Magnusson M, Lagerberg D, Wallby T
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Central Child Healthcare Unit, Uppsala Akademiska Hospital, Uppsala, Sweden.
Child Care Health Dev. 2016 May;42(3):415-23. doi: 10.1111/cch.12327. Epub 2016 Feb 25.
To study potential socioeconomic differences within the general decline in breastfeeding over time.
Data was collected for 51 415 infants born 2004-2010 from the databases of statistics of the Preventive Child Health Care Services in Uppsala and Orebro counties in Sweden and socioeconomic indicators from Swedish national registers. Breastfeeding data (breastfed/not breastfed) from 1 week, 4 months and 6 months of age were used as the main outcome variables. Educational level of the mother was defined as the highest level on a three-grade scale, low, medium and high. Family type was defined as whether the mother was single or married/cohabiting. Family disposable income was divided into quartiles where quartile 1 included the 25% children in families with the lowest incomes. Analyses were conducted by logistic regression models using the methodology of generalized estimating equations (GEE). An exchangeable correlation structure was used to control for the dependence among infants with the same mother.
Breastfeeding rate in Sweden has declined gradually since the late 1990s. The results indicated that overall breastfeeding rates over the study period were influenced by socioeconomic status in a gradient manner but no widening socioeconomic gap was detected. Rather the interaction analyses showed a narrowing socioeconomic gap over the study period between high and low educational level and single versus cohabiting mothers at 4 months. The narrowing socioeconomic gap between the educational level categories was also detectable at 6 months.
No increase in socioeconomic gap was detected within the general decline in Swedish breastfeeding. However, there are reasons to maintain and strengthen the overall breastfeeding supportive measures including extended support for vulnerable groups.
研究母乳喂养随时间普遍下降过程中潜在的社会经济差异。
收集了2004年至2010年在瑞典乌普萨拉和厄勒布鲁县出生的51415名婴儿的预防性儿童保健服务统计数据库数据以及瑞典国家登记册中的社会经济指标。将1周、4个月和6个月大时的母乳喂养数据（母乳喂养/非母乳喂养）用作主要结局变量。母亲的教育水平按低、中、高三个等级量表中的最高水平定义。家庭类型定义为母亲是单身还是已婚/同居。家庭可支配收入分为四分位数，其中第一四分位数包括收入最低家庭中的25%的儿童。使用广义估计方程（GEE）方法通过逻辑回归模型进行分析。采用可交换相关结构来控制同一母亲的婴儿之间的相关性。
自20世纪90年代末以来，瑞典的母乳喂养率逐渐下降。结果表明，研究期间的总体母乳喂养率受社会经济地位的影响呈梯度变化，但未发现社会经济差距扩大。相反，交互分析显示，在研究期间，4个月大时高、低教育水平母亲以及单身与同居母亲之间的社会经济差距在缩小。6个月大时，教育水平类别之间的社会经济差距缩小也很明显。
在瑞典母乳喂养普遍下降的情况下，未发现社会经济差距增加。然而，有理由维持和加强总体母乳喂养支持措施，包括对弱势群体的进一步支持。
