Gao Xing, Mujahid Mahasin S, Nuru-Jeter Amani M, Morello-Frosch Rachel
Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA, USA.
J Urban Health. 2024 Dec;101(6):1143-1154. doi: 10.1007/s11524-024-00902-7. Epub 2024 Sep 27.
Evidence has documented the effects of place on perinatal outcomes, but less is known about the sociopolitical mechanisms, such as gentrification, that shape neighborhood context and produce spatialized inequities in adverse birth outcomes. Leveraging a diverse sample in California, we assessed the associations between gentrification and birth outcomes: preterm birth, small-for-gestational-age, and low birth weight. Gentrification was measured using the Freeman method and the Displacement and Gentrification Typology. Descriptive analysis assessed outcome prevalence and race and ethnicity distribution by exposure and participant characteristics. Overall and race and ethnicity-stratified mixed effects logistic models examined associations between gentrification and birth outcomes, sequentially adjusting for sociodemographic status and pregnancy factors, with a random intercept to account for clustering by census tract. In a sample of 5,116,131 births, outcome prevalence ranged from 1.0% for very preterm birth, 5.0% for low birth weight, 7.9% for preterm birth, and 9.4% for small-for-gestational-age. Adjusting for individual-level factors, gentrification was associated with increased odds of preterm birth (Freeman OR = 1.09, 95% CI 1.07-1.10; Displacement and Gentrification Typology OR = 1.11, 95% CI 1.09-1.13). While Displacement and Gentrification Typology-measured gentrification was consistently associated with greater odds of adverse outcomes, Freeman-measured gentrification was associated with slightly lower odds of small-for-gestational-age and low birth weight. Furthermore, gentrification was associated with birth outcome odds across multiple racial and ethnic groups, but the directions and magnitudes of the associations varied depending on the gentrification assessment methodology and the outcome assessed. Results demonstrate that gentrification plays a role in shaping adverse birth outcomes in California.
有证据记录了居住地点对围产期结局的影响，但对于诸如中产阶级化等塑造邻里环境并在不良出生结局中产生空间不平等的社会政治机制，我们了解得较少。利用加利福尼亚州的多样化样本，我们评估了中产阶级化与出生结局之间的关联：早产、小于胎龄儿和低出生体重。中产阶级化采用弗里曼方法以及流离失所和中产阶级化类型学进行衡量。描述性分析按暴露情况和参与者特征评估结局患病率以及种族和民族分布。总体以及按种族和民族分层的混合效应逻辑模型检验了中产阶级化与出生结局之间的关联，依次对社会人口学状况和妊娠因素进行调整，并采用随机截距以考虑按普查区聚类的情况。在5116131例出生样本中，结局患病率范围为：极早产1.0%、低出生体重5.0%、早产7.9%、小于胎龄儿9.4%。对个体层面因素进行调整后，中产阶级化与早产几率增加相关（弗里曼比值比=1.09，95%置信区间1.07 - 1.10；流离失所和中产阶级化类型学比值比=1.11，95%置信区间1.09 - 1.13）。虽然采用流离失所和中产阶级化类型学衡量的中产阶级化始终与不良结局几率增加相关，但采用弗里曼方法衡量的中产阶级化与小于胎龄儿和低出生体重几率略低相关。此外，中产阶级化与多个种族和民族群体的出生结局几率相关，但关联的方向和程度因中产阶级化评估方法和所评估的结局而异。结果表明，中产阶级化在塑造加利福尼亚州的不良出生结局方面发挥了作用。
