Auger Nathalie, Authier Marie-Andrée, Martinez Jérôme, Daniel Mark
Unité Etudes et analyses de l'état de santé de population, Institut national de santé publique du Québec, Montréal, Québec, Canada.
J Rural Health. 2009 Fall;25(4):342-51. doi: 10.1111/j.1748-0361.2009.00242.x.
Rural relative to urban area and low socioeconomic status (SES) are associated with adverse birth outcomes. Whether a graded association of increasing magnitude is present across the urban-rural continuum, accounting for SES, is unclear. We examined the association between rural-urban continuum, SES and adverse birth outcomes.
Singleton births from 1999 to 2003 (n = 356,147) were linked to Québec municipalities ranked on a continuum of 3 urban and 4 rural areas based on population and economic base. Maternal education was used to represent SES. Odds ratios (OR) were calculated for preterm birth (PTB), low birth weight (LBW), and small-for-gestational-age (SGA) birth, accounting for municipality and individual-level covariates. We used stratified analyses to examine interaction between SES and rural-urban continuum.
Relative to metropolitan area residence, living in small urban or rural areas was associated with adverse birth outcomes. Living in rural areas was associated with SGA birth (OR 1.11, 95% CI 1.05-1.17) and LBW (OR 1.15, 95% CI 1.05-1.26), and living in small urban areas was associated with PTB (OR 1.14, 95% CI 1.08-1.20). Upon stratification by education, living in remote rural relative to metropolitan areas was associated with adverse birth outcomes among university educated mothers only, and living in small urban areas was associated with adverse birth outcomes among mothers with lesser but not higher education. An SES gradient was present in all rural-urban areas, particularly for SGA birth.
Differences in perinatal health exist across the rural-urban continuum, and maternal education has a modifying influence.
农村地区相对于城市地区以及低社会经济地位（SES）与不良出生结局相关。尚不清楚在考虑社会经济地位的情况下，城乡连续体中是否存在程度不断增加的分级关联。我们研究了城乡连续体、社会经济地位与不良出生结局之间的关联。
将1999年至2003年的单胎出生（n = 356,147）与魁北克各市镇相联系，这些市镇根据人口和经济基础在3个城市和4个农村地区的连续体上进行排名。使用母亲教育程度来代表社会经济地位。计算早产（PTB）、低出生体重（LBW）和小于胎龄（SGA）出生的比值比（OR），并考虑市镇和个体水平的协变量。我们使用分层分析来检验社会经济地位与城乡连续体之间的相互作用。
相对于居住在大都市区，居住在小城市或农村地区与不良出生结局相关。居住在农村地区与小于胎龄出生（OR 1.11，95%CI 1.05 - 1.17）和低出生体重（OR 1.15，95%CI 1.05 - 1.26）相关，居住在小城市地区与早产（OR 1.14，95%CI 1.08 - 1.20）相关。按教育程度分层后，相对于大都市区，仅在受过大学教育的母亲中，居住在偏远农村地区与不良出生结局相关，而居住在小城市地区与教育程度较低但非较高的母亲中的不良出生结局相关。在所有城乡地区都存在社会经济地位梯度，特别是对于小于胎龄出生。
城乡连续体中围产期健康存在差异，母亲教育程度具有调节作用。
