Neighborhood socioeconomic status, maternal race and preterm delivery: a case-control study.

PURPOSE: To explore associations between neighborhood socioeconomic context and preterm delivery, independent of maternal and family socioeconomic status, in African-American and white women.

METHODS

A case-control study of African-American (n = 417) and white (n = 1244) women delivering infants at the University of California, San Francisco's Moffitt Hospital, between 1980 and 1990.

RESULTS

Neighborhood socioeconomic contexts were associated with preterm delivery but associations were non-linear and varied with race/ethnicity. For African-American women, living in a neighborhood with either high or low median household income was associated with an increased risk of spontaneous preterm delivery, as was living in a neighborhood with large increases or decreases in the proportion of African-American residents during the study decade. Residence in neighborhoods with high and low rates of male unemployment was associated with a decreased risk of preterm delivery. Among white women only large positive and negative changes in neighborhood male unemployment were associated with risk of preterm delivery.

CONCLUSIONS

Neighborhood factors and changes in neighborhoods over time are related to preterm delivery, although the mechanisms linking local environments to maternal risk remain to be specified.