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Journal ArticleDOI

Pathways of neighbourhood-level socio-economic determinants of adverse birth outcomes

20 Jun 2013-International Journal of Health Geographics (BioMed Central)-Vol. 12, Iss: 1, pp 32-32
TL;DR: Neighbourhood-level socio-economic-related risks are found to have direct effects on low birth weight and preterm birth and the evidence supports both the materialist and psycho-social conceptualizations and the pathways that describe them, although the magnitude of the former is greater than the latter.
Abstract: Background Although socio-economic factors have been identified as one of the most important groups of neighbourhood-level risks affecting birth outcomes, uncertainties still exist concerning the pathways through which they are transferred to individual risk factors. This poses a challenge for setting priorities and developing appropriate community-oriented public health interventions and planning guidelines to reduce the level of adverse birth outcomes.

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Citations
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Journal ArticleDOI
TL;DR: In this article, the effects of maternal body mass index (BMI) and infant sex on adverse birth outcomes were investigated in pre-natal traffic-related air pollution exposure is linked to adverse birth outcome.

98 citations


Cites background from "Pathways of neighbourhood-level soc..."

  • ...We also considered covariates that may co-vary with increased ambient air pollution exposure in these lower-income urban mothers that also may impact birth outcomes including maternal smoking and prenatal psychological stress (Meng et al., 2013)....

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  • ...maternal smoking and prenatal psychological stress (Meng et al., 2013)....

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Journal ArticleDOI
TL;DR: The role of oxidative stress, inflammation and endocrine modification in the pathoetiology of deficient deep placentation is reviewed and how the physical and social environments can act alone and collectively to mediate the established pathology linked to a spectrum of adverse pregnancy outcomes is detailed.
Abstract: Exposure to particulate air pollution and socioeconomic risk factors are shown to be independently associated with adverse pregnancy outcomes; however, their confounding relationship is an epidemiological challenge that requires understanding of their shared etiologic pathways affecting fetal-placental development. The purpose of this paper is to explore the etiological mechanisms associated with exposure to particulate air pollution in contributing to adverse pregnancy outcomes and how these mechanisms intersect with those related to socioeconomic status. Here we review the role of oxidative stress, inflammation and endocrine modification in the pathoetiology of deficient deep placentation and detail how the physical and social environments can act alone and collectively to mediate the established pathology linked to a spectrum of adverse pregnancy outcomes. We review the experimental and epidemiological literature showing that diet/nutrition, smoking, and psychosocial stress share similar pathways with that of particulate air pollution exposure to potentially exasperate the negative effects of either insult alone. Therefore, socially patterned risk factors often treated as nuisance parameters should be explored as potential effect modifiers that may operate at multiple levels of social geography. The degree to which deleterious exposures can be ameliorated or exacerbated via community-level social and environmental characteristics needs further exploration.

69 citations


Cites background from "Pathways of neighbourhood-level soc..."

  • ..., lack of social, familial, and marital support, poverty or financial hardship, physical/verbal abuse, and neighbourhood crime) [12, 24, 26, 54]....

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  • ...buffer the individual-level biological and behavioural factors [24, 26, 54, 128, 224, 225]....

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Journal ArticleDOI
TL;DR: In conclusion, MP birth and low SES multiply the risk of behavioural and emotional problems, and the combination of risk factors identifies children who could benefit greatly from early intervention.
Abstract: Moderately preterm (MP) birth is associated with higher rates of behavioural and emotional problems. To determine the extent to which low socioeconomic status (SES) contributes to these higher rates, we assessed independent and joint effects of MP birth and low SES, overall and by gender. Dutch preventive child health care centres provided a population-based sample of 915 MP children (32-36 weeks gestation) and 543 term-born children, born in 2002/2003. In multivariable logistic regression analyses, we determined the risk of behavioural and emotional problems per standard deviation (SD) decrease in gestational age and SES, using standardized measures for both. We also assessed three SES categories, being low (1SD or more below mean of standardized SES), intermediate (mean ± 1SD), and high (greater than mean + 1SD). The Child Behavior Checklist for 1.5-5 years was used to assess behavioural (externalizing), emotional (internalizing), and total problems at age 4 years. MP children with low SES had significantly higher total problem scores than those with high SES (11.3 vs. 5.1%, respectively). Each SD decrease in SES was associated with a 42% higher odds of elevated total problem scores (OR 1.42, 95% CI 1.14-1.77). No joint effects were found, meaning that lower gestational age independently added to the risk of behaviour problems (OR 1.24, 95% CI 1.00-1.56). Effects of MP birth and low SES were more pronounced in girls. In conclusion, MP birth and low SES multiply the risk of behavioural and emotional problems. The combination of risk factors identifies children who could benefit greatly from early intervention.

52 citations


Cites background from "Pathways of neighbourhood-level soc..."

  • ...lifestyle-associated factors, such as smoking, increase the risk of spontaneous preterm labour [8, 10]....

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Journal ArticleDOI
TL;DR: Geographic information systems (GIS) are increasingly recognized tools in maternal health and are being used to improve maternal health care and provide real-time information about maternal health conditions.

50 citations


Cites background from "Pathways of neighbourhood-level soc..."

  • ...Most studies that introduced geographic variables as risk factors into analyses used non-spatial statistical approaches, including odds ratios, least-squares regression, and multilevel models, with the geographic data serving as one of many explanatory variables [31,32]....

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References
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Journal ArticleDOI

9,050 citations


"Pathways of neighbourhood-level soc..." refers methods in this paper

  • ...Using the SAS PROC FACTOR procedure, a principal component analysis [31] was first conducted on identified person-level risk variables....

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Journal ArticleDOI
29 Apr 2000-BMJ
TL;DR: The literature was reviewed through traditional and electronic means and correlational analyses of gross domestic product and life expectancy and of income inequality and mortality trends based on data from the World Bank, the World Health Organization, and two British sources were supplemented.
Abstract: Studies on the health effects of income inequality have generated great interest. The evidence on this association between countries is mixed,1–4 but income inequality and health have been linked within the United States,5–11 Britain,12 and Brazil.13 Questions remain over how to interpret these findings and the mechanisms involved. We discuss three interpretations of the association between income inequality and health: the individual income interpretation, the psychosocial environment interpretation, and the neo-material interpretation. #### Summary points Income inequality has generally been associated with differences in health A psychosocial interpretation of health inequalities, in terms of perceptions of relative disadvantage and the psychological consequences of inequality, raises several conceptual and empirical problems Income inequality is accompanied by many differences in conditions of life at the individual and population levels, which may adversely influence health Interpretation of links between income inequality and health must begin with the structural causes of inequalities, and not just focus on perceptions of that inequality Reducing health inequalities and improving public health in the 21st century requires strategic investment in neo-material conditions via more equitable distribution of public and private resources We reviewed the literature through traditional and electronic means and supplemented this with correlational analyses of gross domestic product and life expectancy and of income inequality and mortality trends based on data from the World Bank,14 the World Health Organization,15 and two British sources.16 17 According to the individual income interpretation, aggregate level associations between income inequality and health reflect only the individual level association between income and health. The curvilinear relation between income and health at the individual level 18 19 is a sufficient condition to produce health differences between populations with the same average income but different distributions of income.3 20 This interpretation assumes that determinants …

1,477 citations


"Pathways of neighbourhood-level soc..." refers background in this paper

  • ...They may affect a mother’s birth outcomes directly and/or indirectly through the mother’s health behaviour and life style [27]....

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Journal ArticleDOI
TL;DR: Research that identifies and quantifies the causal pathways and mechanisms whereby social disadvantage leads to higher risks of IUGR and preterm birth may eventually help to reduce current disparities and improve pregnancy outcome across the entire socio-economic spectrum.
Abstract: In this paper, we review the evidence bearing on socio-economic disparities in pregnancy outcome, focusing on aetiological factors mediating the disparities in intrauterine growth restriction (IUGR) and preterm birth. We first summarise what is known about the attributable determinants of IUGR and preterm birth, emphasising their quantitative contributions (aetiological fractions) from a public health perspective. We then review studies relating these determinants to socio-economic status and, combined with the evidence about their aetiological fractions, reach some tentative conclusions about their roles as mediators of the socio-economic disparities. Cigarette smoking during pregnancy appears to be the most important mediating factor for IUGR, with low gestational weight gain and short stature also playing substantial roles. For preterm birth, socio-economic gradients in bacterial vaginosis and cigarette smoking appear to explain some of the socio-economic disparities; psychosocial factors may prove even more important, but their aetiological links with preterm birth require further clarification. Research that identifies and quantifies the causal pathways and mechanisms whereby social disadvantage leads to higher risks of IUGR and preterm birth may eventually help to reduce current disparities and improve pregnancy outcome across the entire socio-economic spectrum.

813 citations


"Pathways of neighbourhood-level soc..." refers background in this paper

  • ...In addition to environmental influences, socio-economic factors have been consistently identified as some of the most pervasive neighbourhood-level risk factors associated with LBW and PTB incidence [1-4]....

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  • ...; licensee BioMed Central L Commons Attribution License (http://creativec reproduction in any medium, provided the or use of tobacco, alcohol and illicit drugs, stressful work and living environment, delayed or reduced prenatal care, increased maternal infections, violence and abuse, depression, increased risk of unwanted pregnancy, increased teenage pregnancy, and reduced levels of social and financial support have all been identified as risk factors among low socioeconomic status (SES) groups [4]....

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Journal ArticleDOI
TL;DR: For dichotomous outcomes, the authors discuss when the standard approaches to mediation analysis used in epidemiology and the social sciences are valid, and they provide alternative mediation analysis techniques when thestandard approaches will not work.
Abstract: For dichotomous outcomes, the authors discuss when the standard approaches to mediation analysis used in epidemiology and the social sciences are valid, and they provide alternative mediation analysis techniques when the standard approaches will not work. They extend definitions of controlled direct effects and natural direct and indirect effects from the risk difference scale to the odds ratio scale. A simple technique to estimate direct and indirect effect odds ratios by combining logistic and linear regressions is described that applies when the outcome is rare and the mediator continuous. Further discussion is given as to how this mediation analysis technique can be extended to settings in which data come from a case-control study design. For the standard mediation analysis techniques used in the epidemiologic and social science literatures to be valid, an assumption of no interaction between the effects of the exposure and the mediator on the outcome is needed. The approach presented here, however, will apply even when there are interactions between the effect of the exposure and the mediator on the outcome.

667 citations


"Pathways of neighbourhood-level soc..." refers methods in this paper

  • ...Finally, to assess how the total effect (sum of the direct and indirect effects) of exposure to a given neighbourhoodlevel SES-related variable is transferred through the proposed pathways, mediation analyses for binary-outcome models were conducted following the method described by VanderWeele and Vansteelandt [33]....

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  • ...VanderWeele TG, Vansteelandt S: Odds Ratios for Mediation Analysis for a Dichotomous Outcome....

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