Wehby George L, Nyarko Kwame A, Lopez-Camelo Jorge S
Department of Health Management and Policy, University of Iowa, Iowa City, IA, USA.
Health Econ. 2014 Jan;23(1):69-92. doi: 10.1002/hec.2901. Epub 2013 Jan 22.
Several studies report socioeconomic inequalities in child health and consequences of early disease. However, not much is known about inequalities in health capital accumulation in the womb in response to fetal health shocks, which is essential for finding the earliest sensitive periods for interventions to reduce inequalities. We identify inequalities in birth weight accumulation as a result of fetal health shocks from the occurrence of one of the most common birth defects, oral clefts, within the first 9 weeks of pregnancy, using quantile regression and two datasets from South America and the USA. Infants born at lower birth weight quantiles are significantly more adversely affected by the health shock compared with those born at higher birth weight quantiles, with overall comparable results between the South American and US samples. These results suggest that fetal health shocks increase child health disparities by widening the spread of the birth weight distribution and that health inequalities begin in the womb, requiring interventions before pregnancy.
多项研究报告了儿童健康方面的社会经济不平等以及早期疾病的后果。然而，对于子宫内健康资本积累因胎儿健康冲击而产生的不平等情况，我们了解得并不多，而这对于找出最早的敏感干预时期以减少不平等至关重要。我们利用分位数回归以及来自南美洲和美国的两个数据集，将出生体重积累方面的不平等确定为怀孕前9周内最常见的出生缺陷之一——唇腭裂的发生所导致的胎儿健康冲击的结果。与出生体重分位数较高的婴儿相比，出生体重分位数较低的婴儿受健康冲击的负面影响要大得多，南美洲和美国样本的总体结果具有可比性。这些结果表明，胎儿健康冲击通过扩大出生体重分布的差距而增加了儿童健康差异，并且健康不平等始于子宫内，需要在怀孕前进行干预。
