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Neighborhood Physical Disorder and Adverse Pregnancy Outcomes among Women in Chicago: a Cross-Sectional Analysis of Electronic Health Record Data

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Abstract

Adverse pregnancy outcomes increase infants’ risk for mortality and future health problems. Neighborhood physical disorder may contribute to adverse pregnancy outcomes by increasing maternal chronic stress. Google Street View technology presents a novel method for assessing neighborhood physical disorder but has not been previously examined in the context of birth outcomes. In this cross-sectional study, trained raters used Google’s Street View imagery to virtually audit a randomly sampled block within each Chicago census tract (n = 809) for nine indicators of physical disorder. We used an item-response theory model and spatial interpolation to calculate tract-level neighborhood physical disorder scores across Chicago. We linked these data with geocoded electronic health record data from a large, academic women’s hospital in Chicago (2015–2017, n = 14,309 births). We used three-level hierarchical Poisson regression to estimate prevalence ratios for the associations of neighborhood physical disorder with preterm birth (overall and spontaneous), small for gestational age (SGA), and hypertensive disorder of pregnancy (HDP). After adjustment for maternal sociodemographics, multiparity, and season of birth, living in a neighborhood with high physical disorder was associated with higher prevalence of PTB, SGA, and HDP (prevalence ratios and 95% confidence intervals 1.21 (1.06, 1.39) for PTB, 1.13 (1.01, 1.37) for SGA, and 1.23 (1.07, 1.42) for HDP). Adjustment for neighborhood poverty and maternal health conditions (e.g., hypertension, diabetes, asthma, substance use) attenuated associations. Results suggest that an adverse neighborhood physical environment may contribute to adverse pregnancy outcomes. However, future work is needed to disentangle the unique contribution of physical disorder from other characteristics of disadvantaged neighborhoods.

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Acknowledgments

We thank Allison Mo, Angelina Jose, Argie Claro, Hussain Ali, Jennifer Abel, Julia Davis, Lynn Vo, Meghan Murphy, and Simona Rachapalli for their assistance with conducting the neighborhood audits.

Funding

This research was supported by an NHLBI Training Grant in Cardiovascular Epidemiology and Prevention (award number T32HL069771) and by the Northwestern Medicine Enterprise Data Warehouse Pilot Data Program from the Northwestern University Clinical and Translational Sciences Institute (NUCATS).

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Authors and Affiliations

  1. Division of General Pediatrics, PolicyLab, and the Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Stephanie L. Mayne

  2. Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Stephanie L. Mayne

  3. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Bernard F. Pellissier & Kiarri N. Kershaw

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  1. Stephanie L. Mayne
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Correspondence to Stephanie L. Mayne.

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Mayne, S.L., Pellissier, B.F. & Kershaw, K.N. Neighborhood Physical Disorder and Adverse Pregnancy Outcomes among Women in Chicago: a Cross-Sectional Analysis of Electronic Health Record Data. J Urban Health 96, 823–834 (2019). https://doi.org/10.1007/s11524-019-00401-0

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