452 - The Association of Community Social Vulnerability and Infant Morbidity

Poster Number: 452
Publication Number: 452.64

Background: The US has high rates of poor infant outcomes, including preterm birth and low birthweight, compared to peer nations, with racial and socioeconomic disparities. As social factors influence infant health outcomes, examining the association of community-level social vulnerability with infant morbidity can inform novel opportunities for intervention.

Objective: To examine the association of social vulnerability with the infant outcomes of preterm birth and low birthweight.

Design/Methods: This is a retrospective cross-sectional database study. Data on maternal and infant characteristics at the county level was obtained from the birth cohort linked files from the National Center for Health Statistics (NCHS) Restricted Vitals Statistics database for the years 2014 – 2018. The infant outcomes were preterm birth ( < 37 weeks gestation) and low birthweight ( < 2500 grams). For the exposure of social vulnerability, we used the Social Vulnerability Index (SVI), from the Centers for Disease Control and Prevention. The SVI measures county level social resources using 4 themes (socioeconomic, household characteristics, race/ethnicity, housing/transportation) and scores range from 1 (low vulnerability) to 5 (high vulnerability). We performed multivariable logistic regression for each outcome with the exposure variable of SVI, adjusting for maternal characteristics, reporting adjusted odds ratios (OR) and 95% confidence intervals (95%CI).

Results: There were 3,791,712 infants in the study sample, and 42.1% had public insurance (Table 1). In the multivariable logistic regression model, there were increased odds of preterm birth in higher (SVI 4: OR 1.09, 95%CI 1.05, 1.14; 5: OR 1.13, 95%CI 1.06, 1.20) compared to the lowest SVI category, mothers of Black (OR 1.45, 95%CI 1.39, 1.50) compared to White race, and mothers with public (OR 1.09, 95%CI 1.08, 1.23) compared to private insurance. For low birthweight, increased odds were associated with higher (SVI 3: OR 1.05, 95% CI 1.02, 1.08; 4: OR 1.10, 95%CI 1.05, 1.14; 5: OR 1.14, 95%CI 1.09, 1.19) compared to the lowest SVI category, mothers of Black (OR 1.95, 95% CI 1.87, 2.03) and Asian (OR 1.47, 95% CI 1.42, 1.53), compared to White race, and mothers with public (OR 1.06, 95%CI 1.03, 1.09) compared to private insurance (Table 2).

Conclusion(s): Preterm birth and low birthweight are associated with increased community-level social vulnerability and with persistent racial disparities. Policy approaches addressing community social factors and racial disparities are essential to improve infant health outcomes.