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To examine whether poor mothers and their infants have better or worse health when they live in affluent neighbourhoods.
Cross-sectional analysis of 14 465 white mothers surveyed in the first wave of the Millennium Cohort Study, 3654 of these mothers were defined as poor. The socio-economic context for poor mothers was measured by lower super output area (LSOA)-level measures of income. UK-wide analyses used the LSOA decile ranks of the index of multiple deprivation (IMD) income domain. A subset England-only analysis of 7288 mothers used continuous IMD income domain scores.
Maternal self-rated health and limiting long-term illness (LLI), low birthweight (LBW), and preterm delivery. Logistic regression models were run separately for poor (<£10 400) and non-poor households. Models were adjusted for age, marital status, parity, urban status, duration at address, occupational class and educational attainment.
For poor mothers, odds for LBW and LLI increased with every decile of area income, by 9% and 8% respectively (p<0.05 all models). This contrasted with findings for non-poor mothers – for whom odds decreased 6% and 5% respectively (not significant for LLI). In the subset England-only analysis, for poor mothers, area income was positively associated with LLI and LBW but significant only for LLI. Self-rated health did not vary significantly across areas for poor mothers. In contrast, for non-poor mothers, poor/fair self-rated health was negatively associated with area-level income, decreasing by 11% for each area income decile (p<0.001 all models and England subset). Odds of preterm delivery decreased for poor mothers by 7% per decile (p<0.05), but this was not significant for England-only analyses. No models examining area income in relation to preterm delivery were significant for non-poor mothers.
Apart from preterm delivery, health outcomes of non-poor mothers are improved when they live in more affluent areas. This is not the case for poor mothers, who do not have better self-rated health, and who have higher risk of LBW and LLI in richer areas. These findings may support a psycho-social causal model mediated by area socio-economic density. Further work is needed to test mediating pathways such as social engagement and class discrimination.
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