Neighborhood Threat of Eviction over Time and Risk of Preterm Birth in Black American Women

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Paper Summary

Conflicts of Interest

Identified Weaknesses

Rating Explanation

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Paper Summary

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Moving Stress and Premature Births: Neighborhood Eviction Rates Linked to Pregnancy Risk in Black Women

In a study of Black women, living in a neighborhood with an increasing threat of eviction during pregnancy (compared to before pregnancy) was associated with a 68% increased risk of having a preterm birth. The study controlled for individual and neighborhood socioeconomic factors but relied on participant-reported addresses and lacked data on individual experiences with eviction or other relevant social factors, which could confound the relationship.

Possible Conflicts of Interest

None identified.

Identified Weaknesses

Reliance on participant-reported addresses and potential residual confounding

The study relied on participant-reported addresses and did not account for individual-level eviction experiences or housing instability beyond reported address changes. It's possible there could be residual confounding even with statistical controls.

Lack of individual-level eviction data and other social factors

The study lacked data on individual-level eviction experiences and housing instability. The researchers did not control for other social factors (e.g., racism, discrimination, social support) which could both increase eviction risk and pregnancy complications, creating spurious associations. More granular data on housing challenges is needed for more causal claims.

Potential reverse causation related to lack of prior preterm birth history

Reverse causation could not be ruled out since prior history of preterm birth (a strong risk factor for subsequent preterm birth) was not included in the analysis. If women with a history of preterm birth tend to live in lower-income neighborhoods with high eviction rates (reverse causation), this would inflate the association presented.

Rating Explanation

This is an important study examining a socially relevant exposure and a serious health outcome in a vulnerable population. However, the limitations regarding participant-reported address data and the risk of residual confounding, lack of data on other social factors, and the possibility of reverse causation limit the causal inferences that can be drawn and thus lower the rating. The sample size is adequate and the statistical methods appropriate.

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