Neighborhood Deprivation Increases the Risk of Post-Induction Cesarean Delivery.
Jessica R. Meeker, MPH, is a doctoral candidate in Epidemiology at the University of Pennsylvania Perelman School of Medicine. Her research focus is in understanding disparities among maternal health outcomes through the investigation of neighborhood-level environmental exposures. Jessica is passionate about community engagement and the dissemination of research back to vulnerable communities. In the past, she has worked in collaboration with the federal, state, and local governments, as well as with academic scientists. Jessica holds a Master of Public Health from The University of Pennsylvania, and a Bachelor of Sciences degree in Biology (Pre-Med) from Ursinus College.
The objective of this study was to measure the association between neighborhood deprivation and post-induction cesarean delivery. We conducted a retrospective cohort study of patients ≥ 37 weeks of gestation, with a live, singleton gestation, who underwent labor induction from 2010-2017 at Penn Medicine. We excluded patients with a prior cesarean delivery and those with missing or insufficient address information for geocoding purposes. Our primary exposure was neighborhood deprivation, for which we used the University of Wisconsin’s Area Deprivation Index (ADI). This national ADI score includes 17 indicators of deprivation including poverty and education, and ranges from 1-100 (least to most deprived). We used a generalized linear mixed model to calculate the odds of post-induction cesarean delivery among patients in 4 equally-spaced levels of neighborhood deprivation (ADI scores of 0-24; 25-49; 50-74; 75-100). Our cohort contained 8,672 patients receiving an induction at Penn Medicine and having complete information for confounder adjustment. After adjustment for confounders including patient age, race/ethnicity, parity, marital status, gestational age, pregnancy-related hypertension, diabetes, and maternal obesity, we found that patients living in the highest-level of neighborhood-deprivation were at a 29% increased risk of post-induction cesarean delivery (aOR=1.29, 95% CI 1.05-1.57) compared to the lowest level of neighborhood deprivation. In conclusion, patients living in neighborhoods with higher levels of deprivation had higher odds of post-induction cesarean delivery compared to patients living in less deprived neighborhoods. This work represents an important first step in understanding the impact of disadvantaged neighborhoods on adverse delivery outcomes.
Keywordsmaternal health, severe maternal morbidity, reproductive epidemiology, spatial modeling, neighborhood deprivation
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