Effect of neighbourhood income and maternal education on birth outcomes: a population-based study
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BACKGROUND: Maternal socioeconomic status (SES) is an important determinant of inequity in maternal and fetal health. We sought to determine the extent to which associations between adverse birth outcomes and SES can be identified using individual-level measures (maternal level of education) and community-level measures (neighbourhood income). METHODS: In Quebec, the birth registration form includes a field for the mother's years of education. Using data from birth registration certificates, we identified all births from 1991 to 2000. Using maternal postal codes that can be linked to census enumeration areas, we determined neighbourhood income levels that reflect SES. RESULTS: Lower levels of both maternal education and neighbourhood income were associated with elevated crude risks of preterm birth, small-for-gestational-age (SGA) birth, stillbirth and neonatal and postneonatal death. The effects of maternal education were stronger than, and independent of, those of neighbourhood income. Compared with women in the highest neighbourhood income quintile, women in the lowest quintile were significantly more likely to have a preterm birth (adjusted odds ratio [OR] 1.14, 95% confidence interval [CI] 1.10-1.17), SGA birth (OR 1.18, 95% CI 1.15-1.21) or stillbirth (OR 1.30, 95% CI 1.13-1.48); compared with mothers who had completed community college or at least some university, mothers who had not completed high school were significantly more likely to have a preterm birth (adjusted OR 1.48, 95% CI 1.44-1.52), SGA birth (OR 1.86, 95% CI 1.82-1.91) or stillbirth (OR 1.54, 95% CI 1.36-1.74). INTERPRETATION: Individual and, to a lesser extent, neighbourhood-level SES measures are independent indicators for subpopulations at risk of adverse birth outcomes. Women with lower education levels and those living in poorer neighbourhoods are more vulnerable to adverse birth outcomes and may benefit from heightened clinical vigilance and counselling.
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Studies from industrialized countries demonstrate an association between socioeconomic inequalities (e.g., low education level of women) and preterm birth.
“Studies from industrialized countries demonstrate an association between socioeconomic inequalities (e.g., low education level of women) and preterm birth [52-54].”
From The association between parity, infant gender, higher level of paternal education and preterm birth in Pakistan: a cohort study (2011) · cites this paper as [53]
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“, low education level of women) and preterm birth [52-54].”
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- Authors
- Luo, Z.-C.
- Affiliations
- McGill University (CA)
- Corresponding author
- Luo, Z.-C.
- ORCID
- Luo, Z.-C.
- Venue
- Canadian Medical Association Journal
- Publisher
- CMA Impact Inc.
- Published
- 2006-05-09
- Volume
- 174
- Issue
- 10
- Pages
- 1415-1420
- ISSN
- 0820-3946 (ISSN-L)
- 1488-2329
- PMC
- PMC1455422
- OpenAlex
- W2028048934
- Semantic Scholar
- ec82c60bb321557ff648b76322ebbdbd436fa00b
- Cited by
- 382
- References
- 22
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 11 · 2023: 18 · 2022: 16 · 2021: 21 · 2020: 17 · 2019: 12 · 2018: 14 · 2017: 20 · 2016: 14 · 2015: 23 · 2014: 33 · 2013: 21 · 2012: 24
- FWCI
- 40.54
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Canadian Medical Association Journal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research (2004-2005)
- Topics
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- neighborhood income, maternal education, socioeconomic status, birth outcomes, preterm birth, small-for-gestational-age birth, stillbirth, neonatal death, postneonatal mortality, health disparities, birth registration data
- MeSH terms
- Educational Status, Female, Humans, Income, Pregnancy, Pregnancy Outcome, Quebec, Rural Population, Urban Population, Odds Ratio, Premature Birth
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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