Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, Sweden.
J Epidemiol Community Health. 2020 Jun;74(7):605-611. doi: 10.1136/jech-2019-213503. Epub 2020 Apr 17.
Real-world evaluations of complex interventions are scarce. We evaluated the effect of the Salut Programme, a universal child health promotion intervention in northern Sweden, on income-related inequalities in positive birth outcomes and healthcare utilisation up to 2 years after delivery.
Using the mother's place of residence at delivery, the child and the mother were classified as belonging to either the control area (received care-as-usual) or the intervention area (where the intervention was implemented from 2006) and either the premeasure (children born between 2002 and 2004) or the postmeasure (children born between 2006 and 2008) period. Parents' earned income was used as the socioeconomic ranking variable. The Relative Concentration Index was computed for six binary birth outcome indicators and for inpatient and day patient care for children and their mothers. Changes in inequality over time were compared using a difference-in-difference approach.
Income-related inequalities in birth outcomes and child healthcare utilisation were absent, except that full-term pregnancies were concentrated among the poor at premeasure in the intervention area. In contrast, mothers' healthcare utilisation was significantly pro-poor in the control area. The extent of inequality changed differentially between premeasure and postmeasure for two birth outcomes: full-term pregnancies and infants with normal birth weight. Inequalities in healthcare utilisation did not change significantly in either area over time.
In northern Sweden, income-related inequalities in birth outcomes and child healthcare utilisation are largely absent. However, relative inequalities in mothers' healthcare utilisation are large. We found no evidence that the Salut Programme affected changes in inequality over time.
针对复杂干预措施的真实世界评估较为匮乏。我们评估了 Salut 计划的效果，该计划是在瑞典北部实施的一项普遍的儿童健康促进干预措施，其对与收入相关的积极分娩结果和产后 2 年内医疗保健利用的不平等影响。
根据分娩时母亲的居住地、儿童和母亲的情况，将其分为对照组（接受常规护理）和干预组（2006 年开始实施干预），并分为前测期（2002 年至 2004 年之间出生的儿童）和后测期（2006 年至 2008 年之间出生的儿童）。父母的收入被用作社会经济排名变量。计算了六个二元分娩结果指标和儿童及其母亲的住院和日间病人护理的相对集中指数。使用差异中的差异方法比较了随时间变化的不平等变化。
除了在干预区的前测期，足月妊娠集中在贫困人群中外，与收入相关的分娩结果和儿童医疗保健利用的不平等现象并不存在。相比之下，在对照组中，母亲的医疗保健利用明显偏向贫困人群。在两个分娩结果（足月妊娠和正常出生体重的婴儿）中，不平等程度在预测量和后测量之间存在差异变化：在对照组中，不平等程度随着时间的推移而显著增加。医疗保健利用的不平等在两个地区均无明显变化。
在瑞典北部，与收入相关的分娩结果和儿童医疗保健利用的不平等现象基本不存在。然而，母亲医疗保健利用的相对不平等程度很大。我们没有发现 Salut 计划对随时间变化的不平等产生影响的证据。
