Multivariate Bayesian spatial model of preterm birth and cardiovascular disease among Georgia women: Evidence for life course social determinants of health.

Abstract Background: There is epidemiologic evidence that women who experience preterm birth (PTB) are at elevated risk for cardiovascular disease (CVD) later in life. Each outcome independently has noted spatial and socioeconomic gradients; we test for spatial structure in the population correlation of the two. Methods: Exploratory spatial data analysis and multivariate Bayesian spatial models were fit to describe the spatial correlation of PTB with CVD among women in Georgia counties from 2002 to 2006. Results: Global Moran’s I and local-indicators of spatial association statistics suggest significant co-occurrence of CVD and PTB. Bayesian posterior estimates for multivariate correlation of these outcomes range from r  = 0.11–0.34 for CVD and PTB. Significant spatial correlation persists with control for county covariates among whites but not blacks. Conclusion: Modest evidence for spatial structure of the ecologic correlation of PTB and women’s CVD is consistent with a lifecourse perspective on socially clustered determinants of health.