Understanding how the concentration of neighborhood advantage and disadvantage affects spina bifida risk among births to non‐Hispanic white and Hispanic women, Texas, 1999–2014

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Abstract
Background: This is the first study to utilize the index of concentration at the extremes (ICE) to examine risk factors for spina bifida in Texas. The ICE is a useful measure for providing the degree to which residents in a certain area are concentrated into groups at the extremes of disadvantage and privilege. We introduce two novel ICE measures (language and nativity), and three existing ICE measures (race/ethnicity, income, and education), which we applied specifically to Texas residents.Methods: We used multivariable mixed‐model Poisson regression analyses to estimate spina bifida birth prevalence and prevalence ratios among singleton live births in Texas, 1999–2014, for each of our ICE measures. Maternal census tract at delivery was included in the models as a random effect. Analyses were stratified by maternal race/ethnicity (Hispanics and non‐Hispanic whites). Live births served as denominators for each category.Results: Among non‐Hispanic white women, those in the most disadvantaged versus the advantaged census tract quintile had adjusted relative risk between 1.6 and 8.5 for having a baby affected by spina bifida. However, Hispanic women in the most disadvantaged versus advantaged census tract quintile for four ICE measures had a 33% to 87% lower risk of having an affected pregnancy.Conclusions: Findings suggest spina bifida risk is associated with neighborhood disadvantage or advantage, and that relationship seems to vary by race‐ethnicity. The varied associations between ICE measures and spina bifida by race/ethnicity highlights the importance of using targeted interventions in the prevention of spina bifida.
Funding Information
  • Office of Title V and Family Health, Texas Department of State Health Services

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