(934) Association Between Social Determinants of Health, Neighborhood Indices, and Preterm Birth: A Prospective Study

To evaluate the association between preterm birth and social determinants of health (SDoH) and neighborhood-level socioeconomic indices.

Study Design:

This was a nested case-control prospective study conducted at a tertiary care hospital from February 2024 to July 2025. We limited analysis to individuals aged 18–50 years with singleton pregnancies, gestational age >20 weeks, and livebirth. Participants with preterm births (< 37 weeks) and those with term births were enrolled in a 1:3 ratio. Participants completed the Accountable Health Communities Health-Related Social Needs screening tool, assessing core needs (housing instability, food insecurity, transportation, utility needs, and interpersonal safety) and supplemental needs (financial strain, employment, support, education, physical activity, substance use, mental health, and disability). Neighborhood indices, including Maternal Vulnerability Index (MVI), Area Deprivation Index (ADI), Walkability Index, and Food Desert status, were retrieved using individuals’ home addresses. Relative risks (RR) for SDoH variables were estimated using modified Poisson regression, adjusting for BMI, chronic hypertension (CHTN), and pregestational diabetes (PDM). Neighborhood indices were analyzed using bivariate methods with significance set at p< 0.05.

Results:
We included 280 participants, 209 delivered at term and 71 delivered preterm. Demographic and clinical characteristics were similar between groups except for CHTN (35.2% vs 12.4%, p=0.001), PDM (19.7% vs 6.2%, p=0.001), and gestational diabetes (19.7% vs 9.6%, p=0.024), which were significantly more frequent in the preterm group (Table 1). Compared to the preterm group, the term group had significantly higher substance use (9.9% vs 23.4%, p=0.013). There was no significant difference in core SDoH needs (23.9% vs. 35.9%; p=0.06), supplemental SDoH needs (91.5% vs. 94.7%; p=0.05), or neighborhood indices (Table 2).

Conclusion:

SDoH and neighborhood indices were not associated with preterm birth at a tertiary care hospital. This may reflect the dominant influence of medical risk factors in this population.