Association between time to conception and neighborhood disadvantage as measured by social deprivation index scores in nulliparous gravidae.

Living in a socioeconomically disadvantaged neighborhood has been associated with worse health outcomes, including those related to reproductive health. Identifying and addressing the role of social determinants of health is crucial to providing improved care and achieving better population health in reproductive medicine. Our objective was to examine the relationship between residence in disadvantaged areas in the United States (US) and the length of time to conception (TTC). A 2-hospital, single academic institution population-based database comprised of over 50,000 unique deliveries with conception, pregnancy, and delivery data from August 2011 was employed. We extracted all singleton deliveries of nulliparous gravidae who were actively trying to conceive. From this group, we selected deliveries from spontaneously-conceived pregnancies with information on the length of TTC and pre-conception residence zip code available (n= 4788). To assess levels of associated disadvantage, each delivery was assigned a Social Deprivation Index (SDI) score based on the pre-conception residence zip code. SDI is a composite measure, from 1 to 100, of seven demographic characteristics collected by the American Community Survey based on the following percentages (%): % living in poverty, % with < 12 years of education, % single-parent households, % living in rented housing units, % living in overcrowded housing, % of households without a car, and % nonemployed adults < 65. SDI scores are assigned to generalized US postal zip codes, and higher scores indicate greater area-level deprivation. Our study sample was divided into four quartiles based on SDI scores (Q1: 1-25, Q2: 26-50, Q3: 51-75, and Q4: 76-100). Time to conception was measured in months (range 0-25) with all values > 24 months counted as 25 months. Bivariate and adjusted logistic regression were performed to calculate unadjusted odds ratio [OR] and adjusted OR [aOR] with a p-value < 0.05 considered significant. In our study sample of 4788 deliveries, the mean (IQR) age at delivery was 30 (26-32) and the median (IQR) SDI score was 61 (24-86). Most participants were non-Hispanic (67.6%) and White (80.3%). Approximately a quarter of the participants received Medicaid and Children’s Health Insurance Program (CHIP) benefits. The median (IQR) TTC was 2 (1-6) months. The mean (SD) TTC was noted to be 4.1 (5.0) for Q1, 4.1 (5.1) for Q2, 4.4 (5.6) for Q3, and 4.7 (5.8) for Q4. Thus, we found a statistically significant association between SDI quartile and TTC in unadjusted models [OR 1.05 (95% CI 1.01-1.10)] and in models adjusted for age [aOR (95% CI 1.04-1.14)]. In our study, pre-conception residence in a socioeconomically disadvantaged location as measured by SDI score was associated with an increased TTC in nulliparous gravidae who go on to successfully deliver a liveborn neonate.