The Area Deprivation Index (ADI) is a neighborhood-level index derived from census data to capture spatial socioeconomic status (SES). The primary objective was to assess the joint relationship between race/ethnicity and neighborhood disadvantage on obstetric outcomes at a single Midwestern- academic institution, situated in a city with high economic-segregation.
A retrospective cohort study of births at a single academic institution from 2016–2018 (n=10,442). Birth record data (preterm & low birth weight), and ICD-10 codes (hypertensive-disorders) were geocoded and linked to census-block group ADI. The relationship between race/ethnicity, ADI and outcomes were evaluated using multivariate logistic regression models.
In models interacting race/ethnicity and ADI, racial/ethnic gaps vary greatly. At the lowest deprivation levels, compared to white women, black (OR 3.68, P<.001) and Asian women (OR 1.86, P<.05) were at greater risk for LBW, whereas at the highest levels of deprivation the differences were not significant, and Latinx women exhibited some advantage. Similar patterns are observed for PTB, with black women experiencing greater risk (OR 1.9, P<.10) at the lowest ADI, yet no increased risk at high ADI. Hypertensive disorders were greater among black and white women at all levels of ADI, compared to Asian and Latinx women (odds ratios range across low to high ADI for black women OR 2.41- 8.0, P<.01 and white women OR 1.90–6.0, P<.001).
Racial/ethnic disparities in health are context dependent and should be examined in relation to neighborhood characteristics, perhaps allowing for better-tailored and targeted interventions.