Collins James W, Rankin Kristin M, David Richard J
Division of Neonatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Box #45, 225 E. Chicago, Ave, Chicago, IL, 60611, USA,
Matern Child Health J. 2015 Jul;19(7):1601-7. doi: 10.1007/s10995-015-1670-9.
A paucity of published data exists on the factors underlying the relatively poor birth outcome of non-Hispanic White women in the United States. To determine whether downward economic mobility is a risk factor for preterm birth (<37 weeks, PTB) among upper class-born White women. Stratified and multilevel logistic regression analyses were performed on an Illinois transgenerational dataset of non-Hispanic White infants (1989-1991) and their women (1956-1976) with appended US census income information. The study sample was restricted to singleton births of Chicago-born upper-class (defined by early-life residence in affluent neighborhoods) non-Hispanic White women. Upper class-born White women (n = 4,891) who did not experience downward economic mobility by the time of delivery had a PTB rate of 5.4 %. Those women who experienced slight (n = 5,112), moderate (n = 2,158), or extreme (n = 339) downward economic mobility had PTB rates of 6.5, 8.5, and 10.1 %, respectively; RR (95 % CI) = 1.2 (1.0-4.0), 1.6 (1.3-1.9), and 1.9 (1.3-2.6), respectively. Maternal downward economic mobility was also associated with an increased prevalence of biologic, medical, and behavioral risk factors. Interestingly, the relationship between moderate to extreme downward mobility and preterm birth was stronger among former low birth weight (<2500 g, LBW) than non-LBW women: 2.8 (1.4-5.8) versus 1.6 (1.3-1.9), respectively. In multilevel logistic regression models, the adjusted odds ratio of preterm birth for former LBW and non-LBW women who experienced any downward mobility (compared to those women with lifelong upper class status) equaled 2.4 (1.1-5.3) and 1.1 (1.0-1.1), respectively. Downward economic mobility is associated with an increased risk of preterm birth among upper class-born White urban women; this phenomenon is strongest among former low birth weight women.
关于美国非西班牙裔白人女性相对较差的生育结局背后的因素，公开数据较少。为了确定经济地位下降是否是出生于上层阶级的白人女性早产（<37周，PTB）的风险因素。对伊利诺伊州一个包含非西班牙裔白人婴儿（1989 - 1991年）及其母亲（1956 - 1976年）的跨代数据集进行了分层和多水平逻辑回归分析，并附加了美国人口普查收入信息。研究样本仅限于出生于芝加哥的上层阶级（由早年居住在富裕社区定义）非西班牙裔白人女性的单胎分娩。分娩时未经历经济地位下降的出生于上层阶级的白人女性（n = 4891）的早产率为5.4%。那些经历轻微（n = 5112）、中度（n = 2158）或极度（n = 339）经济地位下降的女性的早产率分别为6.5%、8.5%和10.1%；相对危险度（95%可信区间）分别为1.2（1.0 - 4.0）、1.6（1.3 - 1.9）和1.9（1.3 - 2.6）。母亲经济地位下降还与生物学、医学和行为风险因素的患病率增加有关。有趣的是，在出生体重低（<2500g，LBW）的女性中，中度至极度经济地位下降与早产之间的关系比出生体重正常的女性更强：分别为2.8（1.4 - 5.8）和1.6（1.3 - 1.9）。在多水平逻辑回归模型中，经历任何经济地位下降的出生体重低和出生体重正常的女性早产的调整优势比（与终身处于上层阶级地位的女性相比）分别为2.4（1.1 - 5.3）和1.1（1.0 - 1.1）。经济地位下降与出生于上层阶级的白人城市女性早产风险增加有关；这种现象在出生体重低的女性中最为明显。
