Neighborhood deprivation and preterm delivery during the coronavirus 2019 pandemic

FISHER, Stephanie A.; SAKOWICZ, Allie; BARNARD, Cynthia; KIDDER, Seth; MILLER, Emily S.

Background Prior studies have reported decreases in preterm delivery (PTD) incidence during the coronavirus 2019 (COVID-19) pandemic, however findings are inconsistent. Given wide disparities in the pandemic's impact across communities, neighborhood deprivation may explain observed variation in the relationship between the COVID-19 pandemic and preterm delivery. Objective To characterize changes in the incidence of PTD during the COVID-19 pandemic with attention to effect modification introduced by neighborhood hardship. Study Design This retrospective cohort study included all pregnant patients who delivered at an urban tertiary care hospital during the pandemic (April-November 2020) or pre-pandemic (April-November 2019). We compared the incidence of PTD, spontaneous PTD, and medically indicated PTD prior to 37 weeks’ gestation across epochs. Planned analyses stratified the cohorts by neighborhood deprivation metrics defined by residential zip code, including median neighborhood household income and hardship index (a composite index including dependency, educational attainment, unemployment, poverty, per capita income, and crowded housing). The Breslow-Day test for homogeneity assessed the association of delivery epoch and neighborhood deprivation with PTD outcome. Results Of 16,544 eligible deliveries, 8.7% occurred preterm. Incidences of PTD (8.4% vs. 9.0%, p=0.17), spontaneous PTD (5.0 vs 5.4%, p=0.27), and medically indicated PTD (3.2% v 3.5%, p=0.47) were similar between the pandemic and pre-pandemic epochs. However, PTD (OR 0.78, 95% CI 0.64-0.96) and spontaneous PTD (OR 0.76, 95% CI 0.59-0.99) decreased from the pre-pandemic to pandemic epoch in those living in neighborhoods <50th percentile for median income (Breslow-Day p-values 0.047 and 0.036, respectively). Similarly, PTD (OR 0.78, 95% CI 0.64-0.97) and spontaneous PTD (OR 0.74, 95% CI 0.57-0.98) decreased for those inhabiting neighborhoods in the highest-hardship quartile (Breslow-Day p-values 0.045 and 0.029, respectively). Conclusion Populations residing in socioeconomically disadvantaged neighborhoods experienced reductions in preterm delivery during the COVID-19 pandemic. Neighborhood-level social determinants of health offer insight into the complex etiologies that contribute to preterm delivery, and provide opportunities for public health, equity-focused prevention strategies.