Petrou Stavros, Kupek Emil, Hockley Christine, Goldacre Michael
National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
Paediatr Perinat Epidemiol. 2006 Jan;20(1):14-23. doi: 10.1111/j.1365-3016.2006.00688.x.
The objective of this study was to examine the association between social class of the head of household at the time of birth and mortality and morbidity during the first 10 years of life in a cohort of all 117 212 children born to women who both lived, and delivered in hospital, in Oxfordshire or West Berkshire during the period 1 January 1979 to 31 December 1988. Logistic regression was used to estimate social class gradients, with odds ratios (OR), for mortality during the early neonatal period, late neonatal period, post-neonatal period, post-infancy period and throughout the first 10 years of life. Logistic regression was also used to estimate social class gradients, with ORs, for hospital admission rates for 16 broad groups of diseases during years 0-3, 4-6, 7-10 and throughout the first 10 years of life. Poisson regression was used to estimate social class gradients, with effect sizes, for overall hospital admission rates during years 0-3, 4-6, 7-10 and throughout the first 10 years of life. The study revealed a significant social class gradient in mortality during the first 10 years of life (adjusted OR for each decrement in social class category 1.08; [95% confidence interval 1.03, 1.14]). The study also revealed a significant adjusted social class gradient in hospital admission rates for 14 of the 16 groups of diseases during the first 10 years of life. For the majority of these, the social class gradients had attenuated somewhat by the later childhood years. However, the social class gradient persisted throughout the first 10 years of life for diseases of the respiratory system (1.07 [1.05, 1.08]), diseases of the digestive system (1.06 [1.04, 1.09]), and injury and poisoning (1.07 [1.06, 1.09]). In addition, a significant adjusted social class gradient was found in overall hospital admission rates for each age group studied. This study suggests that there are significant social class inequalities in a wide range of adverse child health outcomes.
本研究的目的是调查1979年1月1日至1988年12月31日期间在牛津郡或西伯克郡居住并在医院分娩的所有117212名儿童队列中，出生时户主的社会阶层与儿童出生后头10年的死亡率和发病率之间的关联。采用逻辑回归来估计社会阶层梯度，即早期新生儿期、晚期新生儿期、新生儿后期、婴儿后期及整个头10年的死亡率的比值比（OR）。逻辑回归还用于估计社会阶层梯度，即0至3岁、4至6岁、7至10岁及整个头10年期间16大类疾病的住院率的OR。采用泊松回归来估计社会阶层梯度，即0至3岁、4至6岁、7至10岁及整个头10年期间总体住院率的效应量。研究显示，在儿童出生后头10年的死亡率方面存在显著的社会阶层梯度（社会阶层类别每下降一级，调整后的OR为1.08；[95%置信区间1.03, 1.14]）。该研究还显示，在儿童出生后头10年，16组疾病中有14组疾病的住院率存在显著的调整后社会阶层梯度。对于其中大多数疾病而言，社会阶层梯度在童年后期有所减弱。然而，呼吸系统疾病（1.07 [1.05, 1.08]）、消化系统疾病（1.06 [1.04, 1.09]）以及损伤和中毒（1.07 [1.06, 1.09]）的社会阶层梯度在整个头10年期间持续存在。此外，在所研究的每个年龄组的总体住院率方面也发现了显著的调整后社会阶层梯度。这项研究表明，在一系列不良儿童健康结局方面存在显著的社会阶层不平等。
