Online Program

Neighborhood poverty and preterm birth revisited: Comparing cross-sectional measures to longitudinal poverty trajectories

Monday, November 4, 2013 : 10:50 a.m. - 11:10 a.m.

Claire Margerison-Zilko, PhD, Center for Social Work Research; Population Research Center, University of Texas at Austin, Austin, TX
Catherine Cubbin, PhD, School of Social Work, The University of Texas at Austin, Austin, TX
Jina Jun, MA, School of Social Work, University of Texas, Austin, TX
Kristen Marchi, MPH, Family and Community Medicine, University of California, San Francisco, San Francisco, CA
Kathryn R. Martin, MPH, PhD, Maternal, Child and Adolescent Health Division, California Department of Public Health, Sacramento, CA
Michael P. Curtis, PhD, Maternal, Child and Adolescent Health Division, California Department of Public Health, Sacramento, CA
Paula Braveman, MD, MPH, Department of Community and Family Medicine, University of California, San Francisco, San Francisco, CA

Background. Neighborhood poverty is associated with increased risk of preterm birth (PTB); however, most of this research uses cross-sectional measures of neighborhood poverty. We hypothesize that the longitudinal poverty experience of a neighborhood may influence factors important to perinatal health such as psychosocial stress or access to health-promoting resources. Our objective was to compare the associations between neighborhood poverty and PTB using both cross-sectional and longitudinal measures of poverty.

Methods. We categorized California neighborhoods (i.e., census tracts) as having low (<5% poor), moderate (5-20% poor), or high (>20% poor) cross-sectional poverty based on data from the American Community Survey 2005-2009 (ACS). We then estimated longitudinal poverty trajectories from 1970-2009 using data from the ACS and the Neighborhood Change Database using three methods: a priori categorization, latent class growth modeling, and non-parametric clustering. We used logistic regression to estimate associations between neighborhood poverty measures and PTB for 24,394 women in the Maternal and Infant Health Assessment who gave birth between 2003-2009.

Results. High (compared to low) neighborhood poverty based on cross-sectional data was not associated with PTB after adjustment for individual-level demographic and socioeconomic factors (OR=1.03, 95% CI=0.88,1.21) . However, trajectories characterized by long-term high (compared to long-term low) neighborhood poverty were associated with 30-40 percent increases in odds of PTB in fully adjusted models (e.g., OR=1.39, 95% CI=1.17, 1.64), regardless of method used to estimate trajectories.

Conclusions. The longitudinal poverty experience of neighborhoods may be more strongly associated with factors influencing birth outcomes compared to cross-sectional measures of poverty.

Learning Areas:

Social and behavioral sciences

Learning Objectives:
Compare methods for assessing longitudinal trajectories of neighborhood poverty. Examine associations between neighborhood poverty (measured using both cross-sectional and longitudinal data) and preterm birth. Discuss the potential implications of using longitudinal data to measure trajectories of neighborhood poverty with respect to birth outcomes.

Keyword(s): Birth Outcomes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have a PhD in epidemiology and have been studying neighborhood characteristics and health for five years as a doctoral student and post-doc.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.