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Income Inequality, Air Toxics and Variation in Adverse Birth Outcomes in Missouri Counties PDF
By:Philip Hamilton Howard
Published on 2002 by

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The rate of adverse birth outcomes varies significantly across Missouri counties. Most investigations into the causes of this variation have focused on variables measured at the individual level. I investigated the potential additional contribution of social and ecological variables, specifically income inequality and air toxics. The study included all singleton births to African-American or non-Hispanic white mothers in Missouri during the years 1989 to 1991 (n = 223,456). Logistic regression for the outcome low birth weight, as well as its two primary components, preterm births and intrauterine growth retardation, was performed using a multilevel model. A multilevel analysis was also conducted for the continuous outcome variable of birthweight. The first level included known individual-level risk factors of socioeconomic status, age, maternal smoking, ethnicity, adequacy of prenatal care, pre-pregnancy body mass index, weight gain during pregnancy, number of previous children and marital status. Level two of the analysis estimated the effects of variables measured at the county level, including six different measures of income inequality and modeled ambient air concentrations of the main air toxic of interest, polycyclic organic matter. A third level of the analysis controlled for spatial autocorrelation, or similarity of counties within regions. Income inequality was positively associated with all of the adverse birth outcomes. Four of the six inequality measures demonstrated strong associations, before and after controlling for individual-level risk factors. Polycyclic organic matter was strongly associated with preterm births, but not with intrauterine growth retardation. It was positively, but weakly associated with low birth weight and birthweight. The results indicate that an ecosocial framework improves prediction of adverse birth outcomes when compared to a focus exclusively on individual-level variables. The contribution of these macro-level variables is relatively small when compared to some known individual-level risk factors. However, the public health significance of income inequality and air toxics may be quite important because, unlike individual-level risk factors, they affect most, if not all pregnant women. Furthermore, the prevalence and the strength of some important individual-level risk factors were themselves found to be associated with income inequality.

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