阿根廷在新冠疫情之前及期间低出生体重风险方面的社会经济不平等：一项横断面研究。
Socioeconomic inequalities in low birth weight risk before and during the COVID-19 pandemic in Argentina: A cross-sectional study.
作者信息
Cuestas Eduardo, Gómez-Flores Martha E, Charras María D, Peyrano Alberto J, Montenegro Clara, Sosa-Boye Ignacio, Burgos Verónica, Giusti Graciela, Espósito Mario, Blanco-Pool Silvyana S, Gurevich Debora P, Ahumada Luis A, Pontoriero Ricardo D, Rizzotti Alina, Bas José I, Vaca María B, Miranda María J, Ferreyra Mirta E, Moreno Gabriela C, Pedicino Héctor, Rojas-Rios Melvy
机构信息
Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
Hospital Materno Neonatal Dr. Ramón Carrillo, Córdoba, Argentina.
出版信息
Lancet Reg Health Am. 2021 Oct;2:100049. doi: 10.1016/j.lana.2021.100049. Epub 2021 Aug 21.
BACKGROUND
The coronavirus disease 2019 (COVID-19) pandemic may have exacerbated existing socioeconomic inequalities in health. In Argentina, public hospitals serve the poorest uninsured segment of the population, while private hospitals serve patients with health insurance. This study aimed to assess whether socioeconomic inequalities in low birth weight (LBW) risk changed during the first wave of the COVID-19 pandemic.
METHODS
This multicenter cross-sectional study included 15929 infants. A difference-in-difference (DID) analysis of socioeconomic inequalities between public and private hospitals in LBW risk in a pandemic cohort (March 20 to July 19, 2020) was compared with a prepandemic cohort (March 20 to July 19, 2019) by using medical records obtained from ten hospitals. Infants were categorized by weight as LBW < 2500 g, very low birth weight (VLBW) < 1500 g and extremely low birth weight (ELBW) < 1000 g. Log binomial regression was performed to estimate risk differences with an interaction term representing the DID estimator. Covariate-adjusted models included potential perinatal confounders.
FINDINGS
Of the 8437 infants in the prepandemic cohort, 4887 (57•9%) were born in public hospitals. The pandemic cohort comprised 7492 infants, 4402 (58•7%) of whom were born in public hospitals. The DID estimators indicated no differences between public versus private hospitals for LBW risk (-1•8% [95% CI -3•6, 0•0]) and for ELBW risk (-0•1% [95% CI -0•6, 0•3]). Significant differences were found between public versus private hospitals in the DID estimators (-1•2% [95% CI, -2•1, -0•3]) for VLBW risk. The results were comparable in covariate-adjusted models.
INTERPRETATION
In this study, we found evidence of decreased disparities between public and private hospitals in VLBW risk. Our findings suggest that measures that prioritize social spending to protect the most vulnerable pregnant women during the pandemic contributed to better birth outcomes.
FUNDING
No funding was secured for this study.
背景
2019年冠状病毒病（COVID-19）大流行可能加剧了现有的健康方面的社会经济不平等。在阿根廷，公立医院服务于最贫困的未参保人群，而私立医院服务于有医疗保险的患者。本研究旨在评估在COVID-19大流行的第一波期间，低出生体重（LBW）风险方面的社会经济不平等是否发生了变化。
方法
这项多中心横断面研究纳入了15929名婴儿。通过使用从十家医院获取的病历，对大流行队列（2020年3月20日至7月19日）中公立医院和私立医院在LBW风险方面的社会经济不平等进行了双重差分（DID）分析，并与大流行前队列（2019年3月20日至7月19日）进行了比较。婴儿按体重分类为LBW<2500g、极低出生体重（VLBW）<1500g和超低出生体重（ELBW）<1000g。进行对数二项回归以估计风险差异，并使用一个代表DID估计量的交互项。协变量调整模型纳入了潜在的围产期混杂因素。
研究结果
在大流行前队列的8437名婴儿中，4887名（57.9%）在公立医院出生。大流行队列包括7492名婴儿，其中4402名（58.7%）在公立医院出生。DID估计量表明，公立医院与私立医院在LBW风险方面（-1.8%[95%CI -3.6, 0.0]）以及在ELBW风险方面（-0.1%[9%CI -0.6, 0.3]）没有差异。在VLBW风险的DID估计量方面，公立医院与私立医院之间存在显著差异（-1.2%[95%CI, -2.1, -0.3]）。在协变量调整模型中结果具有可比性。
解读
在本研究中，我们发现了公立医院与私立医院在VLBW风险方面差距缩小的证据。我们的研究结果表明，在大流行期间优先进行社会支出以保护最脆弱孕妇的措施有助于改善出生结局。
资金
本研究未获得资金支持。
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