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Population-Based Case-Control Study

Heidi K. Blume, MD, MPH; Christian M. Loch, PhD, MPH; Christopher I. Li, MD, PhD

Arch Pediatr Adolesc Med. 2007;161(7):663-668.

Objective  To investigate the association between maternal socioeconomic status and the risk of encephalopathy in full-term newborns.

Design  Population-based case-control study.

Setting  Washington State births from 1994 through 2002 recorded in the linked Washington State Birth Registry and Comprehensive Hospital Abstract Reporting System.

Participants  Cases (n = 1060) were singleton full-term newborns with Comprehensive Hospital Abstract Reporting System International Classification of Diseases, Ninth Revision diagnoses of seizures, birth asphyxia, central nervous system dysfunction, or cerebral irritability. Control cases (n = 5330) were singleton full-term newborns selected from the same database.

Main Exposures  Socioeconomic status was defined by median income of the census tract of the mother's residence, number of years of maternal educational achievement, or maternal insurance status.

Main Outcome Measures  Odds ratios estimating the risk of encephalopathy associated with disadvantaged socioeconomic status were calculated in 3 separate analyses using multivariate adjusted logistic regression.

Results  Newborns of mothers living in neighborhoods in which residents have a low median income were at increased risk of encephalopathy compared with newborns in neighborhoods in which residents have a median income more than 3 times the poverty level (adjusted odds ratio, 1.9; 95% confidence interval, 1.5-2.3). There was also a trend for increasing risk of encephalopathy associated with decreasing neighborhood income (P<.001). Newborns of mothers with less than 12 years of educational achievement had a higher risk of encephalopathy compared with newborns of mothers with more than 16 years of educational achievement (adjusted odds ratio, 1.7; 95% confidence interval, 1.3-2.3). Newborns of mothers receiving public insurance also had a higher risk of encephalopathy compared with newborns of mothers who have commercial insurance (adjusted odds ratio, 1.4; 95% confidence interval, 1.2-1.7).

Conclusion  Disadvantaged socioeconomic status was independently associated with an increased risk of encephalopathy in full-term newborns. These findings suggest that a mother's socioeconomic status may influence the risk of encephalopathy for her full-term newborn.

Author Affiliations: Division of Pediatric Neurology, Children's Hospital and Regional Medical Center (Dr Blume), and Department of Epidemiology (Dr Li), University of Washington, Seattle; and Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle (Drs Loch and Li).

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