Socioeconomic Disparities in Adverse Birth Outcomes in Urban and Rural Contexts: a French Mother-Child Cohort.
BACKGROUND
Although adverse birth outcomes have been associated with neighbourhood deprivation in urban areas, few studies have addressed this issue in rural zones. This study examines whether associations between neighbourhood deprivation and adverse birth outcomes differ in urban and rural contexts, while taking individual characteristics and spatial accessibility of prenatal care (SAPC) into account.


METHODS
Pregnant women from a French mother-child cohort were recruited from 2002 to 2006 in Brittany. Their residential addresses were geocoded into their census blocks (the finest geographical resolution available). Deprivation was assessed at the same neighbourhood level. Models to assess the associations of deprivation, stratified by urban/rural status, with preterm delivery (PTD), with small for gestational age birth weight (SGA) and with small for gestational age head circumference at birth (SHC), estimated odds ratios (ORs), adjusted for maternal socioeconomic characteristics and SAPC.


RESULTS
This study considered 2929 liveborn singleton pregnancies from 780 census blocks. Neighbourhood deprivation was associated with increased risks of SGA and SHC (P trend < 0.01 and 0.03 respectively), only among mothers residing in rural areas. Neighbourhood deprivation had statistically significantly heterogeneous effects on SGA and SHC according to the urban/rural status of maternal residence.


CONCLUSION
These findings suggest that neighbourhood deprivation affects fetal growth differentially in urban and rural areas and that SAPC does not seem to be responsible for this difference. Comparison of these findings with the literature requires caution in the conceptualisation of urban and rural settings.
['Bertin|Mélanie|M|', 'Viel|Jean-François|JF|', 'Monfort|Christine|C|', 'Cordier|Sylvaine|S|', 'Chevrier|Cécile|C|']
D000328:Adult D001724:Birth Weight D005260:Female D005602:France D006297:Health Services Accessibility D054624:Health Status Disparities D006801:Humans D007231:Infant, Newborn D007236:Infant, Small for Gestational Age D000068101:Maternal-Child Health Services D009035:Mothers D016017:Odds Ratio D011203:Poverty D011247:Pregnancy D011256:Pregnancy Outcome D011295:Prenatal Care D012111:Residence Characteristics D012307:Risk Factors D012424:Rural Population D012959:Socioeconomic Factors D014505:Urban Population
adverse birth outcomes neighbourhood deprivation spatial accessibility of prenatal care urban-rural context