Injuries/Violence
Exposure to Chronic Community Violence and Perinatal Outcomes in California (2007-2018) Shelley Jung* Shelley Jung Caitlin Chan Dana Goin Emily F Liu Kara E Rudolph Kristen Marchi William Dow Paula Braveman Mahasin Mujahid Jennifer Ahern
Community violence is a persistent problem in the US, but its impacts on health in the broader community are not well understood. To better understand community-level determinants of perinatal health, we estimated the association of chronic community violence with perinatal outcomes in California using a strong design to mitigate between community confounding.
We combined neighborhood violence data (rate of deaths/injuries per ZIP Code) with hospital records on singleton live births in California from 2007-2018. We estimated propensity scores to identify neighborhoods with similar characteristics (income, poverty, race/ethnicity), but differing levels of community violence, limiting analyses to areas of common support. We estimated excess risk of perinatal outcomes that include preterm birth (PTB), hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), and severe maternal morbidity (SMM) in individuals exposed to high neighborhood violence (≥75th percentile of the 12-month average [Y/N]) during pregnancy. We applied targeted maximum likelihood estimation to estimate risk differences (RD) adjusted for individual- and community-level confounders.
Across 5,067,437 pregnancies (83% of all births), exposure to high community violence was associated with elevated risk of PTB (RD[95% confidence interval (CI)]=1.3 excess cases/1000 births[1.3,1.3]), HDP (RD[95% CI]=3.8 excess cases/1000 births[3.8,3.8]), GDM (RD[95% CI]=8.2 excess cases/1000 births[8.2,8.2]), and SMM (RD[95% CI]=0.6 excess cases/1000 births[0.6,0.6]). We found that exposure to community violence during pregnancy was associated with increased risk of multiple adverse perinatal outcomes, using a design that maximizes the comparability of the exposed and unexposed groups on measured community and individual characteristics. Increased understanding of this relationship has the potential to provide alternative points of intervention to decrease rates of these adverse perinatal outcomes.
