Impact of Income on Small Area Low Birth Weight Incidence Using Multiscale Models

Low birth weight (LBW) is an important public health issue in the US as well as worldwide. The two main causes of LBW are premature birth and fetal growth restriction. Socio-economic status, as measured by family income has been correlated with LBW incidence at both the individual and population levels. In this paper, we investigate the impact of household income on LBW incidence at different geographical levels. To show this, we choose to examine LBW incidences collected from the state of Georgia, in the US, at both the county and public health (PH) district. The data at the PH district are an aggregation of the data at the county level nested within the PH district. A spatial scaling effect is induced during data aggregation from the county to the PH level. To address the scaling effect issue, we applied a shared multiscale model that jointly models the data at two levels via a shared correlated random effect. To assess the benefit of using the shared multiscale model, we compare it with an independent multiscale model which ignores the scale effect. Applying the shared multiscale model for the Georgia LBW incidence, we have found that income has a negative impact at both the county and PH levels. On the other hand, the independent multiscale model shows that income has a negative impact only at the county level. Hence, if the scale effect is not properly accommodated in the model, a different interpretation of the findings could result.