Preterm Birth in the Context of Increasing Income Inequality

Objective: Preterm birth is a leading cause of infant morbidity and mortality. Little is known about the contextual effect of US income inequality on preterm birth, an issue of increasing concern given that the current economic divide is the largest since 1928. Methods: We examined changes in inequality over time in relation to preterm birth among singleton deliveries from an electronic medical record-based cohort (n = 223,512) conducted in 11 US states and the District of Columbia from 2002 to 2008. Increasing income inequality was defined as a positive change in state-level Gini coefficient from the year prior to birth. Multi-level models estimated the independent effect of increasing inequality on preterm birth (>22 and <37 weeks) controlling for maternal demographics, health behaviors, insurance status, chronic medical conditions, and state-level poverty and unemployment during the year of birth. Results: The preterm birth rate was 12.3 % where inequality increased and 10.9 % where it did not. After adjustment, increasing inequality remained significantly associated with preterm birth (adjusted odds ratio 1.07, 95 % confidence interval 1.04, 1.11). We observed no significant interaction by insurance status or race, suggesting that increasing inequality had a broad effect across the population. Conclusions: The contextual effect of increasing income inequality on preterm birth risk merits further study.