BACKGROUND: Preterm birth is the leading cause of infant death in the U.S., contributing to 35% of infant deaths in 2010. In 2014 the Association of Maternal and Child Health Programs (AMCHP) chose Concentrated Disadvantage (CD) for the top 13 most important indicators for predicting maternal and child health. The goal of this study was to compare CD and Concentrated Poverty (CP) as predictors of preterm birth in Missouri.
METHODS: Birth data was accessed from the Missouri Department of Health and Senior Services vital records, 2007-2009. There were 221,601 live singleton births available. CD was calculated using data from the U.S. Census: American Community Survey, 5-year estimates, 2011, by Missouri zip code. CD was calculated using five variables: poverty, female-headed households, public assistance, unemployment, and children <18. Each zip code was assigned a CD Index Score based on the z-score distribution for all zip codes. CD Index Scores were divided into quartiles (Very Low, Low, High, Very High). A binary logistic regression was used to predict preterm birth.
RESULTS: 24,844 (11.2%) of births were preterm. 64.24% of preterm births occurred in High/Very High CD. The preterm birth rate in areas of Very High CD was 13.84%, and in areas of Very Low CD was 9.34%. The adjusted odds of a woman having a preterm delivery were 13.2% higher in Very High CD, compared to Very Low CD. The adjusted odds of a woman having a preterm delivery were 12.5% higher in High CP, compared to No CP. White women in Very High CD had 8.7% greater odds of preterm birth than those in Very Low CD, and 9.1% greater odds in High CP, compared to No CP. Black women in Very High CD had 25.2% greater odds of preterm birth than those in Very Low CD, and 18.6% greater odds in High CP, compared to No CP.
CONCLUSIONS: CD was a slightly better predictor of preterm birth than CP for all races. CD was a slightly worse predictor than CP for White women, but was a better predictor for Black women. CD attempts to account for the more complex interactions within a community, including economic, social, and community-level factors. AMCHP has designated CD as one of the most important indicators in predicting Maternal and Child Health, and it is important to note that race plays a role in how CD impacts women, and should be considered when recommending this indicator.