Henderson Ian, Quenby Siobhan
University of Warwick Warwick Medical School, Coventry, UK
University of Warwick Warwick Medical School, Coventry, UK.
J Epidemiol Community Health. 2025 May 9;79(6):397-403. doi: 10.1136/jech-2023-220996.
Preterm birth (PTB) and small-for-gestational-age (SGA) disproportionately affect women who are Black or Asian. Structural racism produces health inequalities. Identifying latent socioeconomic classes may help to understand the role socioeconomic position (SEP) plays in this inequality.
We included women from the baseline survey of the UK-based Millennium Cohort Study who had a live singleton pregnancy and gave birth from 1 September 2000 to 11 January 2002. Relative risks (RR) with 95% confidence intervals (CI) for PTB and SGA were estimated for ethnic groups compared with women who were white, with adjustment for SEP. Latent SEP classes were then identified using diverse prospective socioeconomic data. Mediation of health inequality via SEP and latent SEP class was tested.
Among 17 701 included women, 6.7% (95% CI 6.2%, 7.1%) experienced PTB and 7.0% (6.5%, 7.5%) SGA. We found evidence that the association between ethnic groups and PTB was mediated by latent SEP class for women who were Bangladeshi, Black African, Black Caribbean and Pakistani, with indirect 'effects' of RR 1.08 (1.01, 1.16), 1.07 (1.01, 1.14), 1.06 (1.00, 1.12) and 1.06 (1.00, 1.13), respectively, relative to White. When using the simple measures of maternal education, household income and marital status, we found no evidence of mediation except for a potential protective effect among Indian women, relative to White. We found similar evidence for SGA, with indirect effects through latent SEP class of RR 1.35 (1.19, 1.52), 1.32 (1.17, 1.48), 1.26 (1.12, 1.41), 1.27 (1.13, 1.42), respectively. When using the simple measures, we found evidence of mediation only among Black African and Black Caribbean women, with RR 1.16 (1.04, 1.30) and 1.12 (1.00, 1.26), respectively, relative to White.
The determinants of inequality appeared to differ by ethnicity. We demonstrated the mediating role of individual-level SEP and a role for latent class analysis to interpret complex combinations of socioeconomic data.
早产（PTB）和小于胎龄儿（SGA）对黑人或亚洲女性的影响尤为严重。结构性种族主义导致了健康不平等。识别潜在的社会经济阶层可能有助于理解社会经济地位（SEP）在这种不平等中所起的作用。
我们纳入了英国千禧队列研究基线调查中的女性，这些女性怀有单胎活产妊娠，并于2000年9月1日至2002年1月11日期间分娩。与白人女性相比，在调整SEP后，估计了各民族PTB和SGA的相对风险（RR）及95%置信区间（CI）。然后使用不同的前瞻性社会经济数据识别潜在的SEP阶层。测试了通过SEP和潜在SEP阶层对健康不平等的中介作用。
在纳入的17701名女性中，6.7%（95%CI 6.2%，7.1%）发生了PTB，7.0%（6.5%，7.5%）为SGA。我们发现，对于孟加拉裔、非洲裔黑人、加勒比裔黑人和巴基斯坦裔女性，种族与PTB之间的关联是由潜在SEP阶层介导的，相对于白人，间接“效应”的RR分别为1.08（1.01，1.16）、1.07（1.01，1.14）、1.06（1.00，1.12）和1.06（1.00，1.13）。当使用母亲教育程度、家庭收入和婚姻状况的简单指标时，除了印度女性相对于白人可能存在保护作用外，我们没有发现中介作用的证据。对于SGA，我们发现了类似的证据，通过潜在SEP阶层的间接效应的RR分别为1.35（1.19，1.52）、1.32（1.17，1.48）、1.26（1.12，1.41）、1.27（1.13，1.42）。当使用简单指标时，我们仅在非洲裔黑人和加勒比裔黑人女性中发现了中介作用的证据，相对于白人，RR分别为1.16（1.04，1.30）和1.12（1.00，1.26）。
不平等的决定因素似乎因种族而异。我们证明了个体水平SEP的中介作用以及潜在阶层分析在解释社会经济数据复杂组合方面的作用。
