Unemployment at municipality level is associated with an increased risk of small for gestational age births - a multilevel analysis of all singleton births during 2005-2010 in Finland

• Type of Material: Article
• Authors: Sari Raisanen, Emory University; Michael Kramer, Emory University; Mika Gissler, National Institute for Health and Welfare; Juho Saari, University of Eastern Finland; Seppo Heinonen, Kuopio University Hospital
• Language: English
• Date: 2014-10-18
• Publisher: BMC (part of Springer Nature)
• Publication Version: Final Published Version
• Copyright Statement: © 2014 Räisänen et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12939-014-0095-1
• Title of Journal or Parent Work: International Journal for Equity in Health
• ISSN: 1475-9276
• Volume: 13
• Issue: 1
• Start Page: 95
• End Page: 95
• Grant/Funding Information: First author (SR) was supported by the Emil Aaltonen Foundation, Saastamoinen Foundation, and Jules and Uldeen Terry Endowment, Emory University.
• Keywords: Science & Technology; INCOME; NEIGHBORHOODS; WEIGHT; OUTCOMES; Preterm birth; METAANALYSIS; Socioeconomic status; Outcome; Childbirth; Multilevel analysis; TRENDS; Small for gestational age; Registries; SOCIOECONOMIC DIFFERENCES; Public, Environmental & Occupational Health; Life Sciences & Biomedicine; PREGNANCY; SMOKING
• Research Categories: Health Sciences, Public Health; Sociology, Public and Social Welfare

Abstract

Introduction: Neighbourhood level deprivation has been shown to influence adverse perinatal outcomes independent of individual level socioeconomic status (SES) in countries with high income inequality, such as the United States. The present study evaluates whether municipality level deprivation defined based on education (proportion of inhabitants with university level education), income (mean income per capita) and unemployment were associated with the prevalence of preterm birth (<37 weeks) and small for gestational age (SGA, birth weight <2 standard deviations) after adjustment for individual level socio-demographics (age, parity, prior preterm births, smoking during pregnancy and SES defined based on maternal occupation at birth) in Finland. Methods: The study design was cross-sectional. The data gathered from the Medical Birth Register included all singleton births (n = 345,952) in 2005-2010. We fitted Generalized Estimating Equations (GEE) models to account for correlation of preterm birth and SGA clustering within municipality. Results: Of all the women with singleton pregnancies, 4.5% (n = 15,615) gave birth preterm and 3.8% (n = 13,111) of their newborns were classified as SGA. Individual level SES and smoking were important risk factors for each outcome in adjusted models. Controlling for individual level factors, women living in intermediate and high unemployment class municipalities were 6.0% (adjusted odds ratio (aOR) = 1.06; 95% confidence interval (CI) 1.01-1.12) and 13.0% (aOR = 1.13; 95% CI 1.06-1.20), respectively, more likely to give birth to an SGA newborn than women living in low unemployment class municipalities. Conclusions: After adjustment for individual level socio-demographics, the prevalence of SGA was around 6-13% higher in municipalities with an intermediate or high unemployment rate than municipalities with the lowest unemployment rate. The results suggested that the unemployment rate has an important public health effect with clinical implications since SGA is associated with a higher risk of adverse long-Term health outcomes.