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. 2023 Nov 1;34(6):774-785.
doi: 10.1097/EDE.0000000000001655. Epub 2023 Sep 26.

Neighborhood Deprivation and Neural Tube Defects

Shannon Pruitt Evans  1   2 , Elizabeth C Ailes  1 , Michael R Kramer  3 , Charles J Shumate  4 , Jennita Reefhuis  1 , Tabassum Z Insaf  5   6 , Mahsa M Yazdy  7 , Suzan L Carmichael  8 , Paul A Romitti  9 , Marcia L Feldkamp  10 , Dayna T Neo  11 , Wendy N Nembhard  12 , Gary M Shaw  8 , Elizabeth Palmi  1   13 , Suzanne M Gilboa  1 ; National Birth Defects Prevention Study
Affiliations

Neighborhood Deprivation and Neural Tube Defects

Shannon Pruitt Evans et al. Epidemiology. .

Abstract

Background: Individual measures of socioeconomic status (SES) have been associated with an increased risk of neural tube defects (NTDs); however, the association between neighborhood SES and NTD risk is unknown. Using data from the National Birth Defects Prevention Study (NBDPS) from 1997 to 2011, we investigated the association between measures of census tract SES and NTD risk.

Methods: The study population included 10,028 controls and 1829 NTD cases. We linked maternal addresses to census tract SES measures and used these measures to calculate the neighborhood deprivation index. We used generalized estimating equations to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) estimating the impact of quartiles of census tract deprivation on NTDs adjusting for maternal race-ethnicity, maternal education, and maternal age at delivery.

Results: Quartiles of higher neighborhood deprivation were associated with NTDs when compared with the least deprived quartile (Q2: aOR = 1.2; 95% CI = 1.0, 1.4; Q3: aOR = 1.3, 95% CI = 1.1, 1.5; Q4 (highest): aOR = 1.2; 95% CI = 1.0, 1.4). Results for spina bifida were similar; however, estimates for anencephaly and encephalocele were attenuated. Associations differed by maternal race-ethnicity.

Conclusions: Our findings suggest that residing in a census tract with more socioeconomic deprivation is associated with an increased risk for NTDs, specifically spina bifida.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Study population and exclusion criteria.
FIGURE 2.
FIGURE 2.
A, Distribution of neighborhood deprivation scores of maternal periconceptional addresses among NTD cases, overall and by NTD type, and controls, National Birth Defects Prevention Study, 1997–2011. B, Distribution of neighborhood deprivation scores of maternal periconceptional addresses by maternal race/ethnicity among controls, National Birth Defects Prevention Study, 1997–2011. NTD indicates neural tube defect.
FIGURE 2.
FIGURE 2.
A, Distribution of neighborhood deprivation scores of maternal periconceptional addresses among NTD cases, overall and by NTD type, and controls, National Birth Defects Prevention Study, 1997–2011. B, Distribution of neighborhood deprivation scores of maternal periconceptional addresses by maternal race/ethnicity among controls, National Birth Defects Prevention Study, 1997–2011. NTD indicates neural tube defect.
See this image and copyright information in PMC

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