Association of neighbourhood socioeconomic trajectories with preterm birth and small-for-gestational-age in the Netherlands: a nationwide population-based study

Lizbeth Burgos Ochoa; Loes Cm Bertens; Pilar Garcia-Gomez; Tom Van Ourti; Eric Ap Steegers; Jasper V Been

doi:10.1016/j.lanepe.2021.100205

Association of neighbourhood socioeconomic trajectories with preterm birth and small-for-gestational-age in the Netherlands: a nationwide population-based study

Lancet Reg Health Eur. 2021 Aug 24:10:100205. doi: 10.1016/j.lanepe.2021.100205. eCollection 2021 Nov.

Authors

Lizbeth Burgos Ochoa¹, Loes Cm Bertens¹, Pilar Garcia-Gomez², Tom Van Ourti^{2

3}, Eric Ap Steegers¹, Jasper V Been^{1

4

5}

Affiliations

¹ Department of Obstetrics and Gynaecology, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands.
² Erasmus School of Economics, Tinbergen Institute and Erasmus Centre for Health Economics Rotterdam, Erasmus University Rotterdam, Rotterdam, The Netherlands.
³ Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
⁴ Division of Neonatology, Department of Paediatrics, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands.
⁵ Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands.

Abstract

Background: Adverse birth outcomes have serious health consequences, not only during infancy but throughout the entire life course. Most evidence linking neighbourhood socioeconomic status (SES) to birth outcomes is based on cross-sectional SES measures, which do not reflect neighbourhoods' dynamic nature. We investigated the association between neighbourhood SES trajectories and adverse birth outcomes, i.e. preterm birth and being small-for-gestational-age (SGA), for births occurring in the Netherlands between 2003 and 2017.

Methods: We linked individual-level data from the Dutch perinatal registry to the Netherlands Institute for Social Research neighbourhood SES scores. Based on changes in their SES across four-year periods, neighbourhoods were categorised into seven trajectories. To investigate the association between neighbourhood SES trajectories and birth outcomes we used adjusted multilevel logistic regression models.

Findings: Data on 2 334 036 singleton births were available for analysis. Women living in stable low-SES neighbourhoods had higher odds of preterm birth (OR[95%CI]= 1·12[1·07-1·17]) and SGA (OR[95%CI]= 1·19[1·15-1·23]), compared to those in high SES areas. Higher odds of preterm birth (OR[95%CI]= 1·12[1·05-1·20]) and SGA (OR[95%CI]=1·12[1·06-1·18]) were also observed for those living in areas declining to low SES. Women living in a neighbourhood where SES improved from low to medium showed higher odds of preterm birth (OR[95%CI]= 1·09[1·02-1·18]), but not of SGA (OR[95%CI]= 1·04[0.98-1·10]). The odds of preterm or SGA birth in other areas were comparable to those seen in high SES areas.

Interpretation: In the Netherlands, disadvantaged neighbourhood SES trajectories were associated with higher odds of adverse birth outcomes. Longitudinal neighbourhood SES measures should also be taken into account when selecting a target population for public health interventions.

Funding: Erasmus Initiative Smarter Choices for Better Health.