Virginia Locality and Perinatal Health: An Ecologic Study Using the Child Opportunity Index 3.0

OBJECTIVE Perinatal infant health is significantly worse in the United States than in comparable high-income nations. Community-level factors are important when examining disparities. The objective of this study was to examine the association between statewide geospatial variation in child opportunity and perinatal infant health. METHODS The Child Opportunity Index (COI) 3.0, an index of community conditions and resources was obtained for 2012–2019; mean and change in the state-normed composite and domains indices were calculated. Infant mortality (rate per 1000 live births), percent preterm birth (PTB; of live births), and percent low birth weight (LBW; of term births) were aggregated (2020–2022) and joined with COI data by Virginia independent city/county. Poisson and beta regression models were fit to quantify the association between mean and change in composite and domain-specific COI with infant mortality, PTB, and LBW, adjusting for spatial effects. RESULTS Localities with higher opportunity had 20% lower (risk ratio, 0.80; 95% credible interval [CrI], 0.74–0.86) infant mortality and smaller percentages of LBW (odds ratio [OR], 0.90; 95% CrI, 0.87–0.93) and PTB (OR, 0.94; 95% CrI, 0.92–0.97) per 1-SD change in COI, adjusting for spatial effects and change in COI. A high proportion of variability (R2 = 0.71–0.98) was explained by the mean COI. COI change was associated with lower infant mortality. CONCLUSION Opportunity varies geographically and is associated with perinatal infant health. To narrow disparities in infant mortality, interventions to improve opportunity should be deployed using a health equity lens. Communities “underperforming” and “overperforming” in perinatal infant health based on opportunity should be investigated to identify structural barriers to mitigate and promising strategies to translate to other communities.