The joint influence of area income, income inequality, and immigrant density on adverse birth outcomes: a population-based studyReport as inadecuate

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BMC Public Health

, 9:237

First Online: 14 July 2009Received: 16 January 2009Accepted: 14 July 2009DOI: 10.1186-1471-2458-9-237

Cite this article as: Auger, N., Giraud, J. & Daniel, M. BMC Public Health 2009 9: 237. doi:10.1186-1471-2458-9-237


BackgroundThe association between area characteristics and birth outcomes is modified by race. Whether such associations vary according to social class indicators beyond race has not been assessed.

MethodsThis study evaluated effect modification by maternal birthplace and education of the relationship between neighbourhood characteristics and birth outcomes of newborns from 1999–2003 in the province of Québec, Canada N = 353,120 births. Areas N = 143 were defined as administrative local health service delivery districts. Multi-level logistic regression was used to model the association between three area characteristics median household income, immigrant density and income inequality and the two outcomes preterm birth PTB and small-for-gestational age SGA birth. Effect modification by social class indicators was evaluated in analyses stratified according to maternal birthplace and education.

ResultsRelative to the lowest tertile, high median household income was associated with SGA birth among Canadian-born mothers odds ratio OR 1.13, 95% confidence interval CI 1.06, 1.20 and mothers with high school education or less OR 1.13, 95% CI 1.02, 1.24. Associations between median household income and PTB were weaker. Relative to the highest tertile, low immigrant density was associated with a lower odds of PTB among foreign-born mothers OR 0.79, 95% CI 0.63, 1.00 but a higher odds of PTB among Canadian-born mothers OR 1.14, 95% CI 1.07, 1.21. Associations with income inequality were weak or absent.

ConclusionThe association between area factors and birth outcomes is modified by maternal birthplace and education. Studies have found that race interacts in a similar manner. Public health policies focussed on perinatal health must consider the interaction between individual and area characteristics.

AbbreviationsCLSClocal community service center

CVcoefficient of variation

GEEgeneralized estimating equations

PTBpreterm birth

SGAsmall-for-gestational age.

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Author: Nathalie Auger - Julie Giraud - Mark Daniel


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