Department of Sociology and Nuffield College, University of Oxford, Manor Road, Oxford OX1 3UQ, UK.
Hum Reprod. 2017 Nov 1;32(11):2305-2314. doi: 10.1093/humrep/dex298.
To what extent do financial, demographic and cultural determinants explain the vast cross-national differences in ART treatments in Europe?
The normative cultural acceptance of ART is a major driver of ART treatments in Europe, above and beyond differences in country wealth, demographic aspects and religious composition.
There are vast differences in the number of ART treatments across European countries, which are to some extent related to country affluence, regulation, and insurance coverage and costs. The role and impact of cultural and normative factors has not been explored in a larger cross-national comparison.
STUDY DESIGN, SIZE, DURATION: A descriptive and comparative cross-national analysis of ART treatment prevalence in over 30 European countries in 2010, with the outcome defined as the total number of ART cycles per million women of reproductive age (15-44 years). Data is drawn from multiple sources (ICMART, US Census Bureau Library, World Bank, Barro-Lee Educational Attainment Dataset, IFFS Surveillance reports, European Values Study and World Religion Database).
PARTICIPANTS/MATERIALS, SETTING, METHODS: Our sample includes data from 35 European countries, where we describe the associations between demographic and cultural factors and the prevalence of ART treatments. Bivariate correlation and ordinary least squares multiple regression analysis serves to establish the relationships between predictor variables and the number of ART treatments per million women aged 15-44 years in a country.
A one-percent increase in national GDP is associated with 382 (95% CI: 177-587) additional ART procedures per million women of reproductive age, yet this effect is reduced to 99 (-92 to 290) treatments once cultural values and demographic factors are accounted for. In our fully adjusted model, normative cultural values measuring the acceptability of ART are the strongest predictor of ART usage, with a one-point increase of average approval in a country associated with 276 (167-385) additional ART treatments per million women of reproductive age.
LIMITATIONS, REASONS FOR CAUTION: Findings are based on a cross-sectional, cross-national analysis, making formal tests of causality impossible and prohibiting inferences to the individual level.
Results indicate that reproductive health policy should openly acknowledge the importance of cultural norms in informally shaping and regulating the wider availability of ART treatment.
STUDY FUNDING/COMPETING INTEREST(S): Funding for this project was provided by the European Union's Seventh Framework Program (FP7 2007-2013) (No. 320116 Families and Societies), European Research Council for the SOCIOGENOME Consolidator Grant (ERC-2013-CoG-615603) and the Wellcome Trust Institutional Strategic Support Fund (all to M.C.M.). The authors have no conflicts of interest to declare.
N/A.
在多大程度上，金融、人口和文化因素可以解释欧洲国家在辅助生殖技术（ART）治疗方面的巨大差异？
除了国家财富、人口方面和宗教构成的差异之外，对 ART 的规范文化接受程度是欧洲 ART 治疗的主要驱动因素。
欧洲各国的 ART 治疗数量存在巨大差异，这在一定程度上与国家富裕程度、法规以及保险覆盖范围和成本有关。在更大的跨国比较中，文化和规范因素的作用和影响尚未得到探索。
研究设计、规模、持续时间：这是一项关于 2010 年欧洲 30 多个国家 ART 治疗流行率的描述性和比较性跨国分析，其结果定义为每百万育龄妇女（15-44 岁）的 ART 周期总数。数据来自多个来源（ICMART、美国人口普查局图书馆、世界银行、Barro-Lee 教育程度数据集、IFFS 监测报告、欧洲价值观研究和世界宗教数据库）。
参与者/材料、设置、方法：我们的样本包括来自 35 个欧洲国家的数据，其中我们描述了人口和文化因素与 ART 治疗流行率之间的关联。单变量相关和普通最小二乘多元回归分析用于确定国家每百万 15-44 岁育龄妇女的 ART 治疗数量与预测变量之间的关系。
国家 GDP 增长 1%，与每百万育龄妇女的 ART 治疗增加 382 次（95%CI：177-587）有关，但考虑到文化价值观和人口因素后，这种影响降至 99 次（-92 至 290 次）。在我们完全调整的模型中，衡量对 ART 可接受性的规范文化价值观是 ART 使用的最强预测因素，国家平均认可程度增加一个点，与每百万育龄妇女的 ART 治疗增加 276 次（167-385 次）有关。
局限性、谨慎的原因：研究结果基于横断面、跨国分析，因此无法进行正式的因果关系检验，也无法推断到个体水平。
结果表明，生殖健康政策应公开承认文化规范在非正式塑造和规范更广泛的 ART 治疗可用性方面的重要性。
研究资金/利益冲突：本项目的资金由欧盟第七框架计划（FP7 2007-2013）（第 320116 号家庭和社会）、欧洲研究理事会的 SOCIOGENOME 整合者赠款（ERC-2013-CoG-615603）和惠康信托基金机构战略支持基金（均为 M.C.M.）提供。作者没有利益冲突需要申报。
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