Neighborhood Tax Foreclosures, Educational Attainment, and Preterm Birth among Urban African American Women

Ecological evidence suggests that neighborhoods with more tax foreclosures also have more adverse birth outcomes. However, whether neighborhood-level tax foreclosures impact individual-level risk for adverse birth outcomes is unknown. We assessed whether living in a neighborhood with high tax foreclosures is associated with a woman's preterm birth (PTB) risk and tested for effect modification by educational attainment, among urban African American women from the Life Influence on Fetal Environments Study (2009-2011; n = 686). We linked survey and medical record data to archival, block-group level tax foreclosure data from the county treasurer. We used Modified Poisson regression with robust error variance and included a foreclosure X education interaction in adjusted models. In the overall sample, neighborhood tax foreclosures did not predict PTB (adjusted relative risk: 0.93, CI: 0.74, 1.16), but the association was modified by educational attainment (interaction p = 0.01). Among women with lower education (n = 227), neighborhood tax foreclosures did not predict PTB risk. The association for women with higher education (n = 401) was statistically significant for a reduction in risk for PTB (adjusted relative risk: 0.74, CI: 0.55, 0.98) among those who lived in neighborhoods with high versus low tax foreclosures. Future studies should seek to identify the mechanisms of this association.