University of Otago, Dunedin, New Zealand.
Iris Data Science, Dunedin, New Zealand.
Womens Health (Lond). 2022 Jan-Dec;18:17455065221075913. doi: 10.1177/17455065221075913.
Aotearoa New Zealand has demonstrable maternal and perinatal health inequity. We examined the relationships between adverse outcomes in a total population sample of births and a range of social determinant variables representing barriers to equity.
Using the Statistics New Zealand Integrated Data Infrastructure suite of linked administrative data sets, adverse maternal and perinatal outcomes (mortality and severe morbidity) were linked to socio-economic and health variables for 97% of births in New Zealand between 2003 and 2018 (~970,000 births). Variables included housing, economic, health, crime and family circumstances. Logistic regression examined the relationships between adverse outcomes and social determinants, adjusting for demographics (socio-economic deprivation, education, parity, age, rural/urban residence and ethnicity).
Māori (adjusted odds ratio = 1.21, 95% confidence interval = 1.18-1.23) and Asian women (adjusted odds ratio 1.39, 95% confidence interval = 1.36-1.43) had poorer maternal or perinatal outcomes compared to New Zealand European/European women. High use of emergency department (adjusted odds ratio = 2.68, 95% confidence interval = 2.53-2.84), disability (adjusted odds ratio = 1.98, 95% confidence interval = 1.83-2.14) and lack of engagement with maternity care (adjusted odds ratio = 1.89, 95% confidence interval = 1.84-1.95) had the strongest relationship with poor outcomes.
Maternal health inequity was strongly associated with a range of socio-economic and health determinants. While some of these factors can be targeted for interventions, the study highlights larger structural and systemic issues that affect maternal and perinatal health.
新西兰奥特亚罗瓦在孕产妇和围产期健康方面存在明显的不平等现象。我们研究了在一个总人口样本的分娩中，一系列代表公平障碍的社会决定因素变量与不良结果之间的关系。
使用新西兰统计局综合数据基础设施套件中的一系列关联行政数据集，将 2003 年至 2018 年期间新西兰 97%的分娩（约 97 万例分娩）的不良孕产妇和围产期结局（死亡率和严重发病率）与社会经济和健康变量相关联。这些变量包括住房、经济、健康、犯罪和家庭情况。使用逻辑回归检验不良结局与社会决定因素之间的关系，同时调整了人口统计学因素（社会经济剥夺、教育、生育次数、年龄、城乡居住和种族）。
与新西兰欧洲/欧洲女性相比，毛利女性（调整后的优势比=1.21，95%置信区间=1.18-1.23）和亚裔女性（调整后的优势比 1.39，95%置信区间=1.36-1.43）的孕产妇或围产期结局更差。急诊就诊次数高（调整后的优势比=2.68，95%置信区间=2.53-2.84）、残疾（调整后的优势比=1.98，95%置信区间=1.83-2.14）和缺乏参与产妇保健（调整后的优势比=1.89，95%置信区间=1.84-1.95）与不良结局的关系最强。
孕产妇健康不平等与一系列社会经济和健康决定因素密切相关。虽然这些因素中的一些可以作为干预的目标，但该研究强调了影响孕产妇和围产期健康的更大的结构性和系统性问题。
