Department of Obstetrics and Gynecology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
BMJ Open. 2020 Feb 2;10(1):e033296. doi: 10.1136/bmjopen-2019-033296.
Using a summary measure of health inequalities, this study evaluated the distribution of adverse birth outcomes (ABO) and related maternal risk factors across area-level socioeconomic status (SES) gradients in urban and rural Alberta, Canada.
Cross-sectional study using a validated perinatal clinical registry and an area-level SES.
The study was conducted in Alberta, Canada. Data about ABO and related maternal risk factors were obtained from the Alberta Perinatal Health Program between 2006 and 2012. An area-level SES index derived from census data (2006) was linked to the postal code at delivery.
Women (n=3 30 957) having singleton live births with gestational age ≥22 weeks.
We estimated concentration indexes to assess inequalities across SES gradients in both rural and urban areas (CIdx and CIdx, respectively) for spontaneous preterm birth (PTB), small for gestational age (SGA), large for gestational age (LGA), gestational hypertension, gestational diabetes, smoking and substance use during pregnancy and pre-pregnancy weight >91 kg.
The highest health inequalities disfavouring low SES groups were identified for substance abuse and smoking in rural areas (CIdx-0.38 and -0.23, respectively). Medium inequalities were identified for LGA (CIdx-0.08), pre-pregnancy weight >91 kg (CIdx-0.07), substance use (CIdx-0.15), smoking (CIdx-0.14), gestational diabetes (CIdx-0.10) and SGA (CIdx-0.07). Low inequalities were identified for PTB (CIdx-0.05; CIdx-0.05) and gestational diabetes (CIdx-0.04). Inequalities disfavouring high SES groups were identified for gestational hypertension (CIdx+0.04), SGA (CIdx+0.03) and LGA (CIdx+0.03).
ABO and related maternal risk factors were unequally distributed across the socioeconomic gradient in urban-rural settings, with the greatest concentrations in lower SES groups of rural areas. Future research is needed on underlying mechanisms driving SES gradients in perinatal health across the rural-urban spectrum.
本研究采用健康不平等综合指标，评估了加拿大艾伯塔省城乡地区社会经济地位（SES）梯度分布中不良出生结局（ABO）和相关产妇危险因素的分布情况。
本研究采用验证后的围产期临床登记系统和地区 SES 进行横断面研究。
本研究在加拿大艾伯塔省进行。ABO 及相关产妇危险因素的数据来源于 2006 年至 2012 年期间的艾伯塔省围产期健康计划。采用源自人口普查数据（2006 年）的地区 SES 指数与分娩时的邮政编码相联系。
单胎活产，孕龄≥22 周的妇女（n=330957）。
我们采用集中指数评估 SES 梯度在城乡地区的不平等程度（分别为 CIdx 和 CIdx），评估指标包括自发性早产（PTB）、小于胎龄儿（SGA）、大于胎龄儿（LGA）、妊娠期高血压、妊娠期糖尿病、孕期吸烟和物质滥用以及孕前体重>91kg。
农村地区 SES 较低的人群中，物质滥用和吸烟的健康不平等程度最高（CIdx-0.38 和-0.23）。发现 LGA（CIdx-0.08）、孕前体重>91kg（CIdx-0.07）、物质使用（CIdx-0.15）、吸烟（CIdx-0.14）、妊娠期糖尿病（CIdx-0.10）和 SGA（CIdx-0.07）等中等程度的不平等。发现 PTB（CIdx-0.05；CIdx-0.05）和妊娠期糖尿病（CIdx-0.04）的不平等程度较低。SES 较高的人群中，妊娠期高血压（CIdx+0.04）、SGA（CIdx+0.03）和 LGA（CIdx+0.03）的不平等程度较高。
在城乡地区的社会经济梯度分布中，ABO 及相关产妇危险因素分布不均，农村地区 SES 较低的人群中集中程度最高。需要进一步研究农村-城市人口围产期健康 SES 梯度背后的潜在机制。
