Do pregnant women living in higher well-being populations in the USA experience lower risk of preterm delivery? A cross-sectional study.

To determine if preterm birth, defined as gestational age <37 weeks, is lower for women living in counties with higher well-being, after accounting for known individual risk factors. Cross-sectional study of all US births in 2011. We obtained birth data from the National Center for Health Statistics which included 3 938 985 individuals. Primary outcome measure was maternal risk of preterm delivery by county; primary independent variable was county-level well-being as measured by the Gallup-Sharecare Well-Being Index (WBI). Women living in counties with higher population well-being had a lower rate of preterm delivery. The rate of preterm birth in counties in the lowest WBI quintile was 13.1%, while the rate of preterm birth in counties in the highest WBI quintile was 10.9%. In the model adjusted for maternal risk factors (age, race, Hispanic ethnicity, smoking status, timing of initiation of prenatal visits, multiparity, maternal insurance payer), the association was slightly attenuated with an absolute difference of 1.9% (95% CI 1.7% to 2.1%; p<0.001). Pregnant women who live in areas with higher population well-being have lower risk of preterm birth, even after accounting for individual risk factors.

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Déclaration de conflit d'intérêts

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare the following competing interests: partial support from the Agency for Healthcare Research and Quality (BR and ES) and the Robert Wood Johnson Foundation (CR, BR, and AA) and the Veterans Administration (BR) for the submitted work; CR and BR receive funding from the Institute for Healthcare Improvement to support their effort in developing and implementing the measurement framework for the 100 Million Healthier Lives initiative; AA is partially supported by the Yale Center for Clinical Investigation through Clinical and Translational Science Award; ER and KK are current or former employees and shareholders of the Healthways corporation (acquired by Sharecare), the company that developed the measure of well-being used in this article; ES, JH, and HK also report receiving support from the Centers for Medicare and Medicaid Services; Dr. Krumholz is a recipient of research agreements from Medtronic and Johnson & Johnson (Janssen), through Yale, to develop methods of clinical trial data sharing; was the recipient of a grant from Medtronic and the Food and Drug Administration, through Yale, to develop methods for postmarket surveillance of medical devices; chairs a cardiac scientific advisory board for UnitedHealth; is a participant/participant representative of the IBM Watson Health Life Sciences Board; is a member of the Advisory Board for Element Science and for FaceBook, and the Physician Advisory Board for Aetna; and is the founder of Hugo, a personal health information platform.