Farley Thomas A, Mason Karen, Rice Janet, Habel Joanna D, Scribner Richard, Cohen Deborah A
Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA.
Paediatr Perinat Epidemiol. 2006 May;20(3):188-200. doi: 10.1111/j.1365-3016.2006.00719.x.
Intrauterine growth retardation and preterm birth are more frequent in African-American women and women of lower socio-economic status, but the reasons for these disparities are not fully understood. The physical and social environments in which these women live may contribute to these disparities. We conducted a multilevel study to explore whether conditions of mothers' neighbourhood of residence contribute to adverse birth outcomes independent of individual-level determinants. We analysed data from 105 111 births in 1015 census tracts in Louisiana during 1997-98, merging it with data from other existing sources on neighbourhood socio-economic status, neighbourhood physical deterioration, and neighbourhood density of retail outlets selling tobacco, alcohol and foods. After controlling for individual-level sociodemographic factors, tract-level median household income was positively associated with both birthweight-for-gestational-age and gestational age at birth. Neighbourhood physical deterioration was associated with these birth outcomes in ecological analyses but only inconsistently associated with them after controlling for individual-level factors. Neither gestational age nor birthweight-for-gestational-age was associated with the neighbourhood density of alcohol outlets, tobacco outlets, fast-food restaurants or grocery supermarkets. We conclude that measures of neighbourhood economic conditions are associated with both fetal growth and the length of gestation independent of individual-level factors, but that readily available measures of neighbourhood retail outlets are not. Additional studies are needed to better understand the nature of environmental influences on birth outcomes.
非裔美国女性以及社会经济地位较低的女性中，胎儿宫内生长受限和早产更为常见，但这些差异的原因尚未完全明了。这些女性所处的自然和社会环境可能导致了这些差异。我们开展了一项多层次研究，以探讨母亲居住社区的环境状况是否会独立于个体层面的决定因素而导致不良分娩结局。我们分析了1997 - 1998年路易斯安那州1015个人口普查区的105111例分娩数据，并将其与其他现有来源中关于社区社会经济地位、社区自然环境恶化以及销售烟草、酒精和食品的零售网点密度的数据相结合。在控制了个体层面的社会人口学因素后，普查区层面的家庭收入中位数与出生体重与孕周比以及出生时的孕周呈正相关。在生态分析中，社区自然环境恶化与这些分娩结局相关，但在控制个体层面因素后，仅与这些结局存在不一致的关联。孕周以及出生体重与孕周比均与酒精销售网点、烟草销售网点、快餐店或食品杂货店的社区密度无关。我们得出结论，社区经济状况指标与胎儿生长及孕周长短相关，且独立于个体层面因素，但社区零售网点的现有指标并非如此。需要开展更多研究以更好地了解环境对分娩结局影响的本质。
