Changes in address and the Child Opportunity Index after delivery in a cohort of first-time mothers

Background The Child Opportunity Index (COI) characterizes social determinants of health across the United States including education, health and environment, and social and economic factors. Analysis of how people changing addresses after having their first baby may change their COI category has not been reported. Objective The objective of the study was to determine the proportion of nulliparous pregnant persons who moved between the time of delivery and at the time of follow-up several years after delivery, to evaluate the changes in the COI over that time, and factors associated with changes. Study Design We performed a secondary analysis of data from participants at a single site in an ongoing prospective cohort study, the nuMoM2b Heart Health follow-up Study (HHS). Residential addresses at nuMoM2b delivery and at follow-up (~9 years) were compared to determine if the participant moved and to evaluate the COI changes. Descriptive characteristics at the time of delivery (age, race, income, pregnancy outcomes) and the COI trajectory were compared for those who did and did not move using chi-square and t-tests. Results 410 participants were analyzed. 304 (74%) changed addresses resulting in changes in census tracts. Moving was associated with a lower mean maternal age (24.3 vs. 27.2 yrs, p≤0.001) and a lower average income (<200% federal poverty level (FPL), 62.3% vs 41.1%, p≤0.001) compared to the participants who did not move. 123 (40.5%) participants moved to a neighborhood with a higher overall COI quintile, 56 (18.4%) participants moved into a lower COI quintile, and 125 (41.1%) participants did not have a change in COI category. White participants who moved were significantly more likely to increase their COI category (55%) compared to non-White participants who moved (22.2%, p≤0.001). There were no differences in how COI changed between White and non-White participants who did not move. Conclusions The majority of the participants moved in the years after delivering their first child. The impact of moving on COI showed disparities; White participants were more likely to increase their COI if they moved compared to non-White groups. Understanding the influence of location-based social determinants of health may help with provision of resources aimed at resolving disparities in health for people after delivery of their first child.