Centre for Chronic Disease, School of Medicine, University of Queensland, Brisbane, QLD, Australia.
Med J Aust. 2010 Jan 4;192(1):14-9. doi: 10.5694/j.1326-5377.2010.tb03394.x.
To describe associations between birthweight and infant, child and early adult mortality from natural causes in a remote Australian Aboriginal community against a background of rapidly changing mortality due to better health services.
DESIGN, PARTICIPANTS AND SETTING: Cohort study of 995 people with recorded birthweights who were born between 1956 and 1985 to an Aboriginal mother in a remote Australian Aboriginal community. Participants were followed through to the end of 2006.
Rates of natural deaths of infants (aged 0 to < 1 year), children (aged 1 to < 15 years) and adults (aged 15 to < 37 years), compared by birth intervals (1956-1965, 1966-1975 and 1976-1985 for infants and children, and 1956-1962 and 1963-1969 for adults) and by birthweight.
Birthweights were low, but increased over time. Deaths among infants and children decreased dramatically over time, but deaths among adults did not. Lower birthweights were associated with higher mortality. Adjusted for birth interval, hazard ratios for deaths among infants, children and adults born at weights below their group birthweight medians were 2.30 (95% CI, 1.13-4.70), 1.78 (95% CI, 1.03-3.07) and 3.49 (95% CI, 1.50-8.09), respectively. The associations were significant individually for deaths associated with diarrhoea in infants, with cardiovascular and renal disease in adults, and marginally significant for deaths from pulmonary causes in children and adults.
The striking improvements in infant and child survival over time must be applauded. We confirmed a predisposing effect of lower birthweights on deaths in infants and children, and showed, for the first time, an association between lower birthweights and deaths in adults. Together, these factors are probably contributing to the current epidemic of chronic disease in Aboriginal people, an effect that will persist for decades. Similar phenomena are probably operating in developing countries.
描述在澳大利亚偏远地区的一个原住民社区中，在因更好的医疗服务而导致死亡率迅速变化的背景下，出生体重与婴儿、儿童和早期成人自然死亡之间的关系。
设计、参与者和环境：对出生于 1956 年至 1985 年间在澳大利亚偏远地区原住民社区的原住民母亲所生的 995 名有记录出生体重的人群进行队列研究。对参与者进行了随访，直至 2006 年底。
按出生间隔（婴儿和儿童为 1956-1965 年、1966-1975 年和 1976-1985 年，成人则为 1956-1962 年和 1963-1969 年）和出生体重比较婴儿（<1 岁）、儿童（<15 岁）和成人（<37 岁）的自然死亡率。
出生体重较低，但随着时间的推移而增加。婴儿和儿童的死亡率随着时间的推移急剧下降，但成年人的死亡率却没有下降。较低的出生体重与较高的死亡率相关。调整出生间隔后，出生体重低于组内出生体重中位数的婴儿、儿童和成人的死亡风险比分别为 2.30（95%可信区间，1.13-4.70）、1.78（95%可信区间，1.03-3.07）和 3.49（95%可信区间，1.50-8.09）。这些关联在婴儿腹泻、成人心血管和肾脏疾病死亡方面具有统计学意义，在儿童和成人肺部疾病死亡方面具有边缘统计学意义。
必须赞扬婴儿和儿童的生存时间的显著改善。我们证实了出生体重较低对婴儿和儿童死亡有一定的易感性，并且首次表明出生体重较低与成人死亡之间存在关联。这些因素共同导致了当前原住民慢性疾病的流行，这种影响将持续数十年。类似的现象可能在发展中国家也在发生。
