Urban inequalities? Birth outcomes across New Jersey cities

Abstract

We investigated whether living in a large city endows a woman with a general level of risk for poor birth outcomes regardless of the specific city, or whether this risk varies across cities. We used individual 1989 and 1990 Vital Statistics birth and death records linked with uniform billing hospital discharge records to analyze prenatal care usage, birthweight, and newborn hospitalization costs in the six most populous cities in New Jersey: Camden, Elizabeth, Jersey City, Newark, Paterson, and Trenton. We used a multivariate framework which controlled for a number of individual socioeconomic, medical, and behavioral risk factors. We also examined whether the racial gaps in birth outcomes vary by city, and whether there are city variations in the effects of other important risk factors such as smoking and unwed motherhood. The results indicate that city of residence is an important predictor of birth outcomes, even after controlling for a number of individual level risk factors, and that the effect of race varies by city of residence. Being black reduces birthweight in the range of 136 to 196 grams and increases the probability of delivering a low birthweight baby in all cities except Camden, where there is no racial gap once individual risk factors were controlled. The results also indicate that many other risk factors have very different effects across large cities, and that it is important to take into consideration the differences between urban areas when formulating policy and targeting interventions designed to reduce poor birth outcomes.