English Paul B, Kharrazi Martin, Davies Stephanie, Scalf Rusty, Waller Lance, Neutra Raymond
Environmental Health Investigations Branch, California Department of Health Services, 1515 Clay Street, Suite 1700, Oakland, CA 94612, USA.
Soc Sci Med. 2003 May;56(10):2073-88. doi: 10.1016/s0277-9536(02)00202-2.
Individual-level maternal risk factors have been able to explain only a small proportion of low birth weight (LBW) births in the US to date and neighborhood-level factors have not been recognized as important predictors of reproductive outcomes. At the US/Mexico border, tremendous demographic changes have taken place between 1980 and 1990. Whether high population growth, economic pressures, and community instability have affected reproductive health in this region is not known. We used spatial epidemiologic methods to investigate the importance of changes in neighborhood and individual-level risk factors in predicting changes in two measures of adverse reproductive health: term and preterm LBW. Using approximately 16,000 births in 1980 and 24,000 births in 1990, we produced a continuous surface of LBW change (Z scores for difference in proportions) for southern San Diego County, CA, and identified statistically significant "hot spots" of elevated risk. Using a geographic information system, data from the 1980 and 1990 US Census were smoothed to link neighborhood-level variables with individual-level data from the 1980 and 1990 California birth certificates. Multivariate regression models were developed to identify individual- and neighborhood-level variables of 1980-1990 changes which were predictive of Z scores of LBW change. Results of conditional autoregressive models were used to assess effects of spatial autocorrelation. The continuous surface of LBW identified areas with statistically significant increases (17 areas for term LBW and 14 areas for preterm LBW). While individual- and neighborhood-level variables explained about an equal amount of variance in term LBW, only neighborhood-level variables were significant predictors of preterm LBW. While changes in maternal race/ethnicity composition and a measure of stability were related to term LBW, measures of affluence were related to preterm LBW. This study highlights the importance of socioeconomic and demographic changes in a woman's neighborhood on reproductive health.
到目前为止，个体层面的孕产妇风险因素仅能解释美国低出生体重（LBW）婴儿出生情况中的一小部分，而社区层面的因素尚未被视为生殖结局的重要预测因素。在美国/墨西哥边境，1980年至1990年间发生了巨大的人口结构变化。目前尚不清楚高人口增长率、经济压力和社区不稳定是否对该地区的生殖健康产生了影响。我们使用空间流行病学方法，研究社区和个体层面风险因素的变化在预测两种不良生殖健康指标（足月和早产低出生体重）变化方面的重要性。利用1980年约16000例出生数据和1990年约24000例出生数据，我们绘制了加利福尼亚州圣地亚哥县南部低出生体重变化的连续表面图（比例差异的Z分数），并确定了风险升高的具有统计学意义的“热点”地区。使用地理信息系统，对1980年和1990年美国人口普查数据进行平滑处理，以便将社区层面变量与1980年和1990年加利福尼亚州出生证明中的个体层面数据相联系。我们建立了多变量回归模型，以识别1980 - 1990年变化中能够预测低出生体重变化Z分数的个体和社区层面变量。条件自回归模型的结果用于评估空间自相关的影响。低出生体重连续表面图确定了具有统计学显著增加的区域（足月低出生体重有17个区域，早产低出生体重有14个区域）。虽然个体和社区层面变量在足月低出生体重方面解释的方差量大致相等，但只有社区层面变量是早产低出生体重的显著预测因素。虽然孕产妇种族/族裔构成的变化以及一项稳定性指标与足月低出生体重有关，但富裕程度指标与早产低出生体重有关。这项研究强调了女性社区中的社会经济和人口结构变化对生殖健康的重要性。
