BORN Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
BMC Pediatr. 2022 Aug 5;22(1):476. doi: 10.1186/s12887-022-03498-6.
The risk of congenital heart disease (CHD) has been found to vary by maternal socioeconomic status (SES) and rural-urban residence. In this study, we examined associations of CHD with two maternal SES indicators and stratified the analysis by maternal rural-urban residence.
This was a population-based retrospective cohort study. We included all singleton stillbirths and live hospital births from April 1, 2012 to March 31, 2018 in Ontario, Canada. We linked the BORN Information System and Canadian Institute for Health Information databases. Multivariable logistic regression models were used to examine associations of CHD with material deprivation index (MDI), social deprivation index (SDI), and maternal residence while adjusting for maternal age at birth, assisted reproductive technology, obesity, pre-pregnancy maternal health conditions, mental health illness before and during pregnancy, substance use during pregnancy, and infant's sex. MDI and SDI were estimated at a dissemination area level in Ontario and were categorized into quintiles (Q1-Q5).
This cohort study included 798,173 singletons. In maternal urban residence, the p trend (Cochran-Armitage test) was less than 0.0001 for both MDI and SDI; while for rural residence, it was 0.002 and 0.98, respectively. Infants living in the most materially deprived neighbourhoods (MDI Q5) had higher odds of CHD (aOR: 1.21, 95% CI: 1.12-1.29) compared to Q1. Similarly, infants living in the most socially deprived neighbourhoods (SDI Q5) had an 18% increase in the odds of CHD (aOR: 1.18, 95% CI: 1.1-1.26) compared to Q1. Rural infants had a 13% increase in the odds of CHD compared to their urban counterparts. After stratifying by maternal rural-urban residence, we still detected higher odds of CHD with two indices in urban residence but only MDI in rural residence.
Higher material and social deprivation and rural residence were associated with higher odds of CHD. Health interventions and policies should reinforce the need for optimal care for all families, particularly underprivileged families in both rural and urban regions. Future studies should further investigate the effect of social deprivation on the risk of CHD development.
已发现先天性心脏病 (CHD) 的风险因产妇社会经济地位 (SES) 和城乡居住而有所不同。在这项研究中，我们检查了 CHD 与两个产妇 SES 指标的关联，并按产妇城乡居住情况对分析进行了分层。
这是一项基于人群的回顾性队列研究。我们纳入了 2012 年 4 月 1 日至 2018 年 3 月 31 日期间在加拿大安大略省的所有单胎死产和活产医院分娩。我们将 BORN 信息系统和加拿大卫生信息研究所数据库进行了关联。多变量逻辑回归模型用于检验 CHD 与物质剥夺指数 (MDI)、社会剥夺指数 (SDI) 以及产妇居住地的关联，同时调整了产妇的出生年龄、辅助生殖技术、肥胖、孕前产妇健康状况、妊娠前后的心理健康状况、妊娠期间的物质使用以及婴儿的性别。MDI 和 SDI 是在安大略省的传播区域层面进行估计的，并分为五组 (Q1-Q5)。
本队列研究纳入了 798173 例单胎。在产妇城市居住的情况下，MDI 和 SDI 的 p 趋势（Cochran-Armitage 检验）均小于 0.0001；而在农村居住的情况下，分别为 0.002 和 0.98。与 MDI Q1 相比，居住在物质条件最匮乏的社区（MDI Q5）的婴儿患 CHD 的几率更高（调整比值比[aOR]：1.21，95%置信区间[CI]：1.12-1.29）。同样，居住在社会条件最匮乏的社区（SDI Q5）的婴儿患 CHD 的几率增加了 18%（调整比值比[aOR]：1.18，95%CI：1.1-1.26）。与城市婴儿相比，农村婴儿患 CHD 的几率增加了 13%。在按产妇城乡居住情况进行分层后，我们仍在城市居住的情况下发现了与两个指数相关的更高 CHD 几率，但在农村居住的情况下仅发现了 MDI。
较高的物质和社会剥夺程度以及农村居住与较高的 CHD 几率相关。卫生干预措施和政策应加强为所有家庭提供最佳护理的必要性，特别是农村和城市地区的贫困家庭。未来的研究应进一步调查社会剥夺对 CHD 发展风险的影响。
