Compromised reproductive health associated with socioeconomically deprived neighbourhoods

A recent study published in JAMA network opened found that women living in socioeconomically disadvantaged neighborhoods in the United States (US) have moderately lower odds of conception without fertility treatment.

Background

Infertility places a huge economic burden in the US and the prevalence among couples belonging to the reproductive age group is 10-15%.

Fertility is a measure of the likelihood of conception of a couple during a menstrual cycle. Modifiable risk factors believed to affect fertility include changes in lifestyle and behavior. It was recently determined that structural, political and environmental factors also influence this measure of fertility.

Socio-economic neighborhood environment includes aspects such as access to education, household income, employment and housing quality. Emerging evidence suggests that a deprived socioeconomic neighborhood environment can impact a community’s reproductive health outcomes. Confusing factors that associate near socioeconomic disadvantage with fertility include stress, allostatic load, and cortisol levels.

The study

This was a prospective cohort study conducted in US couples attempting spontaneous pregnancy, with the aim of establishing a correlation between living in a deprived neighborhood and fertility. Classification at the national and state level of the status of deprived neighborhoods was considered.

For six (consecutive) years, up to 2019, women of childbearing age from the contiguous US completed a questionnaire asking about their sociodemographic and lifestyle characteristics, medical and drug history, and reproductive health.

A total of 6,356 participants had 3,725 pregnancies that occurred during the study period and from 27,427 menstrual cycles, in the 48 US states.

The majority of participants were non-Hispanic white individuals and nulliparous, with at least 16 years of education. Also, the average annual household income of most participants was higher than the general population.

It was noted that nationally, the participants from deprived neighborhoods were younger, had lower educational attainment, and had lower family incomes. In addition, smoking was more common in this group and less likely to be identified as non-Hispanic white individuals.

State-level characteristics were consistent; however, the differences seemed more remarkable. The Spearman correlation between the national and within-state area deprivation index (ADI) rankings, which estimates relative deprivation in a neighborhood or community, was 0.76. ADI is associated with the health outcomes of a population.

There was an inverse correlation between ADI and fertility in participants residing in a region with an ADI > 60. The fertility ratio (FR) showed a linear inverse relationship with the ADI, while fertility represented 19% and 21% reductions in the comparison between the most deprived neighborhoods and the least deprived neighbourhoods, respectively.

Furthermore, the state-level ranking indicated an inverse relationship between the ADI and fertility in participants living in neighborhoods with an ADI > 5. On the other hand, when the most deprived neighborhoods were compared to the least deprived neighborhoods, the FR represented 25% and 23% reductions in fertility, respectively.

Subgroup analysis focused primarily on the state-level ADI ranking, which showed an inverse association of ADI with fertility in participants with an annual household income of <$50,000.

In addition, participants with pregnancy attempts for < three menstrual cycles (at baseline) showed similar results, although non-specific. In addition, the parity of the women did not appear to change the results, while parous participants showed less precise inverse associations.

In addition, the results were less striking when adjusting for race, ethnicity and education level. The overall results seemed to appear further subdued after confusion with household income.

conclusions

The findings highlighted the association of socioeconomically deprived neighborhood environments with compromised reproductive health. Strategies aimed at narrowing the socioeconomic divide can help improve reproductive health and fertility in these communities.