Effect of Neighborhood Socioeconomic Indicators and Violent Crime on Prenatal Care Utilization

Background: Prenatal care is a preventive health care service during pregnancy that has the potential to improve health outcomes for women and their infants. Despite its importance, some women do not receive adequate prenatal care services, particularly those at risk of adverse pregnancy outcomes. Objectives: The main objectives were to examine the relationships between neighborhood social contexts and prenatal care utilization (PNCU) using both geographically weighted regression and multilevel regression analyses. In addition, the role of individual-level characteristics and place of residence in racial/ethnic disparities in late/no prenatal care and in inadequate PNCU was also examined. Method: Birth files of Chicago residents who had a live birth between 2010 and 2014 were linked to community-level (Chicago community area) characteristics. Neighborhood socioeconomic indicators, racial residential segregation, and community racial/ethnic composition were derived from data obtained from the American Community Survey, and community violent crime rates were obtained from the Chicago Police Department. Geographical Information Systems (GIS) tools were used to examine the spatial associations between the neighborhood characteristics and inadequate PNCU using spatial cluster and geographically weighted regression (GWR) analyses. Multilevel logistic regression analyses were also used to examine the associations and to determine if the associations vary by race/ethnicity and Chicago region. Generalized estimating equation models were used to examine the role of maternal characteristics and community racial/ethnic composition in racial/ethnic disparities in late/no prenatal care and in inadequate PNCU. Results: There was evidence of spatial disparities in PNCU in the city of Chicago. The spatial pattern of inadequate PNCU closely follows the spatial distributions of neighborhood hardship, community violent crime rate, and Non-Hispanic Black isolation across Chicago community areas. The relationships between neighborhood hardship, community violent crime rate, and Non-Hispanic Black isolation with respect to PNCU are inextricably complex and vary by race/ethnicity and Chicago region. However, for all racial/ethnic groups combined, neighborhood hardship is ubiquitously associated with inadequate PNCU. Racial/ethnic disparities in PNCU are lower among women with Medicaid coverage than those with private health insurance. The racial/ethnic composition of a woman’s place of residence also plays a role in racial/ethnic disparities in late/no prenatal care and inadequate PNCU. Living in Non-Hispanic white communities may confer an advantage with respect to receiving adequate prenatal care services. Conclusion: Addressing neighborhood hardship has the potential to improve adequate utilization of prenatal care for all Chicago mothers. In addition, providing uniform health insurance for all pregnant women as well as identifying and implementing community-level interventions that favor adequate use of prenatal care services across all neighborhoods irrespective of their racial/ethnic composition may reduce racial/ethnic disparities in PNCU.