Center on Social Disparities in Health, Department of Family and Community Medicine, University of California San Francisco, San Francisco, California 94118, USA.
Am J Prev Med. 2010 Sep;39(3):263-72. doi: 10.1016/j.amepre.2010.05.012.
Adverse birth outcomes, such as preterm birth and low birth weight, have serious health consequences across the life course. Socioeconomic disparities in birth outcomes have not been the subject of a recent systematic review. The aim of this study was to systematically review the literature on the association of socioeconomic disadvantage with adverse birth outcomes, with specific attention to the strength and consistency of effects across socioeconomic measures, birth outcomes, and populations.
Relevant articles published from 1999 to 2007 were obtained through electronic database searches and manual searches of reference lists. English-language studies from industrialized countries were included if (1) study objectives included examination of a socioeconomic disparity in a birth outcome and (2) results were presented on the association between a socioeconomic predictor and a birth outcome related to birth weight, gestational age, or intrauterine growth. Two reviewers extracted data and independently rated study quality; data were analyzed in 2008-2009.
Ninety-three of 106 studies reported a significant association, overall or within a population subgroup, between a socioeconomic measure and a birth outcome. Socioeconomic disadvantage was consistently associated with increased risk across socioeconomic measures, birth outcomes, and countries; many studies observed racial/ethnic differences in the effect of socioeconomic measures.
Socioeconomic differences in birth outcomes remain pervasive, with substantial variation by racial or ethnic subgroup, and are associated with disadvantage measured at multiple levels (individual/family, neighborhood) and time points (childhood, adulthood), and with adverse health behaviors that are themselves socially patterned. Future reviews should focus on identifying interventions to successfully reduce socioeconomic disparities in birth outcomes.
早产和低出生体重等不良出生结局会对人的一生健康造成严重影响。然而，最近的系统综述并未涉及出生结局的社会经济差异。本研究旨在系统综述社会经济劣势与不良出生结局之间关联的文献，特别关注社会经济测量指标、出生结局和人群中效应的强度和一致性。
通过电子数据库搜索和参考文献列表的手动搜索，获取了 1999 年至 2007 年发表的相关文章。如果（1）研究目的包括检查出生结局方面的社会经济差距，以及（2）结果呈现了社会经济预测因素与与出生体重、胎龄或宫内生长相关的出生结局之间的关联，那么来自工业化国家的英语研究将被纳入。两位评审员提取数据并独立评估研究质量；数据于 2008-2009 年进行分析。
93 项研究中的 106 项报告了社会经济测量指标与出生结局之间的关联具有统计学意义，无论是整体上还是在人口亚组内。社会经济劣势与多种社会经济测量指标、出生结局和国家的风险增加均存在一致性关联；许多研究观察到社会经济测量指标的影响存在种族/族裔差异。
出生结局的社会经济差异仍然普遍存在，具有相当大的种族或族裔亚组差异，并且与多个层面（个体/家庭、社区）和时间点（儿童期、成年期）的劣势有关，还与本身具有社会模式的不良健康行为有关。未来的综述应侧重于确定成功减少出生结局社会经济差异的干预措施。
