Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut.
Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Int J Epidemiol. 2019 Feb 1;48(1):275-286. doi: 10.1093/ije/dyy200.
Studies on immigrants revealed an epidemiological paradox whereby low-socioeconomic status (SES) immigrant mothers exhibit favourable birth outcomes compared with native-born mothers. We tested the epidemiological paradox in a context of forced migration, comparing associations of low birthweight (LBW) and maternal SES between Syrian and Lebanese newborns in Lebanon.
We used data from the National Collaborative Perinatal Neonatal Network (NCPNN) of 31 Lebanese hospitals, including 45 442 Lebanese and 4910 Syrian neonates born 2011-13. We assessed associations between LBW and maternal SES for both groups. Logistic regression models examined interactions between maternal origin and SES.
Syrian births increased exponentially between 2011 and 2013, along with the group's forced migration into Lebanon. Although Syrian mothers are more socioeconomically disadvantaged compared with Lebanese mothers, Syrian LBW (6.2%) was only marginally higher than Lebanese LBW (5.6%; P = 0.059). Only 20-24-years-old Syrian women [odds ratio (OR) = 1.70 (1.22-2.36)] and those with ≥ university education [OR = 2.02 (0.98-4.16)] exhibited higher odds of delivering an LBW baby compared with Lebanese women of the same age and education.
The findings do not provide strong evidence for the epidemiological paradox in a forced migration context. However, the relatively advantageous LBW profile among Syrian neonates, despite their mothers' low SES and exposure to acute and chronic psychological stress, points to protective mechanisms. One of these mechanisms may be a collective response by the displaced population to improve neonatal outcomes as a way of recovering from loss and death.
研究表明，低社会经济地位（SES）的移民母亲的生育结果优于本土出生的母亲，这一现象构成了一个流行病学悖论。我们在被迫迁移的背景下检验了这一流行病学悖论，比较了黎巴嫩的叙利亚和黎巴嫩新生儿低出生体重（LBW）与母亲 SES 之间的关联。
我们使用了黎巴嫩 31 家医院的国家合作围产期新生儿网络（NCPNN）的数据，包括 2011-2013 年出生的 45442 名黎巴嫩新生儿和 4910 名叙利亚新生儿。我们评估了两组之间 LBW 与母亲 SES 之间的关联。逻辑回归模型检验了母亲原籍国与 SES 之间的相互作用。
2011 年至 2013 年间，随着叙利亚人被迫涌入黎巴嫩，叙利亚出生人数呈指数级增长。尽管与黎巴嫩母亲相比，叙利亚母亲的社会经济地位较低，但叙利亚的 LBW（6.2%）仅略高于黎巴嫩的 LBW（5.6%；P=0.059）。只有 20-24 岁的叙利亚妇女（优势比[OR]为 1.70（1.22-2.36））和受过大学教育的妇女（OR 为 2.02（0.98-4.16））与同年龄和教育程度的黎巴嫩妇女相比，生育 LBW 婴儿的几率更高。
这些发现并不能为强制迁移背景下的流行病学悖论提供有力证据。然而，尽管叙利亚新生儿的母亲社会经济地位较低，且面临急性和慢性心理压力，但叙利亚新生儿相对有利的 LBW 情况表明存在保护机制。这些机制之一可能是流离失所人口为改善新生儿结局而采取的集体反应，以此作为从损失和死亡中恢复的一种方式。
