Associations of neighbourhood crime with adverse pregnancy outcomes among women in Chicago: analysis of electronic health records from 2009 to 2013
Associations of neighbourhood crime with adverse pregnancy outcomes among women in Chicago: analysis of electronic health records from 2009 to 2013
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DOI：
10.1136/jech-2017-209801
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发表时间：
2018-03-01
影响因子：
6.3
通讯作者：
Kershaw, Kiarri N.
中科院分区：
文献类型：
--
作者：
Mayne, Stephanie L.;Pool, Lindsay R.;Kershaw, Kiarri N.
背景不良妊娠结局与母亲患心血管疾病的高风险和后代未来的健康问题相关。邻里犯罪可能通过增加慢性压力而导致不良妊娠结果，但这种关联的研究相对不足。方法对2009-2013年芝加哥一家医院34383例单胎分娩的电子健康记录进行地理编码，并与社区（芝加哥社区）一级警方记录的1年犯罪率相关联。罪行包括杀人、殴打、刑事罪行和不文明行为。采用社区区域随机截距的多水平logistic回归评估社区总犯罪率与妊娠高血压病（HDP：先兆子痫/妊娠高血压）、早产（PTB）、自发性早产（sPTB）和小胎龄（SGA）出生的横断面关联。模型控制了母婴特征和邻里贫困。然后，我们评估了个别犯罪类别与所有结果之间的联系。结果社区总犯罪率为每年每1000人11.6至303.5起（平均值：61.5起，标准差：40.3）。在完全调整的模型中，1-SD高的总社区犯罪率与HDP （OR: 1.06, 95%CI 1.00至1.13）、PTB （OR: 1.09, 95%CI 1.03至1.15）、sPTB （OR: 1.09, 95%CI 1.03至1.16）和SGA （OR: 1.05, 95%CI 1.01至1.10）的高几率相关。尽管只有攻击/殴打和不文明行为与HDP有关，但不同犯罪类别的关联总体上是一致的。结论：较高的社区犯罪率与不良妊娠结局的几率虽小但显著增加有关。培养更安全社区的干预措施可能是改善妊娠结局的一种有希望的方法。
Background Adverse pregnancy outcomes are associated with higher cardiovascular disease risk among mothers and future health problems of offspring. Neighbourhood crime may contribute to adverse pregnancy outcomes by increasing chronic stress, yet the association has been relatively understudied.Methods Electronic health records from 34383 singleton births at a single hospital in Chicago (2009-2013) were geocoded and linked to 1-year rates of police-recorded crime at the neighbourhood (Chicago community area) level. Crimes included homicide, assault/battery, criminal offences and incivilities. Cross-sectional associations of total neighbourhood crime rates with hypertensive disease of pregnancy (HDP: pre-eclampsia/gestational hypertension), preterm birth (PTB), spontaneous preterm birth (sPTB) and small-for-gestational-age (SGA) birth were assessed using multilevel logistic regression with community-area random intercepts. Models controlled for maternal and infant characteristics and neighbourhood poverty. We then assessed associations between individual crime categories and all outcomes.Results Total neighbourhood crime rates ranged from 11.6 to 303.5 incidents per 1000 persons per year (mean: 61.5, SD: 40.3). A 1-SD higher total neighbourhood crime rate was associated with higher odds of HDP (OR: 1.06, 95%CI 1.00 to 1.13), PTB (OR: 1.09, 95%CI 1.03 to 1.15), sPTB (OR: 1.09, 95%CI 1.03 to 1.16) and SGA (OR: 1.05, 95%CI 1.01 to 1.10) in fully adjusted models. Associations were generally consistent across crime categories, although only assault/battery and incivilities were associated with HDP.Conclusions Higher neighbourhood crime rates were associated with small but significant increases in the odds of adverse pregnancy outcomes. Interventions that cultivate safer neighbourhoods may be a promising approach for improving pregnancy outcomes.