Juárez Sol, Revuelta-Eugercios Bárbara A, Ramiro-Fariñas Diego, Viciana-Fernández Francisco
Centre for Economic Demography, Lund University, Box 7083, 22007, Lund, Sweden,
Matern Child Health J. 2014 Oct;18(8):1814-22. doi: 10.1007/s10995-013-1425-4.
Evidence suggests that educational differences in perinatal outcomes have increased in some countries (Eastern Europe) while remained stable in others (Scandinavian countries). However, less is known about the experience of Southern Europe. This study aims to evaluate the association between maternal education and perinatal outcomes derived from birthweight (low birthweight and macrosomia) and gestational age (pre-term and post-term births) among Spaniards living in the Autonomous Community of Andalusia during the period 2001-2011 (around 19 % of births in Spain); and to evaluate whether the educational differences narrowed or widened during that period, which includes both an economic boom (2001-2008) and the global economic crisis (2009-2011). This study uses the Andalusian Population Longitudinal Database and the Vital Statistics Data provided by the Spanish National Statistics Institute. We study live and singleton births of Spanish mothers who lived in Andalusia at the time of delivery (n = 404,951). ORs with 95 % confidence intervals (crude and adjusted) were estimated using multinomial regression models. A negative educational gradient is observed in all perinatal outcomes studied (i.e., the higher the educational status, the lower the risk of negative perinatal outcomes). However, when disaggregating the sample in two periods, the gradient is only statistically significant for pre-term birth during 2001-2008, while a full gradient is observed in all perinatal indicators in the period 2009-2011 with an increase in the educational inequalities in macrosomia and post-term. Further studies are needed in order to confirm whether there is a causal association between the widening of the educational differences in perinatal outcomes and the onset of the economic crisis in Spain, or the widening can be explained by other factors, such as changes in childbearing patterns and the composition of women accessing motherhood.
有证据表明，围产期结局方面的教育差异在一些国家（东欧）有所增加，而在另一些国家（斯堪的纳维亚国家）则保持稳定。然而，关于南欧的情况了解较少。本研究旨在评估2001年至2011年期间居住在安达卢西亚自治区的西班牙人（约占西班牙出生人口的19%）中，母亲教育程度与出生体重（低出生体重和巨大儿）及孕周（早产和过期产）所衍生的围产期结局之间的关联；并评估在此期间教育差异是缩小还是扩大，这一时期既包括经济繁荣期（2001年至2008年），也包括全球经济危机期（2009年至2011年）。本研究使用安达卢西亚人口纵向数据库以及西班牙国家统计局提供的生命统计数据。我们研究了分娩时居住在安达卢西亚的西班牙母亲的活产单胎分娩情况（n = 404,951）。使用多项回归模型估计了95%置信区间（粗值和校正值）的比值比。在所有研究的围产期结局中均观察到负教育梯度（即教育程度越高，围产期不良结局的风险越低）。然而，将样本分为两个时期时，该梯度仅在2001年至2008年期间的早产情况中具有统计学意义，而在2009年至2011年期间的所有围产期指标中均观察到完整的梯度，巨大儿和过期产方面的教育不平等有所增加。需要进一步研究以确认围产期结局方面教育差异的扩大与西班牙经济危机的爆发之间是否存在因果关联，或者这种扩大是否可以由其他因素解释，例如生育模式的变化以及生育女性的构成变化。
