Burgos Ochoa Lizbeth, Bertens Loes Cm, Garcia-Gomez Pilar, Van Ourti Tom, Steegers Eric Ap, Been Jasper V
Department of Obstetrics and Gynaecology, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands.
Erasmus School of Economics, Tinbergen Institute and Erasmus Centre for Health Economics Rotterdam, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Lancet Reg Health Eur. 2021 Aug 24;10:100205. doi: 10.1016/j.lanepe.2021.100205. eCollection 2021 Nov.
Adverse birth outcomes have serious health consequences, not only during infancy but throughout the entire life course. Most evidence linking neighbourhood socioeconomic status (SES) to birth outcomes is based on cross-sectional SES measures, which do not reflect neighbourhoods' dynamic nature. We investigated the association between neighbourhood SES trajectories and adverse birth outcomes, i.e. preterm birth and being small-for-gestational-age (SGA), for births occurring in the Netherlands between 2003 and 2017.
We linked individual-level data from the Dutch perinatal registry to the Netherlands Institute for Social Research neighbourhood SES scores. Based on changes in their SES across four-year periods, neighbourhoods were categorised into seven trajectories. To investigate the association between neighbourhood SES trajectories and birth outcomes we used adjusted multilevel logistic regression models.
Data on 2 334 036 singleton births were available for analysis. Women living in stable low-SES neighbourhoods had higher odds of preterm birth (OR[95%CI]= 1·12[1·07-1·17]) and SGA (OR[95%CI]= 1·19[1·15-1·23]), compared to those in high SES areas. Higher odds of preterm birth (OR[95%CI]= 1·12[1·05-1·20]) and SGA (OR[95%CI]=1·12[1·06-1·18]) were also observed for those living in areas declining to low SES. Women living in a neighbourhood where SES improved from low to medium showed higher odds of preterm birth (OR[95%CI]= 1·09[1·02-1·18]), but not of SGA (OR[95%CI]= 1·04[0.98-1·10]). The odds of preterm or SGA birth in other areas were comparable to those seen in high SES areas.
In the Netherlands, disadvantaged neighbourhood SES trajectories were associated with higher odds of adverse birth outcomes. Longitudinal neighbourhood SES measures should also be taken into account when selecting a target population for public health interventions.
Erasmus Initiative Smarter Choices for Better Health.
不良出生结局不仅在婴儿期，而且在整个生命过程中都会产生严重的健康后果。大多数将社区社会经济地位（SES）与出生结局联系起来的证据是基于横断面的SES测量，而这并不能反映社区的动态性质。我们调查了2003年至2017年在荷兰出生的社区SES轨迹与不良出生结局之间的关联，即早产和小于胎龄儿（SGA）。
我们将荷兰围产期登记处的个体层面数据与荷兰社会研究所的社区SES分数相链接。根据社区在四年期间SES的变化，将其分为七种轨迹。为了研究社区SES轨迹与出生结局之间的关联，我们使用了调整后的多水平逻辑回归模型。
共有2334036例单胎出生的数据可供分析。与高SES地区的女性相比，生活在稳定的低SES社区的女性早产（OR[95%CI]=1.12[1.07-1.17]）和SGA（OR[95%CI]=1.19[1.15-1.23]）的几率更高。生活在SES下降到低水平地区的女性早产（OR[95%CI]=1.
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