Reproductive
Neighborhood socioeconomic position and use of preconception folic acid-containing supplements in the National Birth Defects Prevention Study, 1997-2011 Anne Marie Darling* Anne Marie Darling Eirini Nestoridi Rashida Smith-Webb Wendy Nembhard Jenil Patel Bailey Wallace Shannon Evans Suzan Carmichael Gary Shaw Mahsa Yazdy
Background: Neighborhood socioeconomic position has been associated with the occurrence of neural tube defects (NTDs). Our objective was to determine any differences in folic acid-containing supplement use, which reduces the risk of NTDs, by neighborhood. Methods: This study included 10,504 control participants from the National Birth Defects Prevention Study who gave birth to liveborn infants between 1997-2011. The neighborhood-level socioeconomic position indicator (nSEPI) was derived through a principal components analysis that incorporated 17 census socioeconomic indicators pertaining to the census tract in which participants lived longest during the 3 months prior to conception. The nSEPI was categorized into tertiles, with the highest tertile representing the lowest socioeconomic position. Folic acid-containing supplement use was defined as any use of folic acid or multivitamins containing folic acid during the 3 months prior to conception. Generalized estimating equations accounting for census-tract clustering and adjusted for individual-level socioeconomic and demographic factors were used to estimate the association between nSEPI tertiles and preconception folic acid-containing supplement use. Associations with individual components of the nSEPI were also examined. Results: Participants residing in low socioeconomic neighborhoods (nSEPI tertile 3) were less likely to report preconception folic acid-containing supplement use (Odds Ratio [OR] 0.66, 95% Confidence Interval [CI] 0.56, 0.77). Individual components of the nSEPI were consistently associated with supplement use, including census tracts with high unemployment ratio (T3 vs. T1: OR 0.61, 95% CI 0.52, 0.72), and high ratio of female headed households with dependents (T3 vs. T1: OR 0.61, 95% CI 0.52, 0.71). Conclusions: Neighborhood socioeconomic inequalities in preconception folic acid-containing supplement use are present and highlight potential opportunities for policy and community level interventions to address these inequalities.