英格兰和威尔士的社会经济状况和族群对早产、新生儿死亡和婴儿死亡率差异的共同影响：基于 2006 年至 2012 年常规数据的基于人群的回顾性队列研究。
Joint contribution of socioeconomic circumstances and ethnic group to variations in preterm birth, neonatal mortality and infant mortality in England and Wales: a population-based retrospective cohort study using routine data from 2006 to 2012.
机构信息
Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
出版信息
BMJ Open. 2019 Jul 31;9(7):e028227. doi: 10.1136/bmjopen-2018-028227.
OBJECTIVES
This study aimed to describe the variation in risks of adverse birth outcomes across ethnic groups and socioeconomic circumstances, and to explore the evidence of mediation by socioeconomic circumstances of the effect of ethnicity on birth outcomes.
SETTING
England and Wales.
PARTICIPANTS
The data came from the 4.6 million singleton live births between 2006 and 2012.
EXPOSURE
The main exposure was ethnic group. Socioeconomic circumstances, the hypothesised mediator, were measured using the Index of Multiple Deprivation (IMD), an area-level measure of deprivation, based on the mother's place of residence.
PRIMARY AND SECONDARY OUTCOME MEASURES
The primary outcomes were birth outcomes, namely: neonatal death, infant death and preterm birth. We estimated the slope and relative indices of inequality to describe differences in birth outcomes across IMD, and the proportion of the variance in birth outcomes across ethnic groups attributable to IMD. We investigated mediation by IMD on birth outcomes across ethnic groups using structural equation modelling.
RESULTS
Neonatal mortality, infant mortality and preterm birth risks were 2.1 per 1000, 3.2 per 1000 and 5.6%, respectively. Babies in the most deprived areas had 47%-129% greater risk of adverse birth outcomes than those in the least deprived areas. Minority ethnic babies had 48%-138% greater risk of adverse birth outcomes compared with white British babies. Up to a third of the variance in birth outcomes across ethnic groups was attributable to differences in IMD, and there was strong statistical evidence of an indirect effect through IMD in the effect of ethnicity on birth outcomes.
CONCLUSION
There is evidence that socioeconomic circumstances could be contributing to the differences in birth outcomes across ethnic groups.
目的
本研究旨在描述不同种族群体和社会经济环境下不良出生结局的风险变化，并探讨社会经济环境对种族与出生结局之间关系的中介作用的证据。
设定
英格兰和威尔士。
参与者
数据来自于 2006 年至 2012 年间的 460 万例单胎活产。
暴露因素
主要暴露因素为种族。假设的中介变量社会经济环境，是根据母亲的居住地点，使用基于区域的剥夺程度指标——多重剥夺指数（IMD）来衡量的。
主要和次要结局测量
主要结局是出生结局，即新生儿死亡、婴儿死亡和早产。我们估计了斜率和不平等相对指数，以描述 IMD 差异下的出生结局，并评估了出生结局在种族群体间差异归因于 IMD 的比例。我们使用结构方程模型，调查了 IMD 对不同种族群体出生结局的中介作用。
结果
新生儿死亡率、婴儿死亡率和早产风险分别为每 1000 例 2.1 例、每 1000 例 3.2 例和 5.6%。最贫困地区的婴儿发生不良出生结局的风险比最不贫困地区的婴儿高 47%-129%。少数族裔婴儿发生不良出生结局的风险比白种英国婴儿高 48%-138%。种族群体间出生结局差异的三分之一归因于 IMD 的差异，并且在种族对出生结局的影响通过 IMD 存在强烈的统计学证据的间接效应。
结论
有证据表明，社会经济环境可能是造成不同种族群体出生结局差异的原因之一。
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