Madden Nigel, Kanugula Samanvi, Yee Lynn M, Rydland Kelsey, Feinglass Joe
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and the Program in Public Health, the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern Library Geospatial and Data Services, and the Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Obstet Gynecol. 2025 Feb 1;145(2):231-240. doi: 10.1097/AOG.0000000000005809. Epub 2024 Dec 12.
To evaluate the association between area poverty and adverse birth outcomes in the diverse birthing population of a large health system.
This was a retrospective cohort study using electronic health record and hospital administrative data for pregnant people at nine hospitals within a large health system in the Chicago metropolitan area from 2018 to 2023. Patient addresses were geocoded and categorized by Census tract area percent poor households. Unadjusted and adjusted Poisson regression models, controlling for individual-level risk factors, evaluated the independent association between area poverty and birth outcomes to determine the degree to which this association is attenuated by the inclusion of individual-level factors in the model.
The study included 85,025 pregnant people. Area poverty was associated with sociodemographic factors, including young age, non-Hispanic Black race, Hispanic ethnicity, Medicaid insurance coverage, higher parity, and several comorbid conditions. Area poverty was associated with adverse birth outcomes and demonstrated a gradient effect with increasing area poverty in bivariable analyses. In unadjusted regression analyses, residence in areas with 5.0% or more poverty was associated with severe maternal morbidity, preterm birth, and low birth weight, and residence in areas with 8.0% or higher poverty was associated with neonatal intensive care unit admission. Although these associations persisted in multivariable analysis for severe maternal morbidity and neonatal intensive care unit admission, the associations with preterm birth and low birth weight persisted only for individuals residing in areas of 12.0% or higher poverty when controlling for individual-level risk factors.
Area poverty was associated with adverse birth outcomes in this birthing population even when controlling for individual-level risk factors, highlighting the need for system- and community-level quality-improvement interventions.
评估在一个大型医疗系统中不同分娩人群的地区贫困与不良分娩结局之间的关联。
这是一项回顾性队列研究，使用了2018年至2023年芝加哥大都市地区一个大型医疗系统内九家医院的孕妇电子健康记录和医院管理数据。对患者地址进行地理编码，并按人口普查区贫困家庭百分比进行分类。未调整和调整后的泊松回归模型，在控制个体层面风险因素的情况下，评估地区贫困与分娩结局之间的独立关联，以确定在模型中纳入个体层面因素后这种关联减弱的程度。
该研究纳入了85,025名孕妇。地区贫困与社会人口学因素相关，包括年轻、非西班牙裔黑人种族、西班牙裔族裔、医疗补助保险覆盖、较高的产次以及几种合并症。地区贫困与不良分娩结局相关，并且在双变量分析中显示出随着地区贫困程度增加的梯度效应。在未调整的回归分析中，居住在贫困率为5.0%或更高地区与严重孕产妇发病、早产和低出生体重相关，居住在贫困率为8.0%或更高地区与新生儿重症监护病房入院相关。尽管这些关联在严重孕产妇发病和新生儿重症监护病房入院的多变量分析中仍然存在，但在控制个体层面风险因素时，与早产和低出生体重的关联仅在居住在贫困率为12.0%或更高地区的个体中持续存在。
即使在控制个体层面风险因素的情况下，地区贫困在该分娩人群中仍与不良分娩结局相关，这凸显了系统和社区层面质量改进干预措施的必要性。
