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US County-Level Variation in Preterm Birth Rates, 2007-2019.

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Preterm birth rates show significant geographic disparities across US counties, masking national stability. Social vulnerability is linked to higher rates, highlighting the need for localized interventions to reduce preventable infant mortality.

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Area of Science:

  • Public Health
  • Epidemiology
  • Maternal and Child Health

Background:

  • Preterm birth is a major cause of infant mortality and morbidity.
  • National preterm birth rates may obscure critical geographic variations and trends at the county level.

Purpose of the Study:

  • To estimate age-standardized preterm birth rates across US counties from 2007 to 2019.
  • To analyze geographic disparities and trends in preterm birth rates at the county level.

Main Methods:

  • Utilized a serial cross-sectional study design with US National Center for Health Statistics data (2007-2019).
  • Calculated age-standardized preterm birth rates using a validated small area estimation model (hierarchical Bayesian spatiotemporal model).
  • Employed log-linear regression to assess changes in preterm birth rates and their association with the Social Vulnerability Index.

Main Results:

  • Significant geographic variation in preterm birth rates was observed, with a notable difference between highest and lowest percentile counties.
  • Counties in the Southeast consistently exhibited higher rates compared to California and New England.
  • While national rates remained stable, nearly 1 in 6 counties experienced increases; higher Social Vulnerability Index quartiles correlated with elevated preterm birth rates.

Conclusions:

  • Substantial geographic disparities in preterm and early preterm birth rates exist, linked to place-based social disadvantage.
  • National-level stability in preterm birth rates conceals concerning increases in numerous individual counties.
  • Findings underscore the importance of addressing localized social determinants to mitigate preterm birth disparities.