Auger Nathalie, Giraud Julie, Daniel Mark
Unité Etudes et Analyses de l'Etat de Santé de la Population, Institut National de Santé Publique du Québec, Montréal, Québec, Canada.
BMC Public Health. 2009 Jul 14;9:237. doi: 10.1186/1471-2458-9-237.
The association between area characteristics and birth outcomes is modified by race. Whether such associations vary according to social class indicators beyond race has not been assessed.
This study evaluated effect modification by maternal birthplace and education of the relationship between neighbourhood characteristics and birth outcomes of newborns from 1999-2003 in the province of Québec, Canada (N = 353,120 births). Areas (N = 143) were defined as administrative local health service delivery districts. Multi-level logistic regression was used to model the association between three area characteristics (median household income, immigrant density and income inequality) and the two outcomes preterm birth (PTB) and small-for-gestational age (SGA) birth. Effect modification by social class indicators was evaluated in analyses stratified according to maternal birthplace and education.
Relative to the lowest tertile, high median household income was associated with SGA birth among Canadian-born mothers (odds ratio (OR) 1.13, 95% confidence interval (CI) 1.06, 1.20) and mothers with high school education or less (OR 1.13, 95% CI 1.02, 1.24). Associations between median household income and PTB were weaker. Relative to the highest tertile, low immigrant density was associated with a lower odds of PTB among foreign-born mothers (OR 0.79, 95% CI 0.63, 1.00) but a higher odds of PTB among Canadian-born mothers (OR 1.14, 95% CI 1.07, 1.21). Associations with income inequality were weak or absent.
The association between area factors and birth outcomes is modified by maternal birthplace and education. Studies have found that race interacts in a similar manner. Public health policies focussed on perinatal health must consider the interaction between individual and area characteristics.
地区特征与出生结局之间的关联因种族而异。尚未评估这种关联是否会因种族以外的社会阶层指标而有所不同。
本研究评估了1999年至2003年加拿大魁北克省（N = 353,120例分娩）新生儿的邻里特征与出生结局之间的关系，通过产妇出生地和教育程度进行效应修正。地区（N = 143）被定义为行政当地卫生服务提供区。采用多水平逻辑回归模型来模拟三个地区特征（家庭收入中位数、移民密度和收入不平等）与早产（PTB）和小于胎龄（SGA）出生这两个结局之间的关联。在根据产妇出生地和教育程度分层的分析中评估社会阶层指标的效应修正。
与最低三分位数相比，家庭收入中位数较高与加拿大出生的母亲发生SGA出生相关（比值比（OR）为1.13，95%置信区间（CI）为1.06，1.20），以及与高中及以下学历的母亲相关（OR为1.13，95%CI为1.02，1.24）。家庭收入中位数与PTB之间的关联较弱。与最高三分位数相比，低移民密度与外国出生的母亲发生PTB的几率较低相关（OR为0.79，95%CI为0.63，1.00），但与加拿大出生的母亲发生PTB的几率较高相关（OR为1.14，95%CI为1. 07，1.21）。与收入不平等的关联较弱或不存在。
地区因素与出生结局之间的关联因产妇出生地和教育程度而改变。研究发现种族也以类似方式相互作用。关注围产期健康的公共卫生政策必须考虑个体特征与地区特征之间的相互作用。
