This cohort study examines the association between disadvantaged neighborhood status and fecundability at the state and national levels among women attempting to conceive a child without the use of fertility treatment.
Higher scores represent neighborhoods with greater disadvantage. We obtained 2 ADI scores for each census block group: national percentile ranking and within-state decile ranking . We hypothesized that the within-state ADI would be more strongly associated with fecundability because it reduces confounding from dissimilar state contexts . Using participants’ geocoded baseline addresses, we assigned each residential address to its corresponding census block group and linked it to its ADI score.
Every 8 weeks after enrollment, participants completed follow-up questionnaires on which they reported current pregnancy status, pregnancy losses, cessation of pregnancy attempt, or initiation of fertility treatment. If participants reported a conception, we asked how their pregnancy was confirmed . For nonpregnant participants, we inquired whether they were still trying to conceive.
In adjusted models, we controlled for clinical factors associated with fertility as precision variables, including participant age , daily multivitamin or folic acid intake, parity , intercourse frequency , last method of contraception used , doing something to improve chances of conception , and year of enrollment .
We used multiple imputation to impute missing data on exposure, outcome, and covariates with fully conditional specifications methods and statistically combined 20 data sets to generate FRs and 95% CIs.Women without follow-up questionnaires were assigned 1 cycle of follow-up, with pregnancy status multiply imputed at that cycle. Missingness ranged from 0 to 3% . All statistical analyses were performed using SAS version 9.4 .
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