The Geographical Correlation Between Historical Preterm Birth Disparities and COVID-19 Burden

Ponnila S Marinescu; Courtney Olson-Chen; J Christopher Glantz; Elaine Hill; Stefanie J Hollenbach

doi:10.1007/s43032-022-01076-w

The Geographical Correlation Between Historical Preterm Birth Disparities and COVID-19 Burden

Reprod Sci. 2023 Apr;30(4):1343-1349. doi: 10.1007/s43032-022-01076-w. Epub 2022 Sep 16.

Authors

Ponnila S Marinescu¹, Courtney Olson-Chen², J Christopher Glantz², Elaine Hill³, Stefanie J Hollenbach^{2

4}

Affiliations

¹ Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Box 668, Rochester, NY, 14642, USA. Ponnila_Marinescu@urmc.rochester.edu.
² Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Box 668, Rochester, NY, 14642, USA.
³ Department of Public Health Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.
⁴ Department of Biomedical Engineering, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, USA.

Abstract

Similar to obstetric outcomes, rates of SARS-CoV-2 (COVID-19) infection are not homogeneously distributed among populations; risk factors accumulate in discrete locations. This study aimed to investigate the geographical correlation between pre-COVID-19 regional preterm birth (PTB) disparities and subsequent COVID-19 disease burden. We performed a retrospective, ecological cohort study of an upstate New York birth certificate database from 2004 to 2018, merged with publicly available community resource data. COVID-19 rates from 2020 were used to allocate ZIP codes to "low-," "moderate-," and "high-prevalence" groups, defined by median COVID-19 diagnosis rates. COVID-19 cohorts were associated with poverty and educational attainment data from the US Census Bureau. The dataset was analyzed for the primary outcome of PTB using ANOVA. GIS mapping visualized PTB rates and COVID-19 disease rates by ZIP code. Within 38 ZIP codes, 123,909 births were included. The median COVID-19 infection rate was 616.5 (per 100 K). PTB (all) and COVID-19 were positively correlated, with high- prevalence COVID-19 ZIP codes also being the areas with the highest prevalence of PTB (F = 11.06, P = .0002); significance was also reached for PTB < 28 weeks (F = 15.87, P < .0001) and periviable birth (F = 16.28, P < .0001). Odds of PTB < 28 weeks were significantly higher in the "high-prevalence" COVID-19 cohort compared to the "low-prevalence" COVID 19 cohort (OR 3.27 (95% CI 2.42-4.42)). COVID-19 prevalence was directly associated with number of individuals below poverty level and indirectly associated with median household income and educational attainment. GIS mapping demonstrated ZIP code clustering in the urban center with the highest rates of PTB < 28 weeks overlapping with high COVID-19 disease burden. Historical disparities in social determinants of health, exemplified by PTB outcomes, map community distribution of COVID-19 disease burden. These data should inspire socioeconomic policies supporting economic vibrancy to promote optimal health outcomes across all communities.

Keywords: COVID-19; Community distribution; Geographic correlation; Infection rate(s); Preterm birth; Socioeconomic status.

MeSH terms

COVID-19 Testing
COVID-19* / epidemiology
Cohort Studies
Female
Humans
Infant, Newborn
Pregnancy
Premature Birth* / epidemiology
Retrospective Studies
SARS-CoV-2