Investigating the Relationship Between Highly Collaborative Local Health Jurisdictions and County-Level Perinatal Health Outcomes

Abstract Objectives Clarifying how cross-sector collaboration relates to perinatal health outcomes is essential in establishing tools to improve maternal and infant health. This study aims to establish if residence in a highly collaborative local health jurisdiction relates to one’s probability of experiencing poor perinatal health outcomes. Methods We measured collaboration between local health departments and social service organizations using data from the 2018 National Longitudinal Survey of Public Health Systems (NALSYS). We then used Latent Class Analysis to identify high and low collaborating counties, followed by multiple logistic regressions to assess the probability of six selected perinatal health outcomes among those residing in high and low collaborating counties at the time of labor and delivery. Health outcome data was selected from the 2018 National Vital Statistics System (NVSS) data. Results Using a national sample of local health departments across the United States, we found significant racial differences in the association between residence in a high collaborating county and the probability of poor perinatal health outcomes. White women experienced a lower probability of poor perinatal health outcomes if they resided in a high versus a low collaborating county, whereas the inverse was true for Black women. When stratified by payer, privately insured individuals had a lower risk of gestational diabetes if they resided in a high collaborating county, whereas those covered by Medicaid saw little to no effect. Conclusions for Practice These results suggest that local health jurisdictions should give greater attention to the needs of historically marginalized populations when planning and implementing collaborative activities to address community health needs.