Socioeconomic Disadvantage Is Associated With Risk and Severity of Anemia [ID: 1377641]

Abstract

INTRODUCTION: Anemia on admission for delivery is a significant contributor to peripartum transfusion. Risk of maternal morbidity including transfusion has been linked to neighborhood deprivation. We sought to explore the relationship between a composite measure of neighborhood-level deprivation and frequency and severity of anemia on admission for delivery. METHODS: We performed an IRB-approved retrospective cohort analysis of delivery admissions in a single health care network from 2015 to 2020. Area deprivation index (ADI) was used to represent neighborhood socioeconomic disadvantage and is a composite index of neighborhood that spans income, education, household characteristics, and housing. The index ranges from 1 to 100 with higher values indicating higher disadvantage. Anemia was defined as hemoglobin less than 11.0 mg/dL and severe anemia less than 9.0 mg/dL. Multivariable binomial regression models assessed the relationship between ADI and anemia. RESULTS: Eighty-five thousand five hundred fifty-three delivery admissions were included. A monotonic linear positive relationship was observed between ADI and anemia. Individuals who reside in the most disadvantaged neighborhoods (ADI>95) had 2.2 times the odds (95% CI 2.1–2.3) of anemia on admission for delivery. For example, individuals who live in a less disadvantaged neighborhood (ADI of 5) had a 11% predicted probability of anemia compared to 23% in individuals who lived in a more disadvantaged neighborhood (ADI of 95). Individuals who lived in the most disadvantaged neighborhoods had a higher rate of severe anemia (1% versus 3%, P<.001). CONCLUSION: Anemia is more likely and more severe in individuals living in disadvantaged neighborhoods. Neighborhood-level interventions could be used to target populations at high risk for anemia and potentially affect maternal outcomes.