Joseph K S, Fahey John, Shankardass Ketan, Allen Victoria M, O'Campo Patricia, Dodds Linda, Liston Robert M, Allen Alexander C
Department of Obstetrics and Gynaecology and the School of Population and Public Health, University of British Columbia and the Children's and Women's Hospital of British Columbia, 4500 Oak Street, Vancouver, British Columbia V6H 3 N1, Canada.
BMC Pregnancy Childbirth. 2014 Mar 27;14:117. doi: 10.1186/1471-2393-14-117.
The literature shows a variable and inconsistent relationship between socioeconomic position and preterm birth. We examined risk factors for spontaneous and iatrogenic preterm birth, with a focus on socioeconomic position and clinical risk factors, in order to explain the observed inconsistency.
We carried out a retrospective population-based cohort study of all singleton deliveries in Nova Scotia from 1988 to 2003. Data were obtained from the Nova Scotia Atlee Perinatal Database and the federal income tax T1 Family Files. Separate logistic models were used to quantify the association between socioeconomic position, clinical risk factors and spontaneous preterm birth and iatrogenic preterm birth.
The study population included 132,714 singleton deliveries and the rate of preterm birth was 5.5%. Preterm birth rates were significantly higher among the women in the lowest (versus the highest) family income group for spontaneous (rate ratio 1.14, 95% confidence interval (CI) 1.03, 1.25) but not iatrogenic preterm birth (rate ratio 0.95, 95% CI 0.75, 1.19). Adjustment for maternal characteristics attenuated the family income-spontaneous preterm birth relationship but strengthened the relationship with iatrogenic preterm birth. Clinical risk factors such as hypertension were differentially associated with spontaneous (rate ratio 3.92, 95% CI 3.47, 4.44) and iatrogenic preterm (rate ratio 14.1, 95% CI 11.4, 17.4) but factors such as diabetes mellitus were not (rate ratio 4.38, 95% CI 3.21, 5.99 for spontaneous and 4.02, 95% CI 2.07, 7.80 for iatrogenic preterm birth).
Socioeconomic position and clinical risk factors have different effects on spontaneous and iatrogenic preterm. Recent temporal increases in iatrogenic preterm birth appear to be responsible for the inconsistent relationship between socioeconomic position and preterm birth.
文献表明社会经济地位与早产之间的关系多变且不一致。我们研究了自然早产和医源性早产的危险因素，重点关注社会经济地位和临床危险因素，以解释所观察到的不一致性。
我们对1988年至2003年新斯科舍省所有单胎分娩进行了一项基于人群的回顾性队列研究。数据来自新斯科舍省阿特利围产期数据库和联邦所得税T1家庭档案。使用单独的逻辑模型来量化社会经济地位、临床危险因素与自然早产和医源性早产之间的关联。
研究人群包括132,714例单胎分娩，早产率为5.5%。自然早产（率比1.14，95%置信区间（CI）1.03，1.25）而非医源性早产（率比0.95，95%CI 0.75，1.19）在最低（相对于最高）家庭收入组的女性中早产率显著更高。对母亲特征进行调整减弱了家庭收入与自然早产的关系，但加强了与医源性早产的关系。高血压等临床危险因素与自然早产（率比3.92，95%CI 3.47，4.44）和医源性早产（率比14.1，95%CI 11.4，17.4）有不同关联，但糖尿病等因素则不然（自然早产率比4.38，95%CI 3.21，5.99，医源性早产率比4.02，95%CI 2.07，7.80）。
社会经济地位和临床危险因素对自然早产和医源性早产有不同影响。近期医源性早产的时间性增加似乎是社会经济地位与早产之间关系不一致的原因。
