Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany.
German Bavarian Quality Assurance Institute for Medical Care, Munich, Germany.
PLoS One. 2020 Jul 20;15(7):e0236020. doi: 10.1371/journal.pone.0236020. eCollection 2020.
We investigated associations of area-level deprivation with obstetric and perinatal outcomes in a large population-based routine dataset.
We used the data of n = 827,105 deliveries who were born in hospitals between 2009 to 2016 in Bavaria, Germany. The Bavarian Index of Multiple Deprivation (BIMD) on district level was assigned to each mother by the zip code of her residential address. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) for preterm deliveries, Caesarian sections (CS), stillbirths, small for gestational age (SGA) births and low 5-minute Apgar scores by BIMD quintiles with and without adjustment for potential confounders.
We observed a significantly increased risk for preterm deliveries in mothers from the most deprived compared to the least deprived districts (e.g. OR [95% CI] for highest compared to lowest deprivation quintile: 1.06 [1.03, 1.09]) in adjusted analyses. Increased deprivation was also associated with higher SGA and secondary CS rates, but with lower proportions of stillbirths, primary CS and low Apgar scores. When one large clinic with an unusually high stillbirth rate was excluded, the association of BIMD with stillbirths was attenuated and almost disappeared.
We found that area-level deprivation in Bavaria was positively associated with preterm and SGA births, confirming previous studies. In contrast, the finding of an inverse association between deprivation and both stillbirth rates and low Apgar score came somewhat surprising. However, we conclude that the stillbirths finding is spurious and reflects regional bias due to a clinic which seems to specialize in termination of pregnancies.
我们在一个大型基于人群的常规数据集调查了区域贫困水平与产科和围产结局的关联。
我们使用了 2009 年至 2016 年期间在德国巴伐利亚州医院出生的 827105 例分娩的数据。根据母亲居住地址的邮政编码，为每位母亲分配了地区一级的巴伐利亚多维贫困指数（BIMD）。我们计算了 BIMD 五分位数与未经调整和调整潜在混杂因素后的早产、剖宫产（CS）、死胎、小于胎龄儿（SGA）和低 5 分钟 Apgar 评分的比值比（OR）及其 95%置信区间（CI）。
我们发现，与最贫困地区的母亲相比，来自最贫困地区的母亲早产的风险显著增加（例如，与最低贫困五分位数相比，最高贫困五分位数的 OR [95%CI]：1.06 [1.03, 1.09]）。在调整分析中，贫困程度的增加也与 SGA 和继发性 CS 率的增加相关，但与死胎率、原发性 CS 和低 Apgar 评分的比例降低相关。当排除一家死胎率异常高的大型诊所后，BIMD 与死胎的关联减弱，几乎消失。
我们发现，巴伐利亚的区域贫困与早产和 SGA 分娩呈正相关，这证实了以前的研究。相比之下，贫困与死产率和低 Apgar 评分呈负相关的发现有些出人意料。然而，我们得出结论，死产的发现是虚假的，反映了由于一家似乎专门从事妊娠终止的诊所导致的地区偏差。
