Neighborhood Deprivation and Racial Disparities in Early Pregnancy Impaired Glucose Tolerance

Cara D. Dolin (), Anne M. Mullin, Rachel F. Ledyard, Whitney R. Bender, Eugenia C. South, Celeste P. Durnwald and Heather H. Burris
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Cara D. Dolin: Department of Obstetrics and Gynecology, Women’s Health Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, OH 44195, USA
Anne M. Mullin: Tufts University School of Medicine, Boston, MA 02111, USA
Rachel F. Ledyard: Division of Neonatology, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
Whitney R. Bender: Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
Eugenia C. South: Urban Health Lab, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
Celeste P. Durnwald: Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
Heather H. Burris: Division of Neonatology, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA

IJERPH, 2023, vol. 20, issue 12, 1-12

Abstract: Objective: There is mounting evidence that neighborhoods contribute to perinatal health inequity. We aimed (1) to determine whether neighborhood deprivation (a composite marker of area-level poverty, education, and housing) is associated with early pregnancy impaired glucose intolerance (IGT) and pre-pregnancy obesity and (2) to quantify the extent to which neighborhood deprivation may explain racial disparities in IGT and obesity. Study Design: This was a retrospective cohort study of non-diabetic patients with singleton births ≥ 20 weeks’ gestation from 1 January 2017–31 December 2019 in two Philadelphia hospitals. The primary outcome was IGT (HbA1c 5.7–6.4%) at <20 weeks’ gestation. Addresses were geocoded and census tract neighborhood deprivation index (range 0–1, higher indicating more deprivation) was calculated. Mixed-effects logistic regression and causal mediation models adjusted for covariates were used. Results: Of the 10,642 patients who met the inclusion criteria, 49% self-identified as Black, 49% were Medicaid insured, 32% were obese, and 11% had IGT. There were large racial disparities in IGT (16% vs. 3%) and obesity (45% vs. 16%) among Black vs. White patients, respectively ( p < 0.0001). Mean (SD) neighborhood deprivation was higher among Black (0.55 (0.10)) compared with White patients (0.36 (0.11)) ( p < 0.0001). Neighborhood deprivation was associated with IGT and obesity in models adjusted for age, insurance, parity, and race (aOR 1.15, 95%CI: 1.07, 1.24 and aOR 1.39, 95%CI: 1.28, 1.52, respectively). Mediation analysis revealed that 6.7% (95%CI: 1.6%, 11.7%) of the Black-White disparity in IGT might be explained by neighborhood deprivation and 13.3% (95%CI: 10.7%, 16.7%) by obesity. Mediation analysis also suggested that 17.4% (95%CI: 12.0%, 22.4%) of the Black–White disparity in obesity may be explained by neighborhood deprivation. Conclusion: Neighborhood deprivation may contribute to early pregnancy IGT and obesity–surrogate markers of periconceptional metabolic health in which there are large racial disparities. Investing in neighborhoods where Black patients live may improve perinatal health equity.

Keywords: census tract; health disparities; maternal obesity; social determinants of health; preconception; prediabetes (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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