83 - The differential impact of neighborhood opportunity on preterm birth among Black women

Poster Number: 83
Publication Number: 83.210

Yarden S. Fraiman, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, United States; Serena A. Rusk, Johns Hopkins School of Public Health, Baltimore, MD, United States; Janet Edwards, Harvard Medical School, boston, MA, United States; Xiaobin Wang, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Jonathan S. Litt, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, United States

Background: Racial and ethnic inequities exist in preterm birth (PTB). Health inequities are due to racism. Neighborhoods are one locus of exposure to structural racism. Prior studies have focused on neighborhood adversity, rather than neighborhood opportunities that can be translated into potential interventions.

Objective: To identify the relationship between neighborhood opportunity and preterm birth within an urban, low-income, longitudinal birth cohort based in Boston, MA.

Design/Methods: Subjects were participants in the Boston Birth Cohort, a case-control study of PTB among high-risk parent-child dyads who delivered live singleton births at Boston Medical Center. Maternal race was self-reported. PTB was defined as delivery < 35 weeks gestational age due to increased health services utilization at < 35 weeks. We matched the 2010 state-normed Child Opportunity Index (COI) to participants’ residential geocode at the time of delivery. Generalized linear mixed effects modeling was used to account for clustering at the census tract. A race x COI interaction term was included to assess the differential impact of neighborhood among subpopulations. We hypothesized that 1) living in lower opportunity neighborhoods would be associated with increased risk of preterm birth and 2) the effect of neighborhood would vary by racial groups.
 

Results: Of the 7980 study participants enrolled from 2000-2018, 4120 (56%) were non-Hispanic Black (NHB), 925 (13%) were non-Hispanic white (NHW), and 2300 (31%) were Hispanic. Among participants, 989 (14%) gave birth at less than 35 weeks GA. NHB women had a higher odds of PTB than NHW women and the overall effect of neighborhood was non-significant. The race x COI interaction term was significant (p = 0.02). In stratified models, NHB women in “Very High” COI neighborhoods had the highest risk of PTB; those living in “Very High” compared to “Very Low” COI neighborhoods had an aOR of PTB at < 35weeks gestation on 2.4 (95% CI: 1.2 – 4.8). This relationship between neighborhood opportunity and PTB was not observed among Hispanic or NHW women.
 Conclusion(s): Contrary to our initial hypothesis, we found that among a high-risk cohort, NHB women in the highest opportunity neighborhoods have an increased odds of PTB. While limited by small samples sizes, these findings may indicate that the potential protective effect of neighborhood opportunity may not be accessible to Black women. Further research is needed to understand potential mechanisms and drivers that explore the racialized impact of the environment on preterm birth.
Table 1. Cohort characteristics
Table 2. Results from overall and stratified models