Schölmerich Vera L N, Erdem Özcan, Borsboom Gerard, Ghorashi Halleh, Groenewegen Peter, Steegers Eric A P, Kawachi Ichiro, Denktaş Semiha
Erasmus University Medical Centre, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, the Netherlands; VU University Amsterdam, Department of Organizational Sciences, Amsterdam, the Netherlands; Harvard School of Public Health, Department of Social and Behavioral Sciences, Boston, Massachusetts, United States of America.
Municipality of Rotterdam, Research and Business Intelligence, Rotterdam, the Netherlands; Erasmus University Medical Center, Department of Public Health, Rotterdam, the Netherlands.
PLoS One. 2014 May 7;9(5):e95873. doi: 10.1371/journal.pone.0095873. eCollection 2014.
Perinatal morbidity rates are relatively high in the Netherlands, and significant inequalities in perinatal morbidity and mortality can be found across neighborhoods. In socioeconomically deprived areas, 'Western' women are particularly at risk for adverse birth outcomes. Almost all studies to date have explained the disparities in terms of individual determinants of birth outcomes. This study examines the influence of neighborhood contextual characteristics on birth weight (adjusted for gestational age) and preterm birth. We focused on the influence of neighborhood social capital--measured as informal socializing and social connections between neighbors--as well as ethnic (minority) density.
Data on birth weight and prematurity were obtained from the Perinatal Registration Netherlands 2000-2008 dataset, containing 97% of all pregnancies. Neighborhood-level measurements were obtained from three different sources, comprising both survey and registration data. We included 3.422 neighborhoods and 1.527.565 pregnancies for the birth weight analysis and 1.549.285 pregnancies for the premature birth analysis. Linear and logistic multilevel regression was performed to assess the associations of individual and neighborhood level variables with birth weight and preterm birth.
We found modest but significant neighborhood effects on birth weight and preterm births. The effect of ethnic (minority) density was stronger than that of neighborhood social capital. Moreover, ethnic (minority) density was associated with higher birth weight for infants of non-Western ethnic minority women compared to Western women (15 grams; 95% CI: 12,4/17,5) as well as reduced risk for prematurity (OR 0.97; CI 0,95/0,99).
Our results indicate that neighborhood contexts are associated with birth weight and preterm birth in the Netherlands. Moreover, ethnic (minority) density seems to be a protective factor for non-Western ethnic minority women, but not for Western women. This helps explain the increased risk of Western women in deprived neighborhoods for adverse birth outcomes found in previous studies.
荷兰围产期发病率相对较高，且围产期发病率和死亡率在不同社区存在显著不平等。在社会经济贫困地区，“西方”女性尤其面临不良分娩结局的风险。几乎所有迄今为止的研究都从出生结局的个体决定因素方面解释了这些差异。本研究考察社区环境特征对出生体重（根据胎龄调整）和早产的影响。我们重点关注社区社会资本的影响——以邻里间的非正式社交和社会联系来衡量——以及种族（少数族裔）密度。
出生体重和早产数据来自荷兰2000 - 2008年围产期登记数据集，该数据集包含了97%的所有妊娠情况。社区层面的测量数据来自三个不同来源，包括调查和登记数据。我们纳入了3422个社区和1527565例妊娠用于出生体重分析，以及1549285例妊娠用于早产分析。进行线性和逻辑多水平回归以评估个体和社区层面变量与出生体重和早产之间的关联。
我们发现社区对出生体重和早产有适度但显著的影响。种族（少数族裔）密度的影响比社区社会资本的影响更强。此外，与西方女性相比，非西方少数族裔女性的婴儿出生体重因种族（少数族裔）密度较高而更高（15克；95%置信区间：12.4/17.5），早产风险也更低（比值比0.97；置信区间0.95/0.99）。
我们的结果表明，在荷兰，社区环境与出生体重和早产有关。此外，种族（少数族裔）密度似乎对非西方少数族裔女性是一个保护因素，但对西方女性不是。这有助于解释先前研究中发现的贫困社区西方女性不良分娩结局风险增加的现象。
