TABLE 1—
Monitoring Health Inequities at the Neighborhood and Census Tract Levels Using the Index of Concentration at the Extremes (ICE) for Income, Race/Ethnicity, and Income Plus Race/Ethnicity and the Poverty Measure, by Tercile: Preterm Births and Premature Mortality, Boston, MA, 2010–2012
| ICE for Income |
ICE for Race/Ethnicity |
ICE for Income + Race/Ethnicity |
Poverty Rate |
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| Area and Tercilea | No. of Areas | Range | Rate, % (95% CI) | RR (95% CI) | Range | Rate, % (95% CI) | RR (95% CI) | Range | Rate, % (95% CI) | RR (95% CI) | Range, % | Rate, % (95% CI) | RR (95% CI) | |
| Preterm births | ||||||||||||||
| Neighborhoodb (n = 15) | ||||||||||||||
| 1 | 5 | −0.363, −0.138 | 9.7 (9.1, 10.4) | 1.09 (0.98, 1.20) | −0.698, −0.059 | 10.7 (10.1, 11.3) | 1.26 (1.14, 1.39) | −0.225, 0.034 | 10.7 (10.1, 11.3) | 1.19 (1.08, 1.31) | 25.1, 38.7 | 9.5 (8.8, 10.1) | 1.07 (0.97, 1.18) | |
| 2 | 5 | −0.090, 0.084 | 9.7 (9.1, 10.3) | 1.08 (0.98, 1.19) | 0.263, 0.608 | 8.8 (8.1, 9.4) | 1.04 (0.93, 1.16) | 0.082, 0.168 | 8.3 (7.7, 9.0) | 0.93 (0.84, 1.04) | 18.1, 20.4 | 10.1 (9.4, 10.7) | 1.14 (1.04, 1.26) | |
| 3 | 5 | 0.125, 0.261 | 8.9 (8.2, 9.6) | 1.00 (Ref) | 0.626, 0.760 | 8.5 (7.8, 9.1) | 1.00 (Ref) | 0.207, 0.386 | 8.9 (8.2, 9.6) | 1.00 (Ref) | 4.8, 15.3 | 8.8 (8.2, 9.5) | 1.00 (Ref) | |
| Census tractc (n = 169) | ||||||||||||||
| 1 | 57 | −0.784, −0.172 | 10.1 (9.4, 10.8) | 1.14 (1.03, 1.26) | −0.884, 0.148 | 10.2 (9.6, 10.8) | 1.20 (1.09, 1.33) | −0.784, −0.006 | 10.3 (9.7, 11.0) | 1.17 (1.06, 1.29) | 27.8, 83.0 | 10.1 (9.4, 10.9) | 1.10 (0.99, 1.22) | |
| 2 | 56 | −0.168, 0.088 | 9.4 (8.8, 10.1) | 1.07 (0.97, 1.18) | 0.160, 0.629 | 9.3 (8.6, 9.9) | 1.09 (0.98, 1.22) | 0.004, 0.206 | 9.1 (8.4, 9.7) | 1.03 (0.93, 1.14) | 14.6, 26.6 | 9.2 (8.6, 9.8) | 1.00 (0.91, 1.10) | |
| 3 | 56 | 0.094, 0.663 | 8.9 (8.2, 9.5) | 1.00 (Ref) | 0.635, 0.972 | 8.5 (7.8, 9.2) | 1.00 (Ref) | 0.208, 0.610 | 8.8 (8.2, 9.5) | 1.00 (Ref) | 0.0, 14.4 | 9.2 (8.6, 9.9) | 1.00 (Ref) | |
| Premature mortality | ||||||||||||||
| Neighborhoodb (n = 15) | ||||||||||||||
| 1 | 5 | −0.363, −0.138 | 230.1 (211.2, 250.7) | 1.46 (1.03, 2.09) | −0.698, −0.059 | 253.7 (232.7, 276.6) | 1.42 (1.23, 1.63) | −0.225, 0.034 | 253.7 (232.7, 276.6) | 1.39 (1.19, 1.61) | 25.1, 38.7 | 234.8 (216.0, 255.2) | 1.33 (1.15, 1.54) | |
| 2 | 5 | −0.090, 0.084 | 221.4 (200.9, 244.0) | 1.38 (0.97, 1.95) | 0.263, 0.608 | 195.1 (175.5, 216.7) | 1.09 (0.93, 1.27) | 0.082, 0.168 | 192.0 (174.1, 211.9) | 1.05 (0.90, 1.23) | 18.1, 20.4 | 226.5 (204.5, 250.7) | 1.29 (1.10, 1.50) | |
| 3 | 5 | 0.125, 0.261 | 183.1 (162.2, 206.8) | 1.00 (Ref) | 0.626, 0.760 | 179.1 (160.2, 200.3) | 1.00 (Ref) | 0.207, 0.386 | 183.1 (162.2, 206.8) | 1.00 (Ref) | 4.8, 15.3 | 175.9 (156.2, 198.3) | 1.00 (Ref) | |
| Census tractc (n = 170) | ||||||||||||||
| 1 | 57 | −0.784, −0.172 | 256.6 (235.3, 279.8) | 1.58 (1.36, 1.83) | −0.884, 0.106 | 253.5 (231.6, 277.4) | 1.66 (1.43, 1.93) | −0.784, −0.006 | 257.3 (235.4, 281.4) | 1.63 (1.40, 1.90) | 27.9, 86.6 | 257.8 (235.6, 282.0) | 1.47 (1.27, 1.71) | |
| 2 | 57 | −0.168, 0.088 | 211.6 (192.0, 233.1) | 1.30 (1.11, 1.52) | 0.148, 0.629 | 207.0 (187.9, 228.0) | 1.35 (1.16, 1.58) | 0.000, 0.206 | 203.4 (184.9, 223.8) | 1.30 (1.10, 1.51) | 14.6, 27.8 | 206.5 (187.8, 227.0) | 1.18 (1.02, 1.37) | |
| 3 | 56 | 0.094, 0.663 | 162.8 (144.3, 183.6) | 1.00 (Ref) | 0.635, 0.972 | 152.9 (135.4, 172.6) | 1.00 (Ref) | 0.208, 0.610 | 157.6 (139.3, 178.3) | 1.00 (Ref) | 0.0, 14.4 | 174.8 (155.7, 196.3) | 1.00 (Ref) | |
Note. CI = confidence interval; RR = rate ratio. Preterm birth values are percentages of total births; premature mortality values are deaths among individuals younger than 65 years (age-adjusted rates per 100 000). Birth and death data are from the Massachusetts Department of Public Health3; census data are from the American Community Survey (5-year estimates; 2008–2012).4 The tercile ranges are identical for the neighborhood-level analyses for preterm births and premature mortality but differ slightly at the census tract level because among the 170 census tracts included in the premature mortality analyses, one could not be included for the preterm birth analyses because it had 0 births. All global tests for comparisons of rates across the terciles for all geographic areas had P < .01 for premature mortality and P < .05 for preterm births with the exception of the poverty measure at the neighborhood level for preterm births (P > .05; exact P values are not shown but are available upon request).
Terciles are from 1 (least privilege) to 3 (most privilege).
Neighborhood analysis population size and rates: total births, 23 687 (preterm, 2247; full term, 21 440; Boston average rate for 2010–2012, 9.5%; 95% CI = 9.1%, 9.9%), and premature deaths, 3271 (Boston 2010 population younger than 65 years, 550 465; Boston average age-adjusted rate for 2010–2012 per 100 000, 211.5; 95% CI = 199.7, 224.0).
Census tract analysis population size and rates: total births, 23 568 (preterm, 2229; full term, 21 339; Boston average rate for 2010–2012, 9.5%; 95% CI = 9.1%, 9.8%), and premature deaths, 3202 (Boston 2010 population younger than 65 years, 554 549; Boston average age-adjusted rate for 2010–2012 per 100 000, 206.3; 95% CI = 194.7, 218.6).