Weightman Alison L, Morgan Helen E, Shepherd Michael A, Kitcher Hilary, Roberts Chris, Dunstan Frank D
Support Unit for Research Evidence (SURE), Information Services, Cardiff University, Cardiff, UK.
BMJ Open. 2012 Jun 14;2(3). doi: 10.1136/bmjopen-2012-000964. Print 2012.
To determine the association between area and individual measures of social disadvantage and infant health in the UK.
Systematic review and meta-analyses.
26 databases and websites, reference lists, experts in the field and hand-searching.
36 prospective and retrospective observational studies with socioeconomic data and health outcomes for infants in the UK, published from 1994 to May 2011.
2 independent reviewers assessed the methodological quality of the studies and abstracted data. Where possible, study outcomes were reported as ORs for the highest versus the lowest deprivation quintile.
In relation to the highest versus lowest area deprivation quintiles, the odds of adverse birth outcomes were 1.81 (95% CI 1.71 to 1.92) for low birth weight, 1.67 (95% CI 1.42 to 1.96) for premature birth and 1.54 (95% CI 1.39 to 1.72) for stillbirth. For infant mortality rates, the ORs were 1.72 (95% CI 1.37 to 2.15) overall, 1.61 (95% CI 1.08 to 2.39) for neonatal and 2.31 (95% CI 2.03 to 2.64) for post-neonatal mortality. For lowest versus highest social class, the odds were 1.79 (95% CI 1.43 to 2.24) for low birth weight, 1.52 (95% CI 1.44 to 1.61) for overall infant mortality, 1.42 (95% CI 1.33 to1.51) for neonatal and 1.69 (95% CI 1.53 to 1.87) for post-neonatal mortality. There are similar patterns for other infant health outcomes with the possible exception of failure to thrive, where there is no clear association.
This review quantifies the influence of social disadvantage on infant outcomes in the UK. The magnitude of effect is similar across a range of area and individual deprivation measures and birth and mortality outcomes. Further research should explore the factors that are more proximal to mothers and infants, to help throw light on the most appropriate times to provide support and the form(s) that this support should take.
确定英国社会弱势地区及个体衡量指标与婴儿健康之间的关联。
系统评价与荟萃分析。
26个数据库及网站、参考文献列表、该领域专家以及手工检索。
1994年至2011年5月发表的36项关于英国婴儿社会经济数据及健康结局的前瞻性和回顾性观察性研究。
2名独立评审员评估研究的方法学质量并提取数据。可能的情况下，研究结果报告为最贫困五分位数与最不贫困五分位数相比的比值比。
与最贫困地区五分位数和最不贫困地区五分位数相比，低出生体重的不良出生结局比值比为1.81（95%置信区间1.71至1.92），早产为1.67（95%置信区间1.42至1.96），死产为1.54（95%置信区间1.39至1.72）。对于婴儿死亡率，总体比值比为1.72（95%置信区间1.37至2.15），新生儿期为1.61（95%置信区间1.08至2.39），新生儿后期为2.31（95%置信区间2.03至2.64）。与最高社会阶层和最低社会阶层相比，低出生体重的比值比为1.79（95%置信区间1.43至2.24），总体婴儿死亡率为1.52（95%置信区间1.44至1.61），新生儿期为1.42（95%置信区间1.33至1.51），新生儿后期为1.69（95%置信区间1.53至1.87）。其他婴儿健康结局也有类似模式，可能发育不良除外，其无明确关联。
本综述量化了英国社会弱势对婴儿结局的影响。在一系列地区及个体贫困衡量指标以及出生和死亡结局方面，影响程度相似。进一步研究应探索更接近母亲和婴儿的因素，以有助于明确提供支持的最合适时机及支持形式。
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