Parra Kimberly L, Farland Leslie V, Harris Robin B, Toro Matthew, Furlong Melissa
Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.
Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA.
Paediatr Perinat Epidemiol. 2025 May;39(4):336-345. doi: 10.1111/ppe.13146. Epub 2024 Dec 4.
The maternal population residing in rural areas, tribal lands or near the United States-Mexico border are at high risk for adverse pregnancy complications, notably gestational diabetes mellitus (GDM). Few studies have considered the socioeconomic status (SES) attributes of neighbourhoods on maternal health during gestation. Given that the national and global rate of GDM is rising, this analysis moves beyond individual-level factors and investigates the role of neighbourhood deprivation on GDM risk.
To investigate the relationship between neighbourhood deprivation and risk of GDM using Arizona state birth records.
This population-based study of singleton live births (N = 481,113) utilised birth certificates from 2014 to 2020 from the AzPEARS study. Using American Community Survey (5-year data) linked to 2010 US Census tracts, a composite neighbourhood deprivation index (NDI) score (continuous and quartiles) was derived from 8 socioeconomic indicators. Risk ratios (RR) and 95% confidence intervals (95% CI) were used to examine the association between NDI and GDM risk, adjusting for maternal age, maternal education, race/ethnicity, parity, rurality, and birth year.
The state-wide incidence of GDM was 7.8% (n = 37,636) with variation by neighbourhoods (4% to 12%). GDM risk was highest for Native Americans (17.6%), Asian/Pacific Islanders (13.7%) and Hispanic/Latinas (8.3%). Compared to mothers living in areas with the lowest quartile of NDI, mothers living in neighbourhoods with the highest deprivation had an adjusted risk ratio of 1.21 for developing GDM (95% CI 1.18, 1.26).
We observed that neighbourhood deprivation was positively associated with a higher risk of GDM for each increase in quartile. These results suggest that NDI, a proxy for neighbourhood socioeconomic status, may contribute to GDM risk. Identifying high-risk neighbourhoods for place-based interventions targeting the most vulnerable birthing populations may be an effective strategy in the prevention of GDM.
居住在农村地区、部落土地或美国与墨西哥边境附近的孕产妇群体面临不良妊娠并发症的高风险，尤其是妊娠期糖尿病（GDM）。很少有研究考虑过邻里社区的社会经济地位（SES）属性对孕期孕产妇健康的影响。鉴于全球和美国国内GDM的发病率都在上升，本分析超越了个体层面的因素，研究了邻里社区贫困程度对GDM风险的作用。
利用亚利桑那州的出生记录，研究邻里社区贫困程度与GDM风险之间的关系。
这项基于人群的单胎活产研究（N = 481,113）使用了AzPEARS研究中2014年至2020年的出生证明。利用与2010年美国人口普查区相关联的美国社区调查（5年数据），从8个社会经济指标中得出了一个综合邻里社区贫困指数（NDI）得分（连续得分和四分位数）。风险比（RR）和95%置信区间（95%CI）用于检验NDI与GDM风险之间的关联，并对孕产妇年龄、孕产妇教育程度、种族/族裔、产次、农村地区和出生年份进行了调整。
全州GDM的发病率为7.8%（n = 37,636），各邻里社区之间存在差异（4%至12%）。美国原住民（17.6%）、亚裔/太平洋岛民（13.7%）和西班牙裔/拉丁裔（8.3%）的GDM风险最高。与居住在NDI四分位数最低地区的母亲相比，居住在贫困程度最高邻里社区的母亲患GDM的调整后风险比为1.21（95%CI 1.18，1.26）。
我们观察到，随着四分位数的每一次增加，邻里社区贫困程度与更高的GDM风险呈正相关。这些结果表明，作为邻里社区社会经济地位指标的NDI可能会导致GDM风险。识别针对最脆弱分娩人群的基于地点的干预措施的高风险邻里社区，可能是预防GDM的有效策略。
