Distressed Community Index and association with preterm birth
Allen A. Ghareeb, Lindsay A. Cheu, Mindy Pike, Shani S. Delaney, Catherine M. AlbrightAbstract
Introduction
Preterm birth in the United States has been increasing since 2014. Interventions aimed at preventing preterm birth have largely focused on preventing its recurrence in specific populations, while neglecting the influence of socioeconomic disparities. Our study aimed to identify the association between the Distressed Community Index, a tool for measuring the comparative economic well‐being of U.S. communities, and preterm birth rate.
Methods
We conducted a retrospective cohort study using data from the Obstetrical Outcomes Assessment Program (OBCOAP). We examined the association between DCI quintiles (quintiles: 1 = prosperous, 5 = distressed) and gestational age at delivery using linear regression, adjusting for prepregnancy substance use, smoking, diabetes, and hypertension, as well as race/ethnicity and obtaining minimal or no prenatal care.
Results
A total of 10,143 individuals were included for analysis, with 39.0% of individuals living in the least distressed communities (DCI quintile = 1) and 2.9% in the most distressed communities (DCI quintile = 5). Individuals in the most distressed communities experienced significantly higher rates of extremely preterm, very preterm, moderate preterm, and late preterm birth compared to the least distressed communities. For individuals in the least distressed quintile, gestational age was 2.5 weeks (95% CI, 2.06, 2.93) later than for individuals in the most distressed quintile, after adjustment for confounders. Among spontaneous births, there was a 5.48 (95% CI, 3.09–9.74) higher odds of preterm birth in the most distressed quintile 5 compared to the least distressed quintile 1.
Conclusion
Our findings demonstrate that the DCI has the potential to be a neighborhood‐level screening tool for populations at risk for preterm birth.