Singh Gopal K, Kogan Michael D
Maternal and Child Health Bureau, Health Resources and Services Administration, 5600 Fishers La, Room 18-41, Rockville, MD 20857, USA.
Pediatrics. 2007 Apr;119(4):e928-39. doi: 10.1542/peds.2005-2181.
This study examines changing patterns of inequalities in US infant, neonatal, and postneonatal mortality rates between 1969 and 2001 by area deprivation and maternal education.
A deprivation index was linked to county vital records data to derive annual infant mortality rates by deprivation quintiles from 1969 to 2000. Rates by maternal education were computed for 1986, 1991, 1996, and 2001 using national linked birth/infant death files. Log-binomial regression was used to estimate relative risks of infant mortality by deprivation and time period. Cox regression was used to model overall and birth weight-specific infant mortality risks by maternal education after adjusting for covariates. Temporal disparities were summarized by log-linear regression and inequality indices.
Although absolute disparities have narrowed over time, relative socioeconomic disparities in infant mortality have increased since 1985. In 1985-1989, infants in the most deprived group had, respectively, 36% and 57% higher risks of neonatal and postneonatal mortality than infants in the least deprived group. The corresponding relative risks increased to 43% and 96% in 1995-2000. The adjusted risk of infant mortality was 22% higher in 1986 for mothers with < 12 years of education than for those with > or = 16 years of education, with the relative risk increasing to 41% in 2001. Disparities were greatest among normal birth weight infants, with education-specific relative risks of neonatal and postneonatal mortality increasing significantly between 1986 and 2001.
Dramatic declines in infant mortality among all of the socioeconomic groups during 1969-2001 represent a major public health success. However, substantial socioeconomic disparities persisted in both neonatal and postneonatal mortality. Relatively larger declines in infant and postneonatal mortality among higher socioeconomic groups have contributed to the widening gap in mortality since 1985. Persistent disparities in infant mortality may reflect increasing polarization among socioeconomic groups in material and social conditions, smoking during pregnancy, and health care services.
本研究通过地区贫困程度和母亲教育程度，考察1969年至2001年间美国婴儿、新生儿及新生儿后期死亡率不平等状况的变化模式。
将一个贫困指数与县生命记录数据相联系，以得出1969年至2000年按贫困五分位数划分的年度婴儿死亡率。利用全国链接的出生/婴儿死亡档案计算1986年、1991年、1996年和2001年按母亲教育程度划分的死亡率。采用对数二项回归估计按贫困程度和时间段划分的婴儿死亡相对风险。在对协变量进行调整后，采用Cox回归对按母亲教育程度划分的总体及出生体重特定的婴儿死亡风险进行建模。通过对数线性回归和不平等指数总结时间差异。
尽管随着时间推移绝对差距有所缩小，但自1985年以来，婴儿死亡率方面的社会经济相对差距有所增加。在1985 - 1989年，最贫困组的婴儿新生儿死亡率和新生儿后期死亡率分别比最不贫困组的婴儿高36%和57%。在1995 - 2000年，相应的相对风险增至43%和96%。1986年，受教育年限不足12年的母亲所生婴儿的校正后死亡风险比受教育年限大于或等于16年的母亲所生婴儿高22%，到2001年相对风险增至41%。正常出生体重婴儿中的差距最大，1986年至2001年间，按教育程度划分的新生儿死亡率和新生儿后期死亡率相对风险显著增加。
1969年至2001年间所有社会经济群体的婴儿死亡率大幅下降是一项重大的公共卫生成就。然而，新生儿和新生儿后期死亡率方面仍存在显著的社会经济差距。社会经济地位较高群体的婴儿和新生儿后期死亡率下降幅度相对较大，导致了自1985年以来死亡率差距的扩大。婴儿死亡率方面持续存在的差距可能反映出社会经济群体在物质和社会条件、孕期吸烟以及医疗服务方面的两极分化加剧。
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