Understanding racial disparities in low birthweight in Pittsburgh, PA: The role of area-level socioeconomic position and individual-level factors

Background: Low birthweight (LBW, <2500g) is a leading cause of infant mortality and differences exist between Blacks and Whites. About 11% of births in Pittsburgh in 2003 were LBW, and the racial differences were wide: 8.4% of LBW infants were born to Whites, whereas 16.0% were born to Blacks. Studies suggest that lower levels of area-level socioeconomic position (SEP) are associated with increased LBW risk.

Objectives: The main research hypothesis tests whether 1) area-level SEP predicts LBW and 2) LBW differences between Blacks and Whites can be explained by area-level SEP. Methods: Using U.S. Census 2000 data, an SEP measure of neighborhood disadvantage (ND) was created for Pittsburgh. LBW, race and other covariates from 10,830 birth records were obtained from the 2003-2006 Allegheny County birth registry. Multilevel logistic regression was utilized to examine how SEP predicts LBW.

Preliminary Results: ND is significantly associated with LBW (OR: 1.31, p<0.001). In addition Blacks are at higher risk for LBW than Whites (OR: 2.12, p<0.001), but the risk decreases for Blacks after adding ND to the model (OR:1.92, p<0.001). 74% of Blacks reside in disadvantaged neighborhoods, compared to 13% of Whites.

Conclusions: An association between ND and LBW exists in Pittsburgh and differences between Blacks and Whites can be partially explained by differences in ND. Public Health Implications: In the absence of individual-level information, knowing one's race and neighborhood may help predict one's risk for LBW. Targeting highly disadvantaged neighborhoods may help reduce LBW in Pittsburgh.