Reime Birgit, Ratner Pamela A, Tomaselli-Reime Sandra N, Kelly Ann, Schuecking Beate A, Wenzlaff Paul
University of British Columbia Vancouver, BC, Canada.
Soc Sci Med. 2006 Apr;62(7):1731-44. doi: 10.1016/j.socscimed.2005.08.017. Epub 2005 Oct 17.
This study examines whether the association between social inequalities and low birth weight (LBW) (occurring in both pre- and full-term births) in Germany can be explained by several potentially confounding factors. These include maternal age, occupational status, marital status, nationality, employment status, smoking, prenatal care, psychosocial stress, obesity, short stature, short inter-pregnancy interval, chronic conditions, and several obstetrical risk factors such as pregnancy induced hypertension. We also examined how the risk for LBW varies over time within each socioeconomic group. We analyzed routinely collected perinatal data on singletons born in the federal state of Lower Saxony, Germany, in 1990, 1995, and 1999 (n = 182,444). After adjustment for all potentially confounding factors in multivariate logistic regression models, working class women, unemployed women, single mothers, and women over 39 years of age were at increased risk for pre- and full-term LBW infants. Migrant status was not related to LBW. We examined variations in the risk for LBW over time within groups, using the 1990 birth cohort as the referent group for the 1995 and 1999 birth cohorts. Compared to 1990, in 1999 women aged 19-34 years, housewives, unemployed women, women of German nationality and women with partners had higher risks for pre- and full-term LBW infants; the eldest subgroup had lower risks for LBW after adjustment for confounding factors. The factors we examined partly explain the social inequalities in LBW occurring in pre- and full-term infants. The subgroups with higher rates of LBW in 1999 compared to 1990, included women experiencing childbirth in an optimal stage of life or in a privileged social context. Public health policies in Germany should target social inequalities contributing to the aetiology of LBW and to the factors that result in increased LBW rates.
本研究探讨德国社会不平等与低出生体重(LBW,包括早产和足月产)之间的关联是否可由若干潜在混杂因素来解释。这些因素包括产妇年龄、职业状况、婚姻状况、国籍、就业状况、吸烟、产前护理、心理社会压力、肥胖、身材矮小、妊娠间隔短、慢性病以及若干产科危险因素,如妊娠高血压。我们还研究了每个社会经济群体中低出生体重风险随时间的变化情况。我们分析了1990年、1995年和1999年在德国下萨克森州出生的单胎围产期常规收集数据(n = 182,444)。在多变量逻辑回归模型中对所有潜在混杂因素进行调整后,工人阶级女性、失业女性、单身母亲以及39岁以上女性生育早产和足月低出生体重婴儿的风险增加。移民身份与低出生体重无关。我们以1990年出生队列作为1995年和1999年出生队列的参照组,研究了各群体中低出生体重风险随时间的变化。与1990年相比,1999年19 - 34岁的女性、家庭主妇、失业女性、德国国籍女性以及有伴侣的女性生育早产和足月低出生体重婴儿的风险更高;年龄最大的亚组在调整混杂因素后低出生体重风险较低。我们研究的因素部分解释了早产和足月婴儿低出生体重方面的社会不平等现象。与1990年相比,1999年低出生体重率较高的亚组包括在生命最佳阶段或享有特权社会背景下分娩的女性。德国的公共卫生政策应针对导致低出生体重病因的社会不平等现象以及导致低出生体重率上升的因素。