado, G., & Greenland, S. (1993). Simulation study of confounder-selection strategies. American Journal of Epidemiology, 138(11), 923–936.

    Article  CAS  PubMed  Google Scholar 

  • Martin, J. A., Hamilton, B. E., & Osterman, M. J. K. (2017). Birth in the United States, 2016. NCHS Data Brief, 287, 1–8.

    Google Scholar 

  • Massey, D. S. (1996). The age of extremes: Concentrated affluence and poverty in the twenty-first century. Demography, 33(4), 395–412.

    Article  CAS  PubMed  Google Scholar 

  • Massey, D. S., & Denton, N. A. (1988). The dimensions of residential segregation. Social Forces, 67, 281–315.

    Article  Google Scholar 

  • Matoba, N., Suprenant, S., Rankin, K., Yu, H., & Collins, J. W. (2019). Mortgage discrimination and preterm birth among African American women: An exploratory study. Health & Place, 59, 1–7.

    Article  Google Scholar 

  • Mendez, D. D., Hogan, V. K., & Culhane, J. (2011). Institutional racism and pregnancy health: Using Home Mortgage Disclosure Act data to develop an index for mortgage discrimination at the community level. Public Health Reports, 126(Suppl. 3), 102–114.

    Article  PubMed  PubMed Central  Google Scholar 

  • Murphy, S. L., Xu, J., Kochanek, K. D., Curtin, S. C., & Arias, E. (2017). Deaths: Final data for 2015. National Vital Statistics Reports, 66(6), 1–75.

    PubMed  Google Scholar 

  • O’Connor, A. (2001). Poverty Knowledge: Social Science, Social Policy, and the Poor in Twentieth-Century US History. Princeton University Press.

    Book  Google Scholar 

  • Phillips, G. S., Wise, L. A., Rich-Edwards, J. W., Stampfer, M. J., & Rosenberg, L. (2009). Income incongruity, relative household income, and preterm birth in the Black Women’s Health Study. Social Science and Medicine, 68(12), 2122–2128.

    Article  PubMed  Google Scholar 

  • Reiff, J. L., Durkin, K. A., & Grossman, J. R. (Eds.). (2005). Redlining. In Encyclopedia of Chicago. Chicago Historical Society.

    Google Scholar 

  • Shrimali, B. P., Pearl, M., Karasek, D., Reid, C., Abrams, B., & Mujahid, M. (2020). Neighborhood privilege, preterm delivery, and related racial/ethnic disparities: An intergenerational application of the Index of Concentration at the Extremes. American Journal of Epidemiology, 189(5), 412–421.

    Article  PubMed  Google Scholar 

  • VanderWeele, T. J., Lantos, J. D., Siddique, J., & Lauderdale, D. S. (2009). A comparison of four prenatal care indices in birth outcome models: Comparable results for predicting small-for-gestational-age outcome but different results for preterm birth or infant mortality. Journal of Clinical Epidemiology, 62(4), 438–445.

    Article  PubMed  Google Scholar 

  • Walks, A. (2013). From financialization to sociospatial polarization of the city? Evidence from Canada. Econ Geogr, 90(1), 33–66.

    Article  Google Scholar 

  • Whitworth, M., Quenby, S., Cockerill, R. O., & Dowswell, T. (2011). Specialised antenatal clincis for women with a pregnancy at high risk of preterm birth (excluding multiple pregnancy) to improve maternal and infant outcomes. Cochrane Database Systematic Review. https://doi.org/10.1002/14651858.CD006760

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, Nemours Children’s Hospital, 6535 Nemours Parkway, Orlando, FL, 32827, USA

    Aaron J. Weiss

  2. City of Chicago, Department of Public Health, Epidemiology, Chicago, IL, USA

    Margarita Reina & Nik Prachand

  3. Department of Pediatrics, Division of Neonatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Aaron J. Weiss, Nana Matoba & James W. Collins Jr.

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  1. Aaron J. Weiss
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  2. Margarita Reina
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  3. Nana Matoba
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  4. Nik Prachand
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  5. James W. Collins Jr.
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Contributions

Aaron Weiss was responsible for developing the research idea, creating the Index of Concentration at the Extremes (ICE) quintiles, and linking that dataset with Chicago vital records. Using SAS software, he created multilevel logistic regression models to assess the relationship between preterm birth and ICE quintiles. He was the primary author of the manuscript, including the tables and figures. Margarita Reina was responsible for creating the ICE-specific census tract maps of Chicago with ArcGIS and assisted with SAS programming. Nana Matoba assisted with the regression analysis and edited the manuscript. Nik Prachand helped develop the research idea and created/organized the vital records. James Collins was the primary mentor for this project. He assisted with developing the research idea, creating the project timeline, and edited the manuscript.

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Correspondence to Aaron J. Weiss.

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The authors declare that they have no conflicts of interest.

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This study qualified as exempt per the Institutional Review Board at the Ann & Robert H. Lurie Children’s Hospital of Chicago.

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Weiss, A.J., Reina, M., Matoba, N. et al. The Relation of Neighborhood Racial and Income Polarity to Preterm Birth Rates in Chicago. Matern Child Health J 27, 556–565 (2023). https://doi.org/10.1007/s10995-023-03608-5

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