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Research Article
Linking Social Vulnerability and Adverse Birth Outcomes in the Southeast United States
Hoda Fotovvat
University of Central Florida
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
This study aims to explore the relationship between social vulnerability (SoVI)indicators (race/ethnicity, population structure, socioeconomic status, housing structure, and access/functional needs) with low birth weight (LBW) and preterm delivery (PTD) rates across the Southeastern United States.
Methods
Annual low birth weight and premature birth rates for all counties were collected between 2000 and 2015. LBW and PTD were recoded into two categories below (0) and above (1) the annual national average for each year. Multinomial logistic regression (MLR) was employed to conduct regression analysis to investigate the relationship.
Results
Twenty-six and twenty-four different social vulnerability indicators were influential in predicting low birth weight rates and preterm delivery across the SE United States from 2005–2015, respectively. Racial and ethnic variables were among the most frequent influential social vulnerability indicators of low birth weights. Like race and ethnicity, counties with low and medium house values have a higher likelihood of low LBW compared to counties with higher house values. Unlike LBW, race and ethnic characteristics influence PTD rates across the study area in different ways. Whereas LBW rates are driven up in counties with low/medium Hispanic populations compared to high percentage counties, PTD is more strongly associated with Black communities. Further, population structure and socioeconomic status indicators provide the most robust indication of counties more likely to have higher PTD than the national average.
Conclusion
Influential variables point toward a dire need to comprehensively understand the links between social vulnerability and LBW and PTD. Moving toward a comprehensive view of social vulnerability borne out of the hazards literature provides a more robust understanding of the drivers of adverse birth outcomes that has rarely been addressed in the literature.
Keywords
Preterm delivery, Low birth weight, Social vulnerability index
Figure 1
Table 1: Selected social vulnerability characteristics for Southeastern states in comparison to US Averages. Source: US Census AS (2014-2018). Bolded values indicated states that are have more vulnerable populations than the US average for any given indicator.
|
|
Persons under 5 years |
Persons 65 years and over |
Black or African American |
With a disability |
Persons without health insurance |
Persons in poverty |
Median household income |
Per capita income in past 12 months |
|
United States |
6.10% |
16.00% |
13.40% |
8.60% |
10.00% |
11.80% |
$60,293 |
$32,621 |
|
Georgia |
6.20% |
13.90% |
32.40% |
8.70% |
15.70% |
14.30% |
$55,679 |
$29,523 |
|
Florida |
5.40% |
20.50% |
16.90% |
8.60% |
16.00% |
13.60% |
$53,267 |
$30,197 |
|
Arkansas |
6.30% |
17.00% |
15.70% |
12.50% |
9.80% |
17.20% |
$45,726 |
$25,635 |
|
Alabama |
6.00% |
16.90% |
26.80% |
11.60% |
12.00% |
16.80% |
$48,486 |
$26,846 |
|
West Virginia |
5.30% |
19.90% |
3.60% |
14.10% |
7.90% |
17.80% |
$44,921 |
$25,479 |
|
Virginia |
6.00% |
15.40% |
19.90% |
8.00% |
10.20% |
10.70% |
$71,564 |
$37,763 |
|
South Carolina |
5.80% |
17.70% |
27.10% |
10.40% |
12.70% |
15.30% |
$51,015 |
$27,986 |
|
North Carolina |
5.90% |
16.30% |
22.20% |
9.50% |
12.70% |
14.00% |
$52,413 |
$29,456 |
|
Mississippi |
6.20% |
15.90% |
37.80% |
11.80% |
14.40% |
19.70% |
$43,567 |
$23,434 |
|
Louisiana |
6.60% |
15.40% |
32.70% |
11.00% |
9.30% |
18.60% |
$47,942 |
$27,027 |
|
Tennessee |
6.00% |
16.40% |
17.10% |
11.10% |
12.00% |
15.30% |
$50,972 |
$28,511 |
|
Kentucky |
6.20% |
16.40% |
8.40% |
13.10% |
6.70% |
16.90% |
$48,392 |
$26,948 |
Table 2: State birth outcome data sources.
|
State |
Resource |
Source |
|
Alabama |
http://www.alabamapublichealth.gov/healthstats |
|
|
Arkansas |
Arkansas Department of Health |
Direct Data Request |
|
Florida |
Florida Department of Health |
http://www.flhealthcharts.com/charts/SearchResult.aspx |
|
Georgia |
Kids Count Data Center |
https://datacenter.kidscount.org/data#GA/2/0/char/0 |
|
Kentucky |
Foundation for a Healthy Kentucky |
http://www.kentuckyhealthfacts.org, www.healthy-ky.org |
|
Louisiana |
Louisiana Office of Public Health, Bureau of Family Health |
Direct Data Request |
|
Mississippi |
Kids Count Data Center |
https://datacenter.kidscount.org/ |
|
North Carolina |
North Carolina Department of Health and Human Services |
https://schs.dph.ncdhhs.gov/data/databook/CD7B%20Preterm%20births.html |
|
South Carolina |
South Carolina Department of Health and Environmental Control |
http://scangis.dhec.sc.gov/scan/bdp/tables/birthtable.aspx |
|
Tennessee |
Tennessee Department of Health |
https://www.tn.gov/health/health-program-areas.html |
|
Virginia |
Virginia Department of Human Resource Management |
Direct Data Request |
|
West Virginia |
West Virginia Department of Health |
Direct Data Request |
Table 3: National Average and Ranges of Low Birth Weights and Pre-Term Births, 2000 - 2015
|
|
National Average |
Low Birth Weights Ranges |
Pre-Term Birth Ranges |
|
||||
|
Year |
Low Birth Weight |
Pre- Term Birth |
Low |
High |
Low |
High |
Source |
|
|
2000 |
7.6 |
11.6 |
0-7.58 |
7.60-24.17 |
0-11.59 |
11.60-34.40 |
https://www.cdc.gov/nchs/data/nvsr/nvsr50/nvsr50_05.pdf |
|
|
2001 |
7.7 |
11.9 |
0-7.67 |
7.70-20.30 |
0.11.80 |
11.90-33.50 |
https://www.cdc.gov/nchs/data/nvsr/nvsr51/nvsr51_02.pdf |
|
|
2002 |
7.8 |
12.1 |
0-7.78 |
7.80-20.40 |
0.12.09 |
12.10-29.20 |
https://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_10.pdf |
|
|
2003 |
7.9 |
12.3 |
0-7.78 |
7.80-20.40 |
0.12.26 |
12.30-29.09 |
https://wonder.cdc.gov/wonder/sci_data/natal/detail/type_txt/natal03/births03.pdf |
|
|
2004 |
8.1 |
12.5 |
0-8.09 |
8.10-28.60 |
0-12.69 |
12.70-27.80 |
https://www.cdc.gov/nchs/data/hestat/prelimbirths04/prelimbirths04health.htm#figg |
|
|
2005 |
8.2 |
12.7 |
0-8.18 |
8.20-24 |
0-12.69 |
12.70-27.80 |
https://www.cdc.gov/nchs/pressroom/sosmap/lbw_births/lbw.htm, https://www.cdc.gov/nchs/pressroom/sosmap/preterm_births/preterm.htm |
|
|
2006 |
8.3 |
12.8 |
0-8.26 |
8.3-24.6 |
0-12.79 |
12.8-29.5 |
https://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_07.pdf |
|
|
2007 |
8.2 |
12.7 |
0-8.19 |
8.2-28.4 |
0-12.68 |
12.7-37.1 |
https://data.unicef.org/resources/data_explorer/unicef_f/?ag=UNICEF&df=GLOBAL_DATAFLOW&ver=1.0&dq=.NT_BW_LBW..&startPeriod=2005&endPeriod=2015 |
|
|
2008 |
8.1 |
12.3 |
0-8.08 |
8.1-30.8 |
0-12.29 |
12.3-30.8 |
https://data.unicef.org/resources/data_explorer/unicef_f/?ag=UNICEF&df=GLOBAL_DATAFLOW&ver=1.0&dq=.NT_BW_LBW..&startPeriod=2005&endPeriod=2015 |
|
|
2009 |
8.1 |
12.1 |
0-8.09 |
8.1-30.7 |
0-12.08 |
12.1-26.2 |
https://www.cdc.gov/nchs/pressroom/sosmap/lbw_births/lbw.htm, https://www.cdc.gov/nchs/pressroom/sosmap/preterm_births/preterm.htm |
|
|
2010 |
8.1 |
11.9 |
0-8.03 |
8.1-35 |
0-11.88 |
11.9-26.39 |
https://www.cdc.gov/nchs/pressroom/sosmap/lbw_births/lbw.htm, https://www.cdc.gov/nchs/pressroom/sosmap/preterm_births/preterm.htm |
|
|
2011 |
8.1 |
11.7 |
0-8 |
8.1-30 |
0-11.67 |
11.7-35.7 |
https://www.cdc.gov/nchs/pressroom/sosmap/lbw_births/lbw.htm, https://www.cdc.gov/nchs/pressroom/sosmap/preterm_births/preterm.htm |
|
|
2012 |
7.9 |
11.7 |
0-7.8 |
7.9-28.6 |
0-11.48 |
11.5-30.6 |
https://www.cdc.gov/nchs/pressroom/sosmap/lbw_births/lbw.htm, https://www.cdc.gov/nchs/pressroom/sosmap/preterm_births/preterm.htm |
|
|
2013 |
8 |
11.3 |
0-7.9 |
8-30.8 |
0-11.27 |
11.3-26.9 |
https://www.cdc.gov/nchs/pressroom/sosmap/lbw_births/lbw.htm, https://www.cdc.gov/nchs/pressroom/sosmap/preterm_births/preterm.htm |
|
|
2014 |
8 |
9.5 |
0-7.9 |
7.9-21.1 |
0-9.49 |
9.5-24.6 |
https://www.cdc.gov/nchs/pressroom/sosmap/lbw_births/lbw.htm, https://www.cdc.gov/nchs/pressroom/sosmap/preterm_births/preterm.htm |
|
|
2015 |
8 |
9.6 |
0-8 |
8.1-22 |
0-9.56 |
9.6-26.2 |
https://www.cdc.gov/nchs/pressroom/sosmap/lbw_births/lbw.htm, https://www.cdc.gov/nchs/pressroom/sosmap/preterm_births/preterm.htm |
|
Due to technical limitations, table 4, 5, 6 is only available as a download in the Supplemental Files section.
This is a list of supplementary files associated with this preprint. Click to download.
- Table4.png
Social vulnerability predictor variable theoretical categories and statistical ranges by binned (low, medium, high) classification used in statistical analysis
- Table5.png
Model outputs showing negative and positive influences of social indicators on low birth weight rates in the Southeast United States (2000 – 2015).
- Table6.png
Model outputs showing negative and positive influences of social indicators on pre-term birth rates in the Southeast United States (2000 – 2015).
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This preprint is under consideration at BMC Pregnancy and Childbirth. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Linking Social Vulnerability and Adverse Birth Outcomes in the Southeast United States
Hoda Fotovvat
University of Central Florida
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 07 Jan, 2021
No community comments so far
Reviewer #1 agreed
On 12 Jan, 2021
Reviewer #2 agreed
On 12 Jan, 2021
Reviewers invited
Invitations sent on 11 Jan, 2021
Editor assigned
On 11 Jan, 2021
Editor invited
On 06 Jan, 2021
Submission checks complete
On 06 Jan, 2021
First submitted
On 22 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Maternal & Fetal Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
This study aims to explore the relationship between social vulnerability (SoVI)indicators (race/ethnicity, population structure, socioeconomic status, housing structure, and access/functional needs) with low birth weight (LBW) and preterm delivery (PTD) rates across the Southeastern United States.
Methods
Annual low birth weight and premature birth rates for all counties were collected between 2000 and 2015. LBW and PTD were recoded into two categories below (0) and above (1) the annual national average for each year. Multinomial logistic regression (MLR) was employed to conduct regression analysis to investigate the relationship.
Results
Twenty-six and twenty-four different social vulnerability indicators were influential in predicting low birth weight rates and preterm delivery across the SE United States from 2005–2015, respectively. Racial and ethnic variables were among the most frequent influential social vulnerability indicators of low birth weights. Like race and ethnicity, counties with low and medium house values have a higher likelihood of low LBW compared to counties with higher house values. Unlike LBW, race and ethnic characteristics influence PTD rates across the study area in different ways. Whereas LBW rates are driven up in counties with low/medium Hispanic populations compared to high percentage counties, PTD is more strongly associated with Black communities. Further, population structure and socioeconomic status indicators provide the most robust indication of counties more likely to have higher PTD than the national average.
Conclusion
Influential variables point toward a dire need to comprehensively understand the links between social vulnerability and LBW and PTD. Moving toward a comprehensive view of social vulnerability borne out of the hazards literature provides a more robust understanding of the drivers of adverse birth outcomes that has rarely been addressed in the literature.
Figure 1
Table 1: Selected social vulnerability characteristics for Southeastern states in comparison to US Averages. Source: US Census AS (2014-2018). Bolded values indicated states that are have more vulnerable populations than the US average for any given indicator.
|
|
Persons under 5 years |
Persons 65 years and over |
Black or African American |
With a disability |
Persons without health insurance |
Persons in poverty |
Median household income |
Per capita income in past 12 months |
|
United States |
6.10% |
16.00% |
13.40% |
8.60% |
10.00% |
11.80% |
$60,293 |
$32,621 |
|
Georgia |
6.20% |
13.90% |
32.40% |
8.70% |
15.70% |
14.30% |
$55,679 |
$29,523 |
|
Florida |
5.40% |
20.50% |
16.90% |
8.60% |
16.00% |
13.60% |
$53,267 |
$30,197 |
|
Arkansas |
6.30% |
17.00% |
15.70% |
12.50% |
9.80% |
17.20% |
$45,726 |
$25,635 |
|
Alabama |
6.00% |
16.90% |
26.80% |
11.60% |
12.00% |
16.80% |
$48,486 |
$26,846 |
|
West Virginia |
5.30% |
19.90% |
3.60% |
14.10% |
7.90% |
17.80% |
$44,921 |
$25,479 |
|
Virginia |
6.00% |
15.40% |
19.90% |
8.00% |
10.20% |
10.70% |
$71,564 |
$37,763 |
|
South Carolina |
5.80% |
17.70% |
27.10% |
10.40% |
12.70% |
15.30% |
$51,015 |
$27,986 |
|
North Carolina |
5.90% |
16.30% |
22.20% |
9.50% |
12.70% |
14.00% |
$52,413 |
$29,456 |
|
Mississippi |
6.20% |
15.90% |
37.80% |
11.80% |
14.40% |
19.70% |
$43,567 |
$23,434 |
|
Louisiana |
6.60% |
15.40% |
32.70% |
11.00% |
9.30% |
18.60% |
$47,942 |
$27,027 |
|
Tennessee |
6.00% |
16.40% |
17.10% |
11.10% |
12.00% |
15.30% |
$50,972 |
$28,511 |
|
Kentucky |
6.20% |
16.40% |
8.40% |
13.10% |
6.70% |
16.90% |
$48,392 |
$26,948 |
Table 2: State birth outcome data sources.
|
State |
Resource |
Source |
|
Alabama |
http://www.alabamapublichealth.gov/healthstats |
|
|
Arkansas |
Arkansas Department of Health |
Direct Data Request |
|
Florida |
Florida Department of Health |
http://www.flhealthcharts.com/charts/SearchResult.aspx |
|
Georgia |
Kids Count Data Center |
https://datacenter.kidscount.org/data#GA/2/0/char/0 |
|
Kentucky |
Foundation for a Healthy Kentucky |
http://www.kentuckyhealthfacts.org, www.healthy-ky.org |
|
Louisiana |
Louisiana Office of Public Health, Bureau of Family Health |
Direct Data Request |
|
Mississippi |
Kids Count Data Center |
https://datacenter.kidscount.org/ |
|
North Carolina |
North Carolina Department of Health and Human Services |
https://schs.dph.ncdhhs.gov/data/databook/CD7B%20Preterm%20births.html |
|
South Carolina |
South Carolina Department of Health and Environmental Control |
http://scangis.dhec.sc.gov/scan/bdp/tables/birthtable.aspx |
|
Tennessee |
Tennessee Department of Health |
https://www.tn.gov/health/health-program-areas.html |
|
Virginia |
Virginia Department of Human Resource Management |
Direct Data Request |
|
West Virginia |
West Virginia Department of Health |
Direct Data Request |
Table 3: National Average and Ranges of Low Birth Weights and Pre-Term Births, 2000 - 2015
|
|
National Average |
Low Birth Weights Ranges |
Pre-Term Birth Ranges |
|
||||
|
Year |
Low Birth Weight |
Pre- Term Birth |
Low |
High |
Low |
High |
Source |
|
|
2000 |
7.6 |
11.6 |
0-7.58 |
7.60-24.17 |
0-11.59 |
11.60-34.40 |
https://www.cdc.gov/nchs/data/nvsr/nvsr50/nvsr50_05.pdf |
|
|
2001 |
7.7 |
11.9 |
0-7.67 |
7.70-20.30 |
0.11.80 |
11.90-33.50 |
https://www.cdc.gov/nchs/data/nvsr/nvsr51/nvsr51_02.pdf |
|
|
2002 |
7.8 |
12.1 |
0-7.78 |
7.80-20.40 |
0.12.09 |
12.10-29.20 |
https://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_10.pdf |
|
|
2003 |
7.9 |
12.3 |
0-7.78 |
7.80-20.40 |
0.12.26 |
12.30-29.09 |
https://wonder.cdc.gov/wonder/sci_data/natal/detail/type_txt/natal03/births03.pdf |
|
|
2004 |
8.1 |
12.5 |
0-8.09 |
8.10-28.60 |
0-12.69 |
12.70-27.80 |
https://www.cdc.gov/nchs/data/hestat/prelimbirths04/prelimbirths04health.htm#figg |
|
|
2005 |
8.2 |
12.7 |
0-8.18 |
8.20-24 |
0-12.69 |
12.70-27.80 |
https://www.cdc.gov/nchs/pressroom/sosmap/lbw_births/lbw.htm, https://www.cdc.gov/nchs/pressroom/sosmap/preterm_births/preterm.htm |
|
|
2006 |
8.3 |
12.8 |
0-8.26 |
8.3-24.6 |
0-12.79 |
12.8-29.5 |
https://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_07.pdf |
|
|
2007 |
8.2 |
12.7 |
0-8.19 |
8.2-28.4 |
0-12.68 |
12.7-37.1 |
https://data.unicef.org/resources/data_explorer/unicef_f/?ag=UNICEF&df=GLOBAL_DATAFLOW&ver=1.0&dq=.NT_BW_LBW..&startPeriod=2005&endPeriod=2015 |
|
|
2008 |
8.1 |
12.3 |
0-8.08 |
8.1-30.8 |
0-12.29 |
12.3-30.8 |
https://data.unicef.org/resources/data_explorer/unicef_f/?ag=UNICEF&df=GLOBAL_DATAFLOW&ver=1.0&dq=.NT_BW_LBW..&startPeriod=2005&endPeriod=2015 |
|
|
2009 |
8.1 |
12.1 |
0-8.09 |
8.1-30.7 |
0-12.08 |
12.1-26.2 |
https://www.cdc.gov/nchs/pressroom/sosmap/lbw_births/lbw.htm, https://www.cdc.gov/nchs/pressroom/sosmap/preterm_births/preterm.htm |
|
|
2010 |
8.1 |
11.9 |
0-8.03 |
8.1-35 |
0-11.88 |
11.9-26.39 |
https://www.cdc.gov/nchs/pressroom/sosmap/lbw_births/lbw.htm, https://www.cdc.gov/nchs/pressroom/sosmap/preterm_births/preterm.htm |
|
|
2011 |
8.1 |
11.7 |
0-8 |
8.1-30 |
0-11.67 |
11.7-35.7 |
https://www.cdc.gov/nchs/pressroom/sosmap/lbw_births/lbw.htm, https://www.cdc.gov/nchs/pressroom/sosmap/preterm_births/preterm.htm |
|
|
2012 |
7.9 |
11.7 |
0-7.8 |
7.9-28.6 |
0-11.48 |
11.5-30.6 |
https://www.cdc.gov/nchs/pressroom/sosmap/lbw_births/lbw.htm, https://www.cdc.gov/nchs/pressroom/sosmap/preterm_births/preterm.htm |
|
|
2013 |
8 |
11.3 |
0-7.9 |
8-30.8 |
0-11.27 |
11.3-26.9 |
https://www.cdc.gov/nchs/pressroom/sosmap/lbw_births/lbw.htm, https://www.cdc.gov/nchs/pressroom/sosmap/preterm_births/preterm.htm |
|
|
2014 |
8 |
9.5 |
0-7.9 |
7.9-21.1 |
0-9.49 |
9.5-24.6 |
https://www.cdc.gov/nchs/pressroom/sosmap/lbw_births/lbw.htm, https://www.cdc.gov/nchs/pressroom/sosmap/preterm_births/preterm.htm |
|
|
2015 |
8 |
9.6 |
0-8 |
8.1-22 |
0-9.56 |
9.6-26.2 |
https://www.cdc.gov/nchs/pressroom/sosmap/lbw_births/lbw.htm, https://www.cdc.gov/nchs/pressroom/sosmap/preterm_births/preterm.htm |
|
Due to technical limitations, table 4, 5, 6 is only available as a download in the Supplemental Files section.