Resnick M B, Gueorguieva R V, Carter R L, Ariet M, Sun Y, Roth J, Bucciarelli R L, Curran J S, Mahan C S
University of Florida, College of Medicine, Department of Pediatrics, PO Box 100296, Gainesville, FL 32610-0296, USA.
Pediatrics. 1999 Dec;104(6):e74. doi: 10.1542/peds.104.6.e74.
To assess the relative effects and the impact of perinatal and sociodemographic risk factors on long-term morbidity within a total birth population in Florida.
School records for 339 171 children entering kindergarten in Florida public schools in the 1992-1993, 1993-1994, or 1994-1995 academic years were matched with Florida birth records from 1985 to 1990. Effects on long-term morbidity were assessed through a multivariate analysis of an educational outcome variable, defined as placement into 9 mutually exclusive categories in kindergarten. Of those categories, 7 were special education (SE) classifications determined by statewide standardized eligibility criteria, 1 was academic problems, and the reference category was regular classroom. Generalized logistic regression was used to simultaneously estimate the odds of placement in SE and academic problems. The impact of all risk factors was assessed via estimated attributable excess/deficit numbers, based on the multivariate analysis.
Educational outcome was significantly influenced by both perinatal and sociodemographic factors. Perinatal factors had greater adverse effects on the most severe SE types, with birth weight <1000 g having the greatest effect. Sociodemographic predictors had greater effects on the mild educational disabilities. Because of their greater prevalence, the impact attributable to each of the factors (poverty, male gender, low maternal education, or non-white race) was between 5 and 10 times greater than that of low birth weight and >10 times greater than that of very low birth weight, presence of a congenital anomaly, or prenatal care.
Results are consistent with the hypothesis that adverse perinatal conditions result in severe educational disabilities, whereas less severe outcomes are influenced by sociodemographic factors. Overall, sociodemographic factors have a greater total impact on adverse educational outcomes than perinatal factors.
评估围产期和社会人口统计学风险因素对佛罗里达州全部出生人口长期发病率的相对影响及作用。
将1992 - 1993、1993 - 1994或1994 - 1995学年进入佛罗里达州公立学校幼儿园的339171名儿童的学校记录与1985年至1990年的佛罗里达州出生记录进行匹配。通过对一个教育结果变量进行多变量分析来评估对长期发病率的影响，该教育结果变量被定义为幼儿园入学时分为9个相互排斥的类别。在这些类别中，7个是由全州标准化资格标准确定的特殊教育（SE）分类，1个是学业问题，参考类别是普通教室。使用广义逻辑回归同时估计进入特殊教育和学业问题类别的几率。基于多变量分析，通过估计归因超额/不足数量来评估所有风险因素的影响。
教育结果受到围产期和社会人口统计学因素的显著影响。围产期因素对最严重的特殊教育类型有更大的不利影响，出生体重<1000克的影响最大。社会人口统计学预测因素对轻度教育残疾有更大影响。由于其较高的患病率，每个因素（贫困、男性、母亲教育程度低或非白人种族）的归因影响比低出生体重高5至10倍，比极低出生体重、存在先天性异常或产前护理高10倍以上。
结果与以下假设一致，即不良围产期状况会导致严重的教育残疾，而较轻的结果则受社会人口统计学因素影响。总体而言，社会人口统计学因素对不良教育结果的总体影响大于围产期因素。
