Geographic Hotspots for Low Birthweight: An Analysis of Counties With Persistently High Rates

Inquiry: a journal of medical care organization, provision and financing

article

Clare C. Brown¹  Jennifer E. Moore²  Holly C. Felix¹  Mary K. Stewart¹  John M. Tilford¹ 

[1]University of Arkansas for Medical Sciences

[2]Institute for Medicaid Innovation

[3]University of Michigan Medical School

关键词: birth outcomes;    prematurity;    low birthweight;   

DOI  :  10.1177/0046958020950999

来源: Sage Journals

【 摘 要 】

This study evaluated persistency in county-level rates of low birthweight outcomes to identify “hotspot counties” and their associated area-level characteristics. Administrative data from the National Center for Health Statistics Birth Data Files, years 2011 to 2016 were used to calculate annual county-level rates of low birthweight. Counties ranking in the worst quintile (Q5) for ≥3 years with a neighboring county in the worst quintile were identified as hotspot counties. Multivariate logistic regression was used to associate county-level characteristics with hotspot designation. Adverse birth outcomes were persistent in poor performing counties, with 52% of counties in Q5 for low birthweight in 2011 remaining in Q5 in 2016. The rate of low birthweight among low birthweight hotspot counties (n = 495) was 1.6 times the rate of low birthweight among non-hotspot counties (9.3% vs 5.8%). The rate of very low birthweight among very low birthweight hotspot counties (n = 387) was twice as high compared to non-hotspot counties (1.8% vs 0.9%). A one standard deviation (6.5%) increase in the percentage of adults with at least a high school degree decreased the probability of low birthweight hotspot designation by 1.7 percentage points ( P  = .006). A one standard deviation (20%) increase in the percentage of the population that was of minority race/ethnicity increased hotspot designation for low birthweight by 5.7 percentage points ( P  < .001). Given the association between low birthweight and chronic conditions, hotspot counties should be a focus for policy makers in order to improve health equity across the life course.

【 授权许可】

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