Bambang S, Spencer N J, Logan S, Gill L
School of Postgraduate Medical Education, University of Warwick, Coventry, UK.
Child Care Health Dev. 2000 Jan;26(1):73-82. doi: 10.1046/j.1365-2214.2000.00152.x.
To study the relationship between cause-specific perinatal death rates, material deprivation and birthweight among births in 3 consecutive years in the West Midlands Health Region.
Retrospective cohort study.
West Midlands Health Region (WMHR).
All births (live and stillbirths) to mothers with addresses in the WMHR in 1991, 1992 and 1993.
Cause-specific perinatal death rates--crude and stratified by birthweight.
Perinatal deaths in the WMHR in 1991-93, collected as part of the national Confidential Enquiry into Stillbirths and Deaths in Infancy, were classified into causes of death by the extended Wigglesworth classification. Crude rates for cause-specific perinatal deaths and rates stratified by birthweight < 2500 g and > or = 2500 g were calculated for each enumeration district (ED) quintile derived by ranking enumeration districts for the whole of the region by Townsend Deprivation Index. Cause-specific rates of death were investigated for a linear trend across ED quintiles. The relative risk of death (most vs least deprived) from specific causes was calculated. Using rates for the least deprived quintile as the reference, deaths from each cause 'attributable' to social inequality were calculated.
Positive linear trends in perinatal deaths were noted with increasing deprivation for each specific cause of death except those classified as 'other causes' (Wigglesworth Class E). Relative risk (most vs least deprived) of perinatal death with a congenital anomaly was 1.98 (confidence interval, CI: 1.36,2.89). For deaths related to antepartum events, intrapartum events and immaturity the risks were 1.81 (CI: 1.39,2.38), 1.48 (CI: 1.10,1.98) and 1.92 (CI 1.45,2.56), respectively. Forty-three (35.7%) perinatal deaths per year were due to congenital anomalies, 63 (29.7%) antepartum events, 36 (21.9%) intrapartum events and 61 (32.7%) immaturity and these were statistically 'attributable' to social inequality. Cause-specific perinatal death rates for babies < 2500 g showed no correlation with deprivation; however, for babies > or = 2500 g the association with deprivation persisted.
All cause-specific rates except those due to 'other causes' showed a positive linear trend with increasing deprivation. These trends were found for infants born > or = 2500 g but were not seen for low birthweight infants (< 2500 g). Almost 30% of deaths were statistically 'attributable' to social inequality. The results of this study suggest that material deprivation plays an important role in the causal pathway leading to perinatal death and needs to be addressed in preventive programmes aimed at the reduction of perinatal deaths.
研究西米德兰兹健康区域连续三年出生人口中特定病因围产期死亡率、物质匮乏与出生体重之间的关系。
回顾性队列研究。
西米德兰兹健康区域（WMHR）。
1991年、1992年和1993年在WMHR有住址的母亲所生的所有活产和死产儿。
特定病因围产期死亡率——粗死亡率及按出生体重分层的死亡率。
1991 - 1993年WMHR的围产期死亡数据作为全国婴儿死产和死亡机密调查的一部分收集，按照扩展的威格尔斯沃思分类法对死亡原因进行分类。计算每个按汤森贫困指数对整个区域的枚举区进行排名得出的枚举区五分位数的特定病因围产期死亡粗率以及按出生体重<2500克和≥2500克分层的率。研究特定病因死亡率在枚举区五分位数间的线性趋势。计算特定病因（最贫困与最不贫困相比）的死亡相对风险。以最不贫困五分位数的率为参照，计算每种病因“归因于”社会不平等的死亡数。
除归类为“其他原因”（威格尔斯沃思E类）外，每种特定死亡原因的围产期死亡均随贫困程度增加呈现正线性趋势。先天性异常导致的围产期死亡相对风险（最贫困与最不贫困相比）为1.98（置信区间，CI：1.36,2.89）。与产前事件、产时事件和未成熟相关的死亡风险分别为1.81（CI：1.39,2.38）、l.48（CI：1.10,1.98）和1.92（CI 1.45,2.56）。每年43例（35.7%）围产期死亡归因于先天性异常，63例（29.7%）归因于产前事件，36例（21.9%）归因于产时事件，61例（32.7%）归因于未成熟，这些在统计学上“归因于”社会不平等。出生体重<2500克婴儿的特定病因围产期死亡率与贫困程度无相关性；然而，出生体重≥2500克婴儿的死亡率与贫困程度的关联依然存在。
除“其他原因”导致的死亡率外，所有特定病因死亡率均随贫困程度增加呈现正线性趋势。这些趋势在出生体重≥2500克的婴儿中存在，但在低出生体重婴儿（<2500克）中未观察到。近30%的死亡在统计学上“归因于”社会不平等。本研究结果表明，物质匮乏在导致围产期死亡的因果途径中起重要作用，在旨在降低围产期死亡的预防项目中需要加以解决。
