Social Determinants of Health

Publications under ‘Social Determinants of Health’ examine the associations of economic and social factors with fertility and reproductive outcomes. 

1. Among North American pregnancy planners, annual household income was positively associated with fecundability up to about $100,000, at which point the effect plateaued. In addition, women with less than 17 years of education had slightly lower fecundability than women with 17 or more years of education. The associations of income and education with fecundability were stronger among women aged ≥30 years. Schrager NL, Wesselink AK, Wang TR, Hatch EE, Rothman KJ, Mikkelsen EM, Boynton-Jarrett RD, Wise LA. Association of income and education with fecundability in a North American preconception cohort. Ann Epidemiol 2020; 50: 41-47.e1.

2. In our “sister” Danish preconception cohort study 10,475 females aged 18-49 years who were trying to conceive between 2007 and 2021, lower educational attainment and lower household income were also associated with lower fecundability after adjusting for potential confounders.  Jørgensen MD, Mikkelsen EM, Hatch EE, Rothman KJ, Wise LA, Sørensen HT, Laursen ASD. Socioeconomic status and fecundability in a Danish preconception cohort. Hum Reprod. 2023 Jun 1;38(6):1183-1193. doi: 10.1093/humrep/dead077. PMID: 37094974; PMCID: PMC10233268.

3. We assessed neighborhood disadvantage using the Area Deprivation Index (ADI), a combination of markers of disadvantage such as housing conditions, employment rates, income, and educational attainment. We found that couples living in neighborhoods with more disadvantage (higher ADI scores) took longer to conceive than those living in more advantaged neighborhoods.
4. We examined the influence of green space in one’s neighborhood on fertility. There is evidence that greater exposure to greenery may improve health by facilitating physical activity, strengthening social connections, and reducing stress. We found that residential green space was associated with greater fertility. Willis MD, Wesselink AK, Hystad P, Pescador Jimenez M, Coleman CM, Kirwa K, Hatch EE, Wise LA. Associations between Residential Greenspace and Fecundability in a North American Preconception Cohort Study. Environ Health Perspect. 2023 Apr;131(4):47012.