Area-level poverty and preterm birth risk: A population-based multilevel analysisReportar como inadecuado

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BMC Public Health

, 8:316

First Online: 15 September 2008Received: 08 March 2008Accepted: 15 September 2008DOI: 10.1186-1471-2458-8-316

Cite this article as: DeFranco, E.A., Lian, M., Muglia, L.J. et al. BMC Public Health 2008 8: 316. doi:10.1186-1471-2458-8-316


BackgroundPreterm birth is a complex disease with etiologic influences from a variety of social, environmental, hormonal, genetic, and other factors. The purpose of this study was to utilize a large population-based birth registry to estimate the independent effect of county-level poverty on preterm birth risk. To accomplish this, we used a multilevel logistic regression approach to account for multiple co-existent individual-level variables and county-level poverty rate.

MethodsPopulation-based study utilizing Missouri-s birth certificate database 1989–1997. We conducted a multilevel logistic regression analysis to estimate the effect of county-level poverty on PTB risk. Of 634,994 births nested within 115 counties in Missouri, two levels were considered. Individual-level variables included demographics factors, prenatal care, health-related behavioral risk factors, and medical risk factors. The area-level variable included the percentage of the population within each county living below the poverty line US census data, 1990. Counties were divided into quartiles of poverty; the first quartile lowest rate of poverty was the reference group.

ResultsPTB < 35 weeks occurred in 24,490 pregnancies 3.9%. The rate of PTB < 35 weeks was 2.8% in counties within the lowest quartile of poverty and increased through the 4 quartile 4.9%, p < 0.0001. High county-level poverty was significantly associated with PTB risk. PTB risk < 35 weeks was increased for women who resided in counties within the highest quartile of poverty, adjusted odds ratio adjOR 1.18 95% CI 1.03, 1.35, with a similar effect at earlier gestational ages < 32 weeks, adjOR 1.27 95% CI 1.06, 1.52.

ConclusionWomen residing in socioeconomically deprived areas are at increased risk of preterm birth, above other underlying risk factors. Although the risk increase is modest, it affects a large number of pregnancies.

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Autor: Emily A DeFranco - Min Lian - Louis J Muglia - Mario Schootman


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