Neighborhood Economic Deprivation, Hispanic Ethnic Enclaves, and Congenital Anomalies in Texas

Congenital anomalies are common, costly, and potentially life-threatening. The impacts of structural determinants of health on risk for these conditions have scarcely been studied. We evaluated associations between residence in economically disadvantaged neighborhoods or Hispanic/Latino enclaves and congenital anomalies.

We performed a registry linkage study of 7.25 million births and 332,935 cases with anomalies in Texas, 1999-2018. We defined exposure groups using maternal residential address at delivery or termination and tract-level Yost socioeconomic index and Hispanic/Latino enclave index scores: high neighborhood socioeconomic status (nSES)-non-enclave (referent), high nSES-enclave, low nSES-non-enclave, and low nSES-enclave. We estimated adjusted birth prevalence ratios (aPRs) and 95% confidence intervals (CIs) for 146 congenital anomalies using Poisson regression.

Maternal residence in a low nSES area was associated with increased prevalence of microcephaly, atrial septal defect, pulmonary artery and pulmonary valve anomalies, patent ductus arteriosus, anomalies of the great veins, polydactyly, and Down syndrome (PRs 1.06-1.96) but decreased prevalence of hypospadias, epispadias, and chordee (PRs 0.67-0.89). Maternal residence in an enclave was associated with increased prevalence of ventricular septal defect, pulmonary artery anomalies, female genital anomalies, and Down syndrome (PRs 1.09-1.96). Pyloric stenosis was associated with residence in a low nSES neighborhood (enclave: PR 1.09, CI 1.03-1.14; non-enclave: PR 1.12, CI 1.06-1.17) and inversely associated with residence in a high nSES enclave (PR 0.89, CI 0.80-0.98).

Neighborhood socioeconomic and sociodemographic factors are associated with congenital anomalies, suggesting differences in risk factors or ascertainment in economically disadvantaged neighborhoods or Hispanic/Latino enclaves.