Vol.3, No.7, 454-459 (2013) Open Journal of Preventiv e Me dic ine
Income diversity and neighborhood variation in low
birth weight rates, Chicago, 1990-2006: Results using
longitudinal and cross-sectional measures
Jessica Kubo1, Diana S. Grigsby-Toussaint2*
1Department of Statistics, University of Illinois, Urbana Champaign, USA
2Department of Kinesiology and Community Health and Division of Nutritional Sciences, University of Illinois, Urbana Champaign,
USA; *Corresponding Author: dgrigs1@illinois.edu
Received 27 July 2013; revised 2 September 2013; accepted 19 September 2013
Copyright © 2013 Jessica Kubo, Diana S. Grigsby-Toussaint. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Although increased risk for adverse birth out-
comes has been associated with neighborhood
socioeconomic disadvantage, most studies have
used cross-sectional measures to account for
neighborhood context. Consequently, dynamic
neighborhood processes that may influence
adverse birth outcomes are not fully understood.
In this study, a longitudinal measure of socio-
economic change was used to explore variation
in low birth weight (LBW) rates between 1990
and 2006 in Chicago neighborhoods. A cross-
sectional measure of neighborhood socioeco-
nomic characteristics was then used to compare
the LBW rates across Chicago neighborhoods
during the same time frame to determine whether
the cross-sectional measure would capture the
same nuances in LBW variation as the longitu-
dinal measure. Consistent with previous studies,
both measures identified higher low birth weight
rates in neighborhoods entrenched in poverty
during the study period. However, the longitu-
dinal measure showed that mothers residing in
low income neighborhoods with high concen-
trations of immigrants had LBW rates that were
lower than mothers residing in high income
neighborhoods. Our results suggest that while
cross-sectional measures of neighborhood so-
cioeconomic context may capture global varia-
tions in low birth weight rates, longitudinal
measures may illuminate subtleties between
neighborhoods that might provide an opportu-
nity for targeted policies to reduce adverse ma-
ternal and child health outcomes.
Keywords: Low Birth Weight; Neighborhood;
Socioecon omic Status
In the United States (US), low birth weight (LBW),
defined as the percentage of babies weighing <2500
grams (5.5 lbs) at birth, persists as a major public health
problem [1,2]. Between 1970 and 2008, LBW prevalence
in the US increased from 7.93% to 8.18% [1,2]. During
this time frame, racial disparities in LBW also persisted,
with African-American LBW rates consistently almost
twice that of Whites [1]. Several studies have demon-
strated that socioeconomic characteristics of neighbor-
hoods may mediate these observed disparities [3-9]. In
addition, higher levels of neighborhood deprivation, usu-
ally measured using constructs of education, income,
poverty, or unemployment, have been found to be pre-
dictive of LBW and other adverse birth outcomes [3-7,
Notwithstanding the fact that these studies do capture
variations in birth outcomes, a major limitation is the use
of single decennial census estimates to measure neighbor-
hood context. Although several studies demonstrate that
longitudinal measures of neighborhood context may bet-
ter explain variations in health [12,13], most studies ex-
amining neighborhood influences on LBW and other
adverse birth outcomes use cross-sectional measures [5,
6,14-17]. In a study by Do [12], results suggest that lon-
gitudinal measures of neighborhood context are particu-
larly salient for disentangling health disparities between
Blacks and Whites. As such, using cross-sectional meas-
ures to investigate differences in birth outcomes between
Blacks and Whites in neighborhoods in the US may un-
derestimate or misestimate the gap in LBW rates, par-
Copyright © 2013 SciRes. OPEN A CCESS
J. Kubo, D. S. Grigsby-Toussaint / Open Journal of Preventive Medicine 3 (2013) 454-459 455
ticularly given dynamic neighborhood processes that
might change over time. Neighborhood disinvestment,
for example, may impact social networks or access to
health service agencies that conceivably influence ma-
ternal stress, and as a consequence, increase poor birth
outcomes. Conversely, neighborhood revitalization may
improve access to better quality foods, and a higher tax
base for resources that could result in a more supportive
environment for health-promoting behaviors for expec-
tant mothers, thus, reducing LBW risk. In the context of
public health planning and surveillance, these neighbor-
hood processes are critical for targeting and tracking
interventions, particularly in major metropolitan areas of
the US that have experienced substantial changes in so-
cioeconomic composition over the last three decades
[18,19]. Thus, incorporation of a longitudinal assessment
metric of neighborhood processes could provide a more
complete picture in understanding LBW risk.
In this study, we use a longitudinal measure of neigh-
borhood socioeconomic change in the city of Chicago to
examine associations with trends in LBW rates. Time
trends in LBW are examined as well as mean LBW over
the study period 1990-2006. We compare the longitudi-
nal measure of neighborhood characteristics to a cross-
sectional measure of neighborhood characteristics based
on quintiles of income categories from the US 2000 cen-
2.1. Low Birth Weight
Publically available de-identified vital statistics data
from the Illinois Project for Local Assessment of Needs
(IPLAN) website was used for this study. The IPLAN
website serves as a repository for102 health indicators
used to assist health departments with community as-
sessments and five-year planning goals [20]. The Center
for Health Statistics at the Illinois Department of Public
Health maintains the IPLAN website, updating vital sta-
tistics data based on birth certificate records reported by
local health departments across the state. Total counts of
live births and LBW infants born to Black and White
women in each of Chicago’s 77 community areas (i.e.,
neighborhoods) between 1990 and 2005 were abstracted
from the IPLAN database. IPLAN defines low birth
weight using the conventional definition of weight at
birth of less than 2500 grams [21]. The final sample size
consisted of 804,289 births; 350,681 to Black mothers,
and 453,428 to White mothers.
2.2. Neighborhood Socioeconomic Context
2.2.1. Definition of Neighborhoods
The administrative unit used for public health planning
in the city of Chicago is the community area, which is
used as a proxy for neighborhoods in this study [22].
Designated in the 1920’s by the Social Science Research
Council at the University of Chicago, these 77 areas
were intended to reflect the cultural and social history of
Chicago [23]. On average, community areas in Chicago
consist of 3 to 4 census tracts and the population count
may range from approximately 3000 to 120,000. On av-
erage, each community area has 37,000 residents [22].
2.2.2. Measure of Socioeconomic Change
An income diversity index of neighborhood socioeco-
nomic context developed by the Metro Chicago Informa-
tion Center (MCIC), an official census center, was used
to characterize neighborhoods. To develop the income
diversity index, the MCIC used data available from the
Neighborhood Change Database (NCDB), a commer-
cially available database of social, demographic, eco-
nomic and housing data on census tracts in the US for
1970, 1980, 1990, and 2000 [24]. The purpose for de-
veloping the index was to examine trends in the socio-
economic composition of neighborhoods over time in
order to develop sound community development policies
Neighborhoods were categorized as stable diversity,
emerging low income, emerging high income, desertifi-
cation, and emerging bipolarity based on patterns of
economic change in Chicago community areas over 30
years [25]. Briefly, stable diversity neighborhoods (n =
19) consist of community areas that have maintained a
socioeconomically diverse population between 1970 and
2000. Emerging low income neighborhoods (n = 11) have
experienced a loss of high income families, while the
reverse occurred with emerging high income neighbor-
hoods (n = 21), where the number of low income fami-
lies is decreasing. Desertification neighborhoods (n = 11)
show patterns of entrenched levels of poverty with a
predominantly African-American population. Finally,
emerging bipolarity neighborhoods (n = 15) show an
increase in both high and low income residents. Table 1
summarizes the characteristics of each type of neighbor-
hood based on the index using US Census 2000 data.
(For detailed methodology on the MCIC income diver-
sity index, see http://www.mcic.org).
2.2.3. Quintiles of Low Income Families
The percent of families considered to be low income
in 2000 was obtained from the MCIC database for each
of the 77 Chicago neighborhoods. These percentages
were used to divide the 77 neighborhoods into quintiles.
The first quintile, which contains the lowest percentage
of low income families, has 17 neighborhoods. The sec-
ond has 16, the third 15, the fourth 14, and the fifth 15.
Copyright © 2013 SciRes. OPEN A CCESS
J. Kubo, D. S. Grigsby-Toussaint / Open Journal of Preventive Medicine 3 (2013) 454-459
Copyright © 2013 SciRes. OPEN A CCESS
2.2.4. Neighborhood Demographics
Census 2000 data was obtained for the 77 Chicago
neighborhoods from the Chicago Metropolitan Agency
for Planning (http://www.cmap.illinois.go v/). Race/eth-
nicity, percent college educated, percent foreign born,
median income, percent in poverty, median property
value, percent female-headed households, and percent
unemployment were calculated using neighborhood-level
data and aggregated by each set of indices used—the IDI
and low income quintiles.
2.3. Statistical Analyses
Race-stratified mean LBW rates were calculated using
counts of LBW and total live births for each neighbor-
hood type based on the income diversity index and for
each quintile of low income families in 2000. Simple
linear regression was performed for each income diver-
sity index category and each quintile of low income. The
year (1990-2006) was used as the predictor, with percent
of LBW as the response. R2 values from simple linear
regression, as well as estimates and p-values of the in-
tercept and predictors are reported. All analyses were
performed using SAS 9.1 (SAS Institute Inc., Cary, NC).
Demographics from the 2000 census were compared
for neighborhoods aggregated using both index methods
(IDI and low-income quintiles) in Table 1. It is observed
that the range of median incomes in thousands of dollars
is lower (28.7 versus 34.4) when using the IDI than when
using income quintiles. Desertification neighborhoods
are 96.2% Black (quintiles range from 12.2 in 0 - 20th
quintile to 80.7 in 80 - 100th quintile). Also, while the 60
- 80th quintile is 61.7% Black, emerging low income
neighborhoods are 37.9% Black.
Between 1990 and 2006, mean LBW rates for Whites
ranged from 6.38% (95% CI, 6.05, 6.71) in emerging
low income neighborhoods to 7.82% (95% CI, 7.07, 8.57)
in desertification neighborhoods (Table 2). Linear re-
gression (Table 3) indicates significant increases in
LBW rates in emerging low income, emerging bipolarity,
stable diversity, and emerging high income neighbor-
hoods during the study period. LBW ranged from 6.61%
(95% CI, 6.18, 7.04) in the 0 - 20 quintile to 6.83% (95%
CI, 6.47, 7.20) in the 80 - 100 quintile during the study
period. Linear regression results show a significant in-
crease in LBW for all quintiles at the 95% level of sig-
The mean LBW rates for Black mothers ranged from
13.9% (95% CI, 13.5, 14.3) in emerging low income
neighborhoods to 16.3% (95% CI, 15.9, 16.7) in deserti-
fication neighborhoods (Table 2). Overall, LBW rates
for this demographic showed a downward trend between
Table 1. Selected demographic characteristics of neighborhood socioeconomic context using the US Decennial Census 2000 esti-
% foreign
% of adults
with a college
% White
% Black
non-Hispanic % Hispanic
property value
in $1000s
household income
in $1000s
% of families
below poverty
N = 11 1.9 13% 1.6 96.2 1.6 105.6 18.9 39.1
Emerging Low
N = 11
28.2 16% 31.9 37.9 44.8 104.9 34.0 18.4
N = 15
22.5 26% 50.0 30.0 23.0 160.0 39.2 13.6
Stable Diversity
N = 19 21.8 27% 33.9 45.0 20.9 147.8 40.2 13.6
Emerging High
N = 21
19.1 39% 63.6 18.9 20.2 222.6 47.6 10.7
US Census 2000
Income Quintile
% foreign
% of adults with
a college
% White
% Black
non-Hispanic % Hispanic
value $
% of
families below
poverty rate
80 - 100
N = 17 8.8 13% 8.4 80.7 15.5 102.0 21.4 35.0
60 - 80
N = 16 17.0 24% 19.1 61.7 18.3 129.1 31.5 21.5
40 - 60
N = 15 27.8 23% 39.3 28.9 41.4 159.9 37.3 16.4
20 - 40
N = 14 25.8 27% 51.9 28.8 23.0 150.8 41.3 10.5
0 - 20
N = 15 16.7 43% 75.6 12.2 11.7 238.3 55.8 4.9
J. Kubo, D. S. Grigsby-Toussaint / Open Journal of Preventive Medicine 3 (2013) 454-459 457
Table 2. Mean low birth weight rate by income diversity index and US Census 2000 quintile of income families for White, Black and
combined mothers.
White Black Combined
All Neighborhoods 6.78 (6.48, 7.08) 15.27 (14.93, 15.61) 10.44 (10.12, 10.76)
Income Diversity Index Mean (95% CI) Mean (95% CI) Mean (95% CI)
Desertification 7.82 (7.07, 8.57) 16.30 (15.87, 16.73) 15.75 (15.41, 16.10)
Emerging Low Income 6.38 (6.05, 6.71) 13.89 (13.51, 14.27) 8.11 (7.84, 8.39)
Emerging Bipolarity 7.15 (6.76, 7.55) 15.27 (14.93, 15.61) 10.86 (10.56, 11.16)
Stable Diversity 6.66 (6.34, 6.99) 14.55 (14.17, 14.93) 10.41 (10.04, 10.77)
Emerging High Income 6.85 (6.53, 7.18) 15.27 (14.83, 15.72) 8.99 (8.71, 9.26)
White Black Combined
US Census 2000 Income Quintile Mean (95% CI) Mean (95% CI) Mean (95% CI)
80 - 100 6.83 (6.47, 7.20) 15.97 (15.56, 16.38) 13.26 (12.90, 13.61)
60 - 80 6.83 (6.50, 7.17) 14.92 (14.55, 15.29) 11.43 (11.10, 11.75)
40 - 60 6.87 (6.57, 7.17) 15.08 (14.64, 15.52) 9.24 (8.93, 9.55)
20 - 40 6.76 (6.43, 7.09) 14.60 (14.07, 15.13) 8.61 (8.25, 8.96)
0 - 20 6.61 (6.18, 7.04) 14.37 (13.89, 14.84) 7.86 (7.53, 8.20)
Table 3. Results of linear regression of low birth weight rates on years for White, Black, and combined mothers.
White Black Combined
All Neighborhoods 0.0007 <0.0001 0.0006 0.0127 0.0007 0.0004
Income Diversity Index Coefficient P-value Coefficient P-value Coefficient P-value
Desertification 0.0012 0.3967 0.0012 0.0009 0.0005 0.0362
Emerging Low Income 0.0007 0.0029 0.0001 0.7692 0.0003 0.0636
Emerging Bipolarity 0.0011 0.0002 0.0002 0.5674 0.0002 0.4448
Stable Diversity 0.0006 0.0032 0.0002 0.5168 0.0007 0.0203
Emerging High Income 0.0007 0.0009 0.0004 0.3986 0.0004 0.0302
White Black Combined
US Census 2000 Income Quintile Coefficient P-value Coefficient P-value Coefficient P-value
80 - 100 0.0006 0.0474 0.0008 0.0146 0.0007 0.0075
60 - 80 0.0006 0.0102 0.0004 0.2330 0.0003 0.1360
40 - 60 0.0004 0.0254 0.0001 0.8527 0.0002 0.2588
20 - 40 0.0006 0.0035 0.0006 0.3283 0.0004 0.1227
0 - 20 0.0014 <0.0001 0.0007 0.1502 0.0007 0.0014
1990 and 2006 (P < 0.05), with significant decreases in
LBW rates for desertification neighborhoods. Black
LBW rates ranged from 14.4% (95% CI, 13.9, 14.8) in
the 0 - 20 quintile to 16.0 (95% CI, 15.6, 16.4). A
non-significant increase in LBW rates was noted for the
40 - 60 quintile; non-significant decreases occurred in
the 0 - 20, 20 - 40, and 60 - 80 quintile. Neighborhoods
in the 80 - 100 quintile experienced a significant de-
crease in LBW rates.
Regression results for White mothers were significant
for all quintiles, however, for desertification neighbor-
hoods no significant time trend was observed. For Black
Copyright © 2013 SciRes. OPEN A CCESS
J. Kubo, D. S. Grigsby-Toussaint / Open Journal of Preventive Medicine 3 (2013) 454-459
mothers only the 80 - 100 quintile with the highest per-
centage of low income families had significant regres-
sion results; similarly, using the IDI only desertification
neighborhoods had significant time trends. Combined
results also showed a difference in the two index meth-
ods—for Black and White mothers, desertification, sta-
ble diversity, and emerging high income had significant
time trends; only the 0 - 20 and 80 - 100 quintiles had
significant time trends. Further, the 0 - 20 quintile with
the least percentage of low income families had a posi-
tive slope; emerging high income neighborhoods had a
negative slope.
Consistent with other studies exploring adverse birth
outcomes and neighborhood context using cross-sectional
measures, we found that Black and White women resid-
ing in neighborhoods entrenched in poverty, with high
concentrations of Blacks, were more likely to have higher
LBW risk [3,4]. Additionally, consonant with national
estimates, LBW rates for Blacks were consistently dou-
ble those of Whites for the study period. Notwithstanding,
it is interesting to note that emerging low income neigh-
borhoods have the lowest LBW rates of all neighbor-
hoods and seem to confer some protection against LBW
risk for both Black and White mothers. This finding may
be due to high concentrations of Latino immigrants in
these neighborhoods (Table 1), where some studies have
suggested that better social support may attenuate the
impact of limited material resources on health [26].
Higher LBW risk for Black and White mothers residing
in emerging high income neighborhoods may be due to
more highly educated women residing in these neighbor-
hoods who tend to be older at first birth [27]. As a con-
sequence of being older at first birth, these women may
also be more likely to use assisted reproductive technol-
ogy that has also been shown to be associated with high-
er LBW risk [28].
Comparing the two classification schemes, aggregated
demographics over 77 neighborhoods using the US cen-
sus 2000 estimates shows an increasing gradient of per-
cent Black, percent in poverty and proportion of female
headed households and a decreasing gradient of median
income from the lowest quintile of low income house-
holds to the highest. The IDI, on the other hand, shows
desertification neighborhoods in stark contrast with other
indices for these measures. The IDI as a longitudinal
measure appears to better capture the entrenched poverty
of the desertification neighborhoods, while the method of
income quintiles misses this in the quintile with the high-
est low income families.
To our knowledge, few studies have undertaken inves-
tigations of neighborhood influences on birth outcomes
using a longitudinal measure of socioeconomic context.
The income diversity index is particularly unique as it
allows us to examine patterns in LBW risk in Chicago
neighborhoods while accounting for the influence of
neighborhood revitalization and immigration patterns,
thus providing a more nuanced view of neighborhood
influences on LBW. In addition, the income diversity
index was specifically designed to address issues related
to community development for the city of Chicago, thus
it may serve as a more practical tool for public health
planning to address LBW risk.
This study was not without its limitations. First, the
use of vital statistics data at the neighborhood level
without individual level covariates limited our ability to
account for potential confounders. For example, infor-
mation on mothers’ length of residence would have im-
proved our ability to better quantify the influence of
neighborhoods on LBW risk. Second, while we had data
on racial categories of the mothers in our study, we did
not have data on ethnicity. As such, some of the women
in our population may be misclassified as Black or White,
when their ascribed status was Hispanic. This could ac-
count for the lower LBW rates for both Blacks and
Whites in the emerging low income neighborhoods in
our study. Third, while our measure of neighborhood
context accounts for socioeconomic change over a thirty-
year period, it is primarily based on a measure of family
income, which is only one aspect of neighborhoods that
may influence health.
The goal of this study was to use a longitudinal meas-
ure of neighborhood context based on population-based
data for LBW in the city of Chicago. While our results
corroborate previous findings [8,10] that neighborhoods
with high concentrations of African-Americans and high
levels of poverty have higher rates of LBW, it also pro-
vides a nuanced view of the impact of neighborhood
immigrant and revitalization patterns on the birth out-
comes of Black and White residents. Thus, measures that
seek to capture socioeconomic characteristics of neighbor-
hoods over time may provide better insight for targeted
policies to reduce adverse health outcomes as part of
city-wide public health planning efforts.
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