LAUSR

PURPOSE Research examining the association between crime and health outcomes has been hampered by a lack of reliable small-area (e.g. census tract or census block-group) crime data. Our objective is to assess the accuracy of synthetically estimated crime indices for use in health research by using preterm birth as a case study. METHODS We used violent crime data reported by 47 law enforcement agencies in 15 counties in Atlanta, Georgia and compared them with commercially estimated crime rates from the same year to assess (1) how two measures of crime were correlated; and (2) if the associations between violent crime rate indices and preterm birth (PTB) varied as a function of the source of crime index. To assess the association between violent crime and PTB, we used multilevel logistic regression and controlled for potential individual and neighborhood-level confounders. RESULTS Violent crime, both estimated and observed, was positively correlated with poverty, neighborhood proportion Black, and NDI, however the association was stronger using estimated rates as compared to observed crime rates. The association between living in a high violent crime neighborhood and pre-term birth was only consistent for white women across the two crime indices after covariate adjustment. For Black women, the association between living in a high violent crime neighborhood and PTB is systematically underestimated across all models when the estimated crime rate is used. CONCLUSIONS There is evidence that model-estimated crime rates are not reliable proxies for crime in an urban area even when appropriate confounders are adjusted for.