Elsevier

Social Science & Medicine

Volume 120, November 2014, Pages 180-189
Social Science & Medicine

Ethnic enclaves and gestational diabetes among immigrant women in New York City

https://doi.org/10.1016/j.socscimed.2014.09.026Get rights and content

Highlights

  • First study on ethnic enclaves and gestational diabetes (GDM) among immigrants.

  • Geographic clustering of GDM apparent in New York City.

  • Ethnic enclaves not protective of GDM in most immigrant groups.

  • Enclaves linked to higher risk of GDM for South Central Asian and Mexican women.

Abstract

Previous research has shown that immigrants living in their own ethnic enclave are at decreased risk of poor health outcomes, but this question has not been studied in relation to gestational diabetes, an important early marker of lifecourse cardiovascular health. We ascertained gestational diabetes, census tract of residence, and individual-level covariates for Sub-Saharan African, Chinese, South Central Asian, Non-Hispanic Caribbean, Dominican, Puerto Rican, Mexican, and Central and South American migrant women using linked birth-hospital discharge data for 89,703 singleton live births in New York City for the years 2001–2002. Using 2000 census data, for each immigrant group we defined a given census tract as part of an ethnic enclave based on the population distribution for the corresponding ethnic group. We estimated odds ratios for associations between living in an ethnic enclave and risk of gestational diabetes adjusted for neighborhood deprivation, percent commercial space, education, age, parity, and insurance status, using multilevel logistic regression. Overall, we found no effect of ethnic enclave residence on gestational diabetes in most immigrant groups. Among South Central Asian and Mexican women, living in a residential ethnic enclave was associated with an increased odds of gestational diabetes. Several explanations are proposed for these findings. Mechanisms explaining an increased risk of gestational diabetes in South Central Asian and Mexican ethnic enclaves should be examined.

Introduction

A growing body of literature suggests that living in a neighborhood of shared ethnic ancestry, or ‘ethnic enclave’, has a positive influence on immigrant health (Pickett and Wilkinson, 2008). Research regarding the influence of ethnic enclaves on pregnancy health has been limited, however, by the use of broad ethnic categories and a lack of focus on immigrant women. Gestational diabetes is a substantial public health problem among immigrant women, and therefore is a particularly relevant health outcome to study in relation to ethnic enclaves. An investigation of how ethnic enclaves influence the risk of gestational diabetes among specific immigrant groups will inform our understanding of how neighborhoods influence immigrant health.

Section snippets

Background

Gestational diabetes is a significant public health problem affecting approximately 7% of pregnancies, with implications for the mother's and infant's health across the lifecourse (Trial, 2004). Gestational diabetes mellitus, defined as diabetes with onset during pregnancy, is a common but serious pregnancy complication that can result in increased morbidity to both the infant and mother, including perinatal mortality, preterm birth, cesarean section, macrosomia, and trauma during delivery (

Data sources and study sample

We used a dataset consisting of New York City birth certificate data linked to hospitalization data for the years 2001–2002 for 242,097 births. The birth data were geocoded to the mother's 2000 census tract by the New York City Department of Mental Health and Hygiene. Of 242,097 eligible singleton live births, we excluded 4675 (1.9%) with missing data on the census tract of mother's residence, and 17,920 (7.5%) whose mother's residence was outside of New York City, leaving a total of 210,926

Results

The percentage of women with gestational diabetes varied geographically, with apparent clustering in Queens (Fig. 1). Neighborhoods with a percentage of gestational diabetes in the highest quintile (8% or higher) were present in every borough. A large number of neighborhoods in the lowest quintile of gestational diabetes percentage were located in Manhattan, Brooklyn, and Staten Island. Gestational diabetes also varied substantially among immigrant groups - the percentage with gestational

Discussion

In contrast to our hypothesis that living in an ethnic enclave is protective of gestational diabetes, we found no association between ethnic enclave residence and gestational diabetes in most immigrant groups. Two exceptions included a greater risk of gestational diabetes among South Central Asian women living in an ethnic enclave defined at the 90th and 95th percentile of ethnic concentration, and among Mexican women living in an ethnic enclave defined at the 95th percentile of ethnic

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