Preterm Birth in the Context of Increasing Income Inequality

Abstract

Objective Preterm birth is a leading cause of infant morbidity and mortality. Little is known about the contextual effect of US income inequality on preterm birth, an issue of increasing concern given that the current economic divide is the largest since 1928. Methods We examined changes in inequality over time in relation to preterm birth among singleton deliveries from an electronic medical record-based cohort (n = 223,512) conducted in 11 US states and the District of Columbia from 2002 to 2008. Increasing income inequality was defined as a positive change in state-level Gini coefficient from the year prior to birth. Multi-level models estimated the independent effect of increasing inequality on preterm birth (>22 and <37 weeks) controlling for maternal demographics, health behaviors, insurance status, chronic medical conditions, and state-level poverty and unemployment during the year of birth. Results The preterm birth rate was 12.3 % where inequality increased and 10.9 % where it did not. After adjustment, increasing inequality remained significantly associated with preterm birth (adjusted odds ratio 1.07, 95 % confidence interval 1.04, 1.11). We observed no significant interaction by insurance status or race, suggesting that increasing inequality had a broad effect across the population. Conclusions The contextual effect of increasing income inequality on preterm birth risk merits further study.

Epidemiology of late preterm and early term births – An international perspective

“…The relationship between social disadvantage and preterm birth is observed across diverse contexts, including European countries with strong social welfare systems [47]. The most recent US findings relate national income inequality to preterm birth time trends [48]. Research on associations of sociodemographic risk factors with early term birth are lacking, but a French study found many similar determinants including short stature, a low level of education, and foreign origin (for other European and Sub-Saharan nationals), although the impact of risk factors was greater for preterm than for early term births [43].…”

Decomposition of socioeconomic inequalities in preterm deliveries in Tehran, Iran

“…3,4 Socioeconomic status is a well-established factor associated with morbidity and mortality; for most health outcomes, the poor have worse outcomes compared with those of higher socioeconomic status. 5 Such an association has also been established for preterm delivery at the community level; however, it is less understood at the household and individual levels. 6,7 A plethora of studies [8][9][10] have demonstrated socioeconomic inequalities in congenital anomalies, low delivery weight, and infant mortality.…”

Hospital care for viral gastroenteritis in socio‐economic and geographical context in Sweden 2006–2013

“…This vaccination has a potential to be particularly important for children with young parents with a short education. Previous studies, however, have shown that vaccines do not always reach the population groups that need them the most . Further studies are needed to investigate how the introduction of this vaccination changes the patterns of socio‐demographic risk factors for hospital admissions.…”