Primary Submission Category: Socioeconomic status
The influence of maternal life course neighborhood exposures on Black/White disparities in adverse birth outcomes in South Carolina
Authors: Abigail Kappelman, Annie Ro, Belinda Needham, Lindsay Admon, Nancy Fleischer,
Presenting Author: Abigail Kappelman*
Introduction: Exposure of mothers to neighborhood-level social disadvantage, defined as low college completion and high poverty levels, from childhood to adulthood may impact infant low birth weight (LBW). Concurrently, Black/White differences in life course neighborhood social disadvantage exposure and effect may provide insight on disparities in birth outcomes.
Methods: Using a multigenerational dataset of maternally linked birth certificates from South Carolina (1989-2020), we defined maternal neighborhood exposure in childhood and in adulthood as either disadvantaged (census tract with > period-specific median poverty or < period-specific median college completion) or affluent, allowing construction of four trajectories (always disadvantaged, upwardly mobile, downwardly mobile, always affluent). Multivariable logistic regression models estimated associations between maternal trajectories and infant LBW. We adjusted for maternal age, socioeconomic indicators, and comorbidities; infant sex; and county rurality. Interaction terms tested for effect modification by maternal Black/White race of the association of interest.
Results: LBW was more prevalent for Black vs. White women overall (13.4 vs. 7.1%) and within every trajectory of exposure (all p<0.001). Black women were more likely than White women to be always disadvantaged (college: 33.3 vs. 27.5%; poverty: 46.0 vs. 17.2%; both p<0.001) and were less likely to be upwardly mobile (both p<0.001). Only the always affluent trajectories, to which Black mothers were least likely to be exposed, were associated with lower odds of LBW (always affluent vs. always disadvantaged (reference); college, aOR 0.89 [95%CI 0.83-0.95]; poverty, 0.91 [0.85-0.97]). Interactions with maternal race were not significant.
Discussion: The greater life course exposure of Black mothers to disadvantaged neighborhoods highlights how adverse neighborhood exposures can contribute to racial disparities even without effect modification present.