Spurlock C W, Moser M, Flynn L J
J Ky Med Assoc. 1989 Mar;87(3):111-9.
Our objective was to analyze differences in postneonatal mortality rates between the southeastern (Appalachian) region of Kentucky and the remainder of the state to identify factors associated with increased mortality in the Appalachian (AP) region. The relative risk of postneonatal deaths in the AP region when compared with the remainder of Kentucky (KY) was 1.38 (95% confidence interval = 1.15-1.65). Adjustment for birth weight, maternal age, and marital status of the parents had no appreciable effect on the risk ratio; however, adjustment for maternal education negated the increased risk of postneonatal death among the AP region births. When causes of postneonatal death were compared, three specific disease groupings were disproportionately represented among AP infants: Sudden Infant Death Syndrome (SIDS); congenital malformations; and infections. Most striking was the excess risk of infection-related death because it represents a preventable component in the postneonatal mortality excess of the AP region; and, because of the apparent association with maternal "under education." These findings are discussed within a public health intervention context.
我们的目标是分析肯塔基州东南部（阿巴拉契亚）地区与该州其他地区之间新生儿期后死亡率的差异，以确定与阿巴拉契亚（AP）地区死亡率升高相关的因素。与肯塔基州（KY）其他地区相比，AP地区新生儿期后死亡的相对风险为1.38（95%置信区间=1.15-1.65）。对出生体重、母亲年龄和父母婚姻状况进行调整对风险比没有明显影响；然而，对母亲教育程度进行调整后，AP地区出生的新生儿期后死亡风险增加的情况消失了。在比较新生儿期后死亡原因时，AP地区婴儿中三种特定疾病类别所占比例过高：婴儿猝死综合征（SIDS）；先天性畸形；以及感染。最引人注目的是与感染相关死亡的额外风险，因为它是AP地区新生儿期后死亡率过高的一个可预防因素；而且，由于其与母亲“教育程度低”明显相关。本文在公共卫生干预背景下对这些发现进行了讨论。
