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Original research
Living in a block group with a higher eviction rate is associated with increased odds of preterm delivery
  1. Alexa A Freedman1,2,
  2. Britney P Smart2,
  3. Lauren S Keenan-Devlin2,
  4. Ann Borders2,3,4,
  5. Linda M Ernst5,
  6. Gregory E Miller1,6
  1. 1Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
  2. 2Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois, USA
  3. 3Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  4. 4Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  5. 5Department of Pathology, NorthShore University HealthSystem, Evanston, Illinois, USA
  6. 6Department of Psychology, Northwestern University, Evanston, Illinois, USA
  1. Correspondence to Dr Alexa A Freedman, Institute for Policy Research, Northwestern University, Evanston, IL 60201, USA; alexa.freedman{at}northwestern.edu

Abstract

Background Housing instability is associated with adverse pregnancy outcomes. Recent studies indicate that eviction, which may affect a larger segment of the population than other forms of housing instability, is also associated with adverse pregnancy outcomes. However, these studies evaluate eviction across large areas, such as counties, so it remains unclear whether these patterns extend to individual-level pregnancy outcomes.

Methods We used data on a cohort of all singleton live births at a single Chicago hospital between March 2008 and March 2018 to investigate the associations between block-group eviction rates and individual adverse pregnancy outcomes. Eviction data were obtained from the Eviction Lab at Princeton University. Generalised estimating equations were used to estimate associations and account for correlations among individuals living in the same block groups.

Results Individuals living in block groups in the highest quartile for eviction filing rate were 1.17 times as likely to deliver preterm (95% CI: 1.08 to 1.27) and 1.13 times as likely to deliver a small for gestational age infant (95% CI: 1.03 to 1.25) as compared with individuals living in block groups in the lowest quartile. Further, tests for linear trend indicated that for each quartile increase in eviction filing rate, there was a corresponding increase in odds of adverse outcomes (p<0.05). Results were strongest in magnitude for those with low neighbourhood and individual socioeconomic status, who are most likely to be renters and affected by local eviction policies.

Conclusion Our results suggest that individuals living in block groups with higher eviction rates are more likely to deliver preterm. Future research should explore associations of individual experience with eviction on adverse pregnancy outcomes and examine whether policies to improve tenant protections also impact pregnancy outcomes.

  • housing
  • pregnancy
  • neighborhood/place

Data availability statement

No data are available. We do not have permission to share study data.

https://doi.org/10.1136/jech-2020-215377

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    Data availability statement

    No data are available. We do not have permission to share study data.

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    Footnotes

    • Contributors AAF acquired and analysed the data with feedback from BPS, LSK-D, AB, LME and GEM. All authors assisted with interpretation of the results. AAF and BPS drafted the manuscript and LSK-D, AB, LME and GEM critically reviewed and provided feedback on multiple versions of the manuscript. All authors approved the final manuscript.

    • Funding This work was supported, in part, by the National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (award number F32HD100076), National Institute on Minority Health and Health Disparities (award number R01MD011749), and National Center for Advancing Translational Sciences (award number UL1TR001422).

    • Disclaimer The sponsors were not involved in the study design, data analysis, manuscript drafting or decision to submit for publication.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.