Assessing the Impact of Neighborhood Deprivation on Birth Defects among North Carolina singleton live births from 2011-2015
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One in 33 babies born in North Carolina (NC) are diagnosed with any birth defect. Little has been done to examine the association between community-level risk factors and birth defects. The objective of this study was to estimate the association of census-tract level neighborhood deprivation and prevalence of birth defects. Data from 2011-2015 from the NC Birth Defects Monitoring Program, the State Center for Health Statistics, and Census were combined. The Neighborhood Deprivation Index (NDI) was created using principal component analysis with census variables representing income/poverty, education, employment, housing, and occupation; we dichotomized NDI into high and low deprivation areas. Linear binomial regression was used to estimate the prevalence differences (PD) of birth defect diagnoses in the first year of life stratified by with and without early prenatal care (within first 5 months), adjusting for gestational parent age, education level at delivery, and race/ethnicity. Among the final sample of 566,799 births, 17,691 infants (3.1%) were diagnosed with at least one birth defect in the first year of life. The adjusted prevalence of birth defects among those with early prenatal care was 35.57 per 10,000 higher for those in high deprivation neighborhoods compared to those in low deprivation neighborhoods (PD=35.57, 95% CI: (25.26, 45.88)). The adjusted prevalence of birth defects among those without early prenatal care was 2.27 per 10,000 lower for those in high deprivation neighborhoods compared to those in low deprivation neighborhoods (PD=-2.27, 95% CI: (-39.84, 35.81)). Among those with early prenatal care, high levels of neighborhood deprivation had a significant impact on birth defect prevalence. These findings can be used to inform more specific research into other environmental- or neighborhood-level exposures that should be investigated in relation to birth defects, along with research into specific birth defects and groupings.