Abstract
Background and Aims: African American adults generally have higher prevalence of morbidities than whites in the United States. Living in lower socioeconomic status (SES) neighborhoods increases the likelihood of poor health. The extent to which lower SES contributes to a higher rate of pregnancy complications for African Americans requires investigation. We explored racial differences in likelihood of maternal morbidities and whether these differences were moderated by neighborhood SES.
Methods: Pregnancies were defined from linked birth certificates and hospital records. We studied 9,726 pregnancies for non-Hispanic African American women and 10,272 for non-Hispanic white women enrolled with Kaiser Permanente Georgia (KPGA) from 2000–2006. Morbidities during pregnancy were ascertained from all outpatient and inpatient diagnoses and procedures classified by a previously validated maternal morbidity grouper. SES was measured from a factor analysis of 7 US Census measures associated with tract or block group of residence. Factor scores were divided into quartiles. Likelihood of selected morbidities was estimated using logistic regression adjusted for race, SES quartile, and mother’s age. Parameter estimates were adjusted for repeated observations (pregnancies) per woman during the study period.
Results: 14% of pregnancies were characterized by anemia, 13% by hypertension, and 7% by mental disorders. African American women were more likely than white women to live in lowest SES quartile neighborhoods (34% vs. 16%; p<0.05). Adjusted for age and SES, pregnancies characterized by anemia and hypertension were significantly more likely among African Americans than whites (OR = 2.24 and 1.30, respectively). Mental disorders were significantly less likely among African Americans (OR = 0.50). Adjusted for age and race, low SES neighborhoods had a significantly greater moderating effect among whites than among African Americans. Among whites, the adjusted ORs for the lowest SES quartile (vs. highest) were 1.21 (95% CI: 1.40, 1.01) for hypertension, 1.97 (95% CI: 2.40, 1.61) for anemia, and 1.27 (95% CI: 1.57, 1.03) for mental disorders.
Conclusions: Neighborhood SES had a significant moderating effect on selected morbidities during live birth pregnancy episodes in this HMO. Compared to African American women, living in low SES neighborhoods significantly increased the risk of major morbidities during pregnancy episodes among white women.
- Received May 27, 2010.
- Accepted May 27, 2010.
