社区收入和母亲教育程度对出生结局的影响：一项基于人群的研究。
Effect of neighbourhood income and maternal education on birth outcomes: a population-based study.
作者信息
Luo Zhong-Cheng, Wilkins Russell, Kramer Michael S
机构信息
Department of Epidemiology and Biostatistics, McGill University, Montreal, Que.
出版信息
CMAJ. 2006 May 9;174(10):1415-20. doi: 10.1503/cmaj.051096.
BACKGROUND
Maternal socioeconomic status (SES) is an important determinant of inequity in maternal and fetal health. We sought to determine the extent to which associations between adverse birth outcomes and SES can be identified using individual-level measures (maternal level of education) and community-level measures (neighbourhood income).
METHODS
In Quebec, the birth registration form includes a field for the mother's years of education. Using data from birth registration certificates, we identified all births from 1991 to 2000. Using maternal postal codes that can be linked to census enumeration areas, we determined neighbourhood income levels that reflect SES.
RESULTS
Lower levels of both maternal education and neighbourhood income were associated with elevated crude risks of preterm birth, small-for-gestational-age (SGA) birth, stillbirth and neonatal and postneonatal death. The effects of maternal education were stronger than, and independent of, those of neighbourhood income. Compared with women in the highest neighbourhood income quintile, women in the lowest quintile were significantly more likely to have a preterm birth (adjusted odds ratio [OR] 1.14, 95% confidence interval [CI] 1.10-1.17), SGA birth (OR 1.18, 95% CI 1.15-1.21) or stillbirth (OR 1.30, 95% CI 1.13-1.48); compared with mothers who had completed community college or at least some university, mothers who had not completed high school were significantly more likely to have a preterm birth (adjusted OR 1.48, 95% CI 1.44-1.52), SGA birth (OR 1.86, 95% CI 1.82-1.91) or stillbirth (OR 1.54, 95% CI 1.36-1.74).
INTERPRETATION
Individual and, to a lesser extent, neighbourhood-level SES measures are independent indicators for subpopulations at risk of adverse birth outcomes. Women with lower education levels and those living in poorer neighbourhoods are more vulnerable to adverse birth outcomes and may benefit from heightened clinical vigilance and counselling.
背景
孕产妇社会经济地位（SES）是孕产妇和胎儿健康不平等的一个重要决定因素。我们试图确定使用个体层面指标（母亲教育水平）和社区层面指标（邻里收入）能够在多大程度上识别不良分娩结局与SES之间的关联。
方法
在魁北克，出生登记表包含母亲受教育年限这一项目。利用出生登记证书中的数据，我们确定了1991年至2000年期间的所有出生情况。通过可与人口普查枚举区相联系的母亲邮政编码，我们确定了反映SES的邻里收入水平。
结果
母亲教育水平和邻里收入水平较低均与早产、小于胎龄（SGA）儿出生、死产以及新生儿和新生儿后期死亡的粗风险升高相关。母亲教育水平的影响比邻里收入的影响更强且独立于邻里收入的影响。与邻里收入最高五分位数组的女性相比，最低五分位数组的女性早产（调整优势比[OR]1.14，95%置信区间[CI]1.10 - 1.17）、SGA儿出生（OR 1.18，95% CI 1.15 - 1.21）或死产（OR 1.30，95% CI 1.13 - 1.48）的可能性显著更高；与完成社区大学学业或至少上过一些大学的母亲相比，如果母亲未完成高中学业，其早产（调整OR 1.48，95% CI 1.44 - 1.52）、SGA儿出生（OR 1.86，95% CI 1.82 - 1.91）或死产（OR 1.54，95% CI 1.36 - 1.74）的可能性显著更高。
解读
个体层面以及在较小程度上社区层面的SES指标是有不良分娩结局风险亚人群的独立指标。教育水平较低的女性以及居住在较贫困社区的女性更容易出现不良分娩结局，可能会从加强临床监测和咨询中受益。
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