Individual and Community-Level Predictors of Anemia in Chicago-Area Pregnancies: A Multi-Level Analysis of Electronic...

Anemia is associated with pregnancy complications, including preterm birth, peripartum hemorrhage, and maternal and fetal mortality. Pregnant people of color have higher anemia prevalence compared with White pregnant people, contributing to disparities in pregnancy outcomes. Social determinants of health (SDoH), place-based characteristics that negatively influence health, may help explain anemia disparities.

We aimed to quantify community-level variation in prenatal anemia prevalence and identify associated individual- and community-level characteristics.

Electronic health records for 3,800 pregnant patients at a tertiary academic medical center in 2015-2019 were linked using home location with community variables from the Chicago Health Atlas. Multilevel log Poisson regression models were used to assess individual and community characteristics predictive of anemia prevalence.

Anemia prevalence was 20%. Higher rates were concentrated in Chicago's South and West Sides, regions with greater health disparities and lower access to resources. In bivariate analyses, community-level poverty, crime, and food access measures were associated with anemia. However, in multilevel models, only 3% of the variance in anemia prevalence was explained by differences between community areas. Individual characteristics-age, race, and ethnicity-remained significant predictors, while community-level characteristics were not independently associated with anemia.

Prenatal anemia prevalence was high and varied across Chicago neighborhoods. Yet, community-level characteristics did not provide additional explanatory insight. Stark racial disparities in anemia prevalence highlight the need for research into both SDoH in more geographically diverse samples and individual-level clinical risk factors. These insights inform intervention targets to improve pregnancy outcomes and reduce disparities.