The joint influence of area income, income inequality, and immigrant density on adverse birth outcomes: a population-based study
AuthorAuger, N; Giraud, J; Daniel, M
Source TitleBMC Public Health
PublisherBIOMED CENTRAL LTD
University of Melbourne Author/sDaniel, Mark
AffiliationMedicine - St Vincent'S Hospital
Document TypeJournal Article
CitationsAuger, N., Giraud, J. & Daniel, M. (2009). The joint influence of area income, income inequality, and immigrant density on adverse birth outcomes: a population-based study. BMC PUBLIC HEALTH, 9 (1), https://doi.org/10.1186/1471-2458-9-237.
Access StatusAccess this item via the Open Access location
Open Access at PMChttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714302
C1 - Journal Articles Refereed
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 1999-2003 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.
KeywordsEpidemiology; Community Child Health; Health Policy Evaluation; Child Health
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