The joint influence of area income, income inequality, and immigrant density on adverse birth outcomes: A population-based study

Nathalie Auger, Julie Giraud, Mark Daniel

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Background. The 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. Methods. This study evaluated effect modification by maternal birthplace and education of the relationship between neighbourhood characteristics and birth outcomes of newborns from 19992003 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. Results. Relative 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. Conclusion. The 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.

Original languageEnglish
Pages (from-to)1-11
Number of pages11
JournalBMC Public Health
Volume9
Issue number237
DOIs
Publication statusPublished - 2009
Externally publishedYes

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Joints
Mothers
Parturition
Premature Birth
Population
Odds Ratio
Confidence Intervals
Education
Social Class
Gestational Age
Public Policy
Health Policy
Health Services
Canada
Public Health
Logistic Models
Newborn Infant
Health

Cite this

@article{c6fb5d884b604c4a8f92d02aa1f35e45,
title = "The joint influence of area income, income inequality, and immigrant density on adverse birth outcomes: A population-based study",
abstract = "Background. The 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. Methods. This study evaluated effect modification by maternal birthplace and education of the relationship between neighbourhood characteristics and birth outcomes of newborns from 19992003 in the province of Qu{\'e}bec, 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. Results. Relative 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. Conclusion. The 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.",
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The joint influence of area income, income inequality, and immigrant density on adverse birth outcomes: A population-based study. / Auger, Nathalie; Giraud, Julie; Daniel, Mark.

In: BMC Public Health, Vol. 9, No. 237, 2009, p. 1-11.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The joint influence of area income, income inequality, and immigrant density on adverse birth outcomes: A population-based study

AU - Auger, Nathalie

AU - Giraud, Julie

AU - Daniel, Mark

PY - 2009

Y1 - 2009

N2 - Background. The 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. Methods. This study evaluated effect modification by maternal birthplace and education of the relationship between neighbourhood characteristics and birth outcomes of newborns from 19992003 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. Results. Relative 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. Conclusion. The 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.

AB - Background. The 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. Methods. This study evaluated effect modification by maternal birthplace and education of the relationship between neighbourhood characteristics and birth outcomes of newborns from 19992003 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. Results. Relative 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. Conclusion. The 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.

KW - Adult

KW - educational status

KW - emigrants and immigrants

KW - health status disparities

KW - Logistic Models

KW - Residence Characteristics

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U2 - 10.1186/1471-2458-9-237

DO - 10.1186/1471-2458-9-237

M3 - Article

VL - 9

SP - 1

EP - 11

JO - BMC Public Health

JF - BMC Public Health

SN - 1471-2458

IS - 237

ER -