Neighborhood Evictions, Marital/Cohabiting Status, and Preterm Birth among African American Women

Abstract

Introduction: Housing stability is an impor­tant determinant of health, but no studies to our knowledge have examined the spill-over effects of neighborhood eviction rates on individual risk of preterm birth (PTB) among African American women.Objective: We assessed whether living in a neighborhood with high eviction rates was associated with risk of PTB among African American women, and whether marital/co­habiting status modified the association.Methods: We spatially linked interview, medical record, and current address data from the Life-course Influences on Fetal Environments Study (2009-2011, N=1386) of postpartum African American women from Metropolitan Detroit, Michigan, to publicly available data on block-group level rates of eviction filings and judgements. PTB was defined as birth before 37 completed weeks of gestation and occurred in 16.3% of the sample (n=226). Eviction rate vari­ables were rescaled by their interquartile ranges (75th vs 25th percentiles). Women self-reported whether they were married to, or cohabiting with, the father of their baby during the in-person interview. We used Modified Poisson regression with robust er­ror variance to estimate relative risks of PTB associated with each eviction variable sepa­rately and included an interaction term with marital/cohabiting status (P<.10 considered significant) in adjusted models.Results: In the overall sample, neighbor­hood eviction filings and judgements did not predict PTB, but the associations were modified by marital/cohabiting status (P for interaction = .02, and .06, respectively). Among women who were married/cohabit­ing, those who lived in neighborhoods with high eviction filings (adjusted relative risk: 1.25, 95% CI: 1.06, 1.47) and eviction judgements (adjusted relative risk: 1.18, 95% CI: 1.05, 1.33) had higher risk of PTB than women who did not. Little evidence of an association was observed for women who were not married/cohabiting.Conclusions: Future studies should examine the mechanisms of the reported associations to identify novel intervention targets (eg, addressing landlord discrimina­tion) and policy solutions (eg, ensuring a living wage and providing affordable hous­ing assistance to everyone who qualifies) to reduce the burden of PTB among African Americans. Ethn Dis. 2021;31(2):197-204; doi:10.18865/ed.31.2.197