Journal
INTERNATIONAL JOURNAL OF HEALTH GEOGRAPHICS
Volume 12, Issue -, Pages -Publisher
BMC
DOI: 10.1186/1476-072X-12-32
Keywords
Mediation analysis; Pathways of adverse birth outcomes; Neighbourhood-level socio-economic determinants; Preterm birth; Low birth weight
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Background: Although socio-economic factors have been identified as one of the most important groups of neighbourhood-level risks affecting birth outcomes, uncertainties still exist concerning the pathways through which they are transferred to individual risk factors. This poses a challenge for setting priorities and developing appropriate community-oriented public health interventions and planning guidelines to reduce the level of adverse birth outcomes. Method: This study examines potential direct and mediated pathways through which neighbourhood-level socioeconomic determinants exert their impacts on adverse birth outcomes. Two hypothesized models, namely the materialist and psycho-social models, and their corresponding pathways are tested using a binary-outcome multilevel mediation analysis. Live birth data, including adverse birth outcomes and person-level exposure variables, were obtained from three public health units in the province of Ontario, Canada. Corresponding neighbourhood-level socio-economic, psycho-social and living condition variables were extracted or constructed from the 2001 Canadian Census and the first three cycles (2001, 2003, and 2005) of the Canadian Community Health Surveys. Results: Neighbourhood-level socio-economic-related risks are found to have direct effects on low birth weight and preterm birth. In addition, 20-30% of the total effects are contributed by indirect effects mediated through person-level risks. There is evidence of four person-level pathways, namely through individual socio-economic status, psycho-social stress, maternal health, and health behaviours, with all being simultaneously at work. Psychosocial pathways and buffering social capital-related variables are found to have more impact on low birth weight than on preterm birth. Conclusion: The evidence supports both the materialist and psycho-social conceptualizations and the pathways that describe them, although the magnitude of the former is greater than the latter.
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