Heaman Maureen I, Green Chris G, Newburn-Cook Christine V, Elliott Lawrence J, Helewa Michael E
Faculty of Nursing, University of Manitoba, Winnipeg MB.
J Obstet Gynaecol Can. 2007 Oct;29(10):806-16. doi: 10.1016/s1701-2163(16)32637-8.
Analysis of regional variations in use of prenatal care to identify individual-level and neighbourhood-level determinants of inadequate prenatal care among women giving birth in the province of Manitoba.
Data were obtained from Manitoba Health administrative databases and the 1996 Canadian Census. An index of prenatal care use was calculated for each singleton live birth from 1991 to 2000 (N = 149,291). Births were geocoded into 498 geographic districts, and a spatial analysis was conducted, consisting of data visualization, spatial clustering, and data modelling using Poisson regression.
We found wide variation in rates of inadequate prenatal care across geographic areas, ranging from 1.1% to 21.5%. Higher rates of inadequate care were found in the inner-city of Winnipeg and in northern Manitoba. After adjusting for individual characteristics, the highest rates of inadequate prenatal care were among women living in neighbourhoods with the lowest average family income, the highest proportion of the population who were unemployed, the highest rates of recent immigrants, the highest percentage of the population reporting Aboriginal status, the highest percentage of single parent families, the highest percentage of the population with fewer than nine years of education, and the highest rates of women who smoked during pregnancy.
Social inequalities exist in the use of prenatal care among Manitoba women, despite there being a universally funded health care system. Regional disparities in rates of inadequate prenatal care emphasize the need for further research to determine specific risk factors for inadequate prenatal care in socioeconomically disadvantaged neighbourhoods, followed by provision of effective targeted services.
分析产前护理使用情况的区域差异，以确定曼尼托巴省分娩妇女产前护理不足的个体层面和社区层面决定因素。
数据来自曼尼托巴省卫生行政数据库和1996年加拿大人口普查。计算了1991年至2000年每个单胎活产（N = 149,291）的产前护理使用指数。将分娩地点地理编码到498个地理区域，并进行空间分析，包括数据可视化、空间聚类以及使用泊松回归进行数据建模。
我们发现不同地理区域产前护理不足率差异很大，范围从1.1%到21.5%。温尼伯市中心和曼尼托巴省北部的护理不足率较高。在调整个体特征后，产前护理不足率最高的是居住在平均家庭收入最低、失业率最高、新移民比例最高、报告具有原住民身份的人口比例最高、单亲家庭比例最高、受教育年限少于九年的人口比例最高以及孕期吸烟妇女比例最高的社区中的妇女。
尽管有普遍资助的医疗保健系统，但曼尼托巴省妇女在产前护理使用方面存在社会不平等。产前护理不足率的区域差异强调需要进一步研究，以确定社会经济弱势社区产前护理不足的具体风险因素，随后提供有效的针对性服务。
