title: Socioeconomic Disparities in Adverse Birth Outcomes in Urban and Rural Contexts: a French Mother-Child Cohort.
abstract: BACKGROUND
  Although adverse birth outcomes have been associated with neighbourhood deprivation in urban areas, few studies have addressed this issue in rural zones. This study examines whether associations between neighbourhood deprivation and adverse birth outcomes differ in urban and rural contexts, while taking individual characteristics and spatial accessibility of prenatal care (SAPC) into account.
  
  
  METHODS
  Pregnant women from a French mother-child cohort were recruited from 2002 to 2006 in Brittany. Their residential addresses were geocoded into their census blocks (the finest geographical resolution available). Deprivation was assessed at the same neighbourhood level. Models to assess the associations of deprivation, stratified by urban/rural status, with preterm delivery (PTD), with small for gestational age birth weight (SGA) and with small for gestational age head circumference at birth (SHC), estimated odds ratios (ORs), adjusted for maternal socioeconomic characteristics and SAPC.
  
  
  RESULTS
  This study considered 2929 liveborn singleton pregnancies from 780 census blocks. Neighbourhood deprivation was associated with increased risks of SGA and SHC (P trend < 0.01 and 0.03 respectively), only among mothers residing in rural areas. Neighbourhood deprivation had statistically significantly heterogeneous effects on SGA and SHC according to the urban/rural status of maternal residence.
  
  
  CONCLUSIONS
  These findings suggest that neighbourhood deprivation affects fetal growth differentially in urban and rural areas and that SAPC does not seem to be responsible for this difference. Comparison of these findings with the literature requires caution in the conceptualisation of urban and rural settings.
authors.affiliation: IRSET - Inserm UMR 1085, University of Rennes 1, Rennes, France.|EHESP, School of Public Health, Rennes, France.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Bertin
authors.affiliation: IRSET - Inserm UMR 1085, University of Rennes 1, Rennes, France.|Department of Epidemiology and Public Health, University Hospital, Rennes, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Viel
authors.affiliation: IRSET - Inserm UMR 1085, University of Rennes 1, Rennes, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Monfort
authors.affiliation: IRSET - Inserm UMR 1085, University of Rennes 1, Rennes, France.
authors.forename: Sylvaine
authors.initials: S
authors.lastname: Cordier
authors.affiliation: IRSET - Inserm UMR 1085, University of Rennes 1, Rennes, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Chevrier
mesh_terms: D000328:Adult; D001724:Birth Weight; D005260:Female; D005602:France / Q000453:epidemiology; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D000068101:Maternal-Child Health Services / Q000458:organization & administration; D009035:Mothers; D016017:Odds Ratio; D011203:Poverty / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012307:Risk Factors; D012424:Rural Population; D012959:Socioeconomic Factors; D014505:Urban Population
keywords: adverse birth outcomes; neighbourhood deprivation; spatial accessibility of prenatal care; urban-rural context