OBJECTIVE To evaluate the association between area poverty and adverse birth outcomes in the diverse birthing population of a large health system. METHODS This was a retrospective cohort study using electronic health record and hospital administrative data for pregnant people at nine hospitals within a large health system in the Chicago metropolitan area from 2018 to 2023. Patient addresses were geocoded and categorized by Census tract area percent poor households. Unadjusted and adjusted Poisson regression models, controlling for individual-level risk factors, evaluated the independent association between area poverty and birth outcomes to determine the degree to which this association is attenuated by the inclusion of individual-level factors in the model. RESULTS The study included 85,025 pregnant people. Area poverty was associated with sociodemographic factors, including young age, non-Hispanic Black race, Hispanic ethnicity, Medicaid insurance coverage, higher parity, and several comorbid conditions. Area poverty was associated with adverse birth outcomes and demonstrated a gradient effect with increasing area poverty in bivariable analyses. In unadjusted regression analyses, residence in areas with 5.0% or more poverty was associated with severe maternal morbidity, preterm birth, and low birth weight, and residence in areas with 8.0% or higher poverty was associated with neonatal intensive care unit admission. Although these associations persisted in multivariable analysis for severe maternal morbidity and neonatal intensive care unit admission, the associations with preterm birth and low birth weight persisted only for individuals residing in areas of 12.0% or higher poverty when controlling for individual-level risk factors. CONCLUSION Area poverty was associated with adverse birth outcomes in this birthing population even when controlling for individual-level risk factors, highlighting the need for system- and community-level quality-improvement interventions.

中文翻译：

---

地区贫困和不良出生结果：质量改进的机会。


目的 评估大型卫生系统的不同出生人群中地区贫困与不良出生结局之间的关联。方法 这是一项回顾性队列研究，使用 2018 年至 2023 年芝加哥大都会区大型卫生系统内 9 家医院的孕妇的电子健康记录和医院管理数据。对患者地址进行地理编码，并按人口普查区域贫困家庭百分比进行分类。控制个体水平风险因素的未调整和调整泊松回归模型评估了地区贫困与出生结果之间的独立关联，以确定在模型中纳入个体水平因素后这种关联的减弱程度。结果 该研究包括 85,025 名孕妇。地区贫困与社会人口因素相关，包括年轻、非西班牙裔黑人种族、西班牙裔、医疗补助保险覆盖率、较高的胎价和几种合并症。地区贫困与不良出生结局相关，并在双变量分析中显示出随着地区贫困增加的梯度效应。在非调整回归分析中，居住在贫困率为 5.0% 或以上的地区与严重的孕产妇发病率、早产和低出生体重相关，居住在贫困率为 8.0% 或更高的地区与新生儿重症监护病房入住相关。尽管这些关联在严重孕产妇发病率和新生儿重症监护病房收视率的多变量分析中持续存在，但在控制个体水平的风险因素时，与早产和低出生体重的关联仅在居住在 12.0% 或更高贫困地区的个体中持续存在。 结论 即使在控制个体层面的风险因素的情况下，该地区贫困也与该出生人群的不良出生结局相关，突出了系统和社区层面质量改进干预措施的必要性。