Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Women Health. 2021 Mar;61(3):244-253. doi: 10.1080/03630242.2020.1856294. Epub 2021 Jan 3.
Given the significance of educational equality as one of the key social determinants of health in maternal health outcomes, the present study aimed to assess maternal mortality inequality and its main contributors based on the level of education amongst mothers living in Isfahan, Iran. In this case-control study, all 171 maternal deaths in the Isfahan Province during 2001-2016 were taken from the national maternal mortality surveillance system (as a case group). For the control group, 523 mothers who were alive were selected from 22 health centers located in 21 cities in the province of Isfahan. Concentration index and curve were used to measure educational inequality in maternal mortality. The chi-square test was used to select explanatory social and health variables to enter the decomposition model. The analyses were performed with STATA 12. Social and healthcare factors accounted for 43.57% and 23.44% of educational inequality, respectively. The normalized maternal mortality concentration index was -0.13 (95% CI, -0.10 to -0.02). Among the social factors, the mother's education level (38.14%) and immigrant status (25.39%) contributed the most to educational inequality. Regarding healthcare factors, proximate medical causes (14.49%) and the number of pregnancies (9.72%) had the highest contribution. Maternal mortality has been distributed unequally among the less and more educated mothers in Iran, which suggests that promoting health literacy is imperative, especially for women with lower education levels.
鉴于教育平等是母婴健康结果的关键社会决定因素之一，本研究旨在评估伊朗伊斯法罕省母亲教育水平与母婴死亡率不平等及其主要决定因素之间的关系。本病例对照研究从全国母婴死亡率监测系统中获取了 2001 年至 2016 年期间伊斯法罕省的 171 例孕产妇死亡病例（作为病例组）。为了构建对照组，从该省 21 个城市的 22 个卫生中心随机抽取了 523 名存活母亲。采用集中指数和曲线来衡量母婴死亡率的教育不平等程度。采用卡方检验选择有意义的社会和卫生变量来纳入分解模型。分析采用 STATA 12 软件进行。社会和医疗保健因素分别解释了母婴死亡率教育不平等的 43.57%和 23.44%。标准化母婴死亡率集中指数为-0.13（95%CI，-0.10 至-0.02）。在社会因素中，母亲的教育水平（38.14%）和移民身份（25.39%）对教育不平等的贡献最大。在医疗保健因素中，直接医疗原因（14.49%）和妊娠次数（9.72%）的贡献最高。伊朗母婴死亡率在受教育程度较低和较高的母亲中分布不均，这表明提高健康素养势在必行，特别是对受教育程度较低的妇女而言。
