Kamenetsky Maria, Bailey Erin, Lowry Alexa, Gangnon Ronald, Stafeil Brian, Hoppe Kara
Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin,
Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
WMJ. 2024;123(6):422-426.
There are significant disparities in the rates of maternal and infant morbidity and mortality in the United States - a discrepancy of particular importance in Wisconsin, where Non-Hispanic Black women experience the highest mortality rates in the country. The adverse effects of neighborhood socioeconomic status and geographical distance to obstetrical care outcomes have been demonstrated previously, with poor neighborhood socioeconomic status having been linked to higher rates of preterm births and low birth weight infants, which both increase the risk of neonatal morbidity and mortality. The objective of this study was to investigate the contributions of Area Deprivation Index and geographic location on age-matched birth weight z-scores.
We conducted a retrospective cohort study of all singleton births >22 weeks' gestation in Dane County, Wisconsin, from January 2016 through June 2018. Generalized additive models were adjusted for race/ethnicity, cigarette use, delivery route, pregnancy-related or chronic hypertension, pregestational and gestational diabetes, number of prenatal visits, maternal age, total weight gain, and pre-pregnancy body mass index.
There is evidence of an association between birth weight z-score and spatial location (median P value 0.006). With area deprivation, we found no evidence of an association with birth weight z-score (-0.01; 95% CI, -0.03 to 0.01; P = 0.109). Mean birth weight z-scores were lowest (-0.72) in the urban center of Madison, while mean birth weight z-score was highest (0.18) in rural areas near the northeast, southeast, and southwest county borders. We found an effect of race/ethnicity on birth weight.
We identified geographic variations in birth weight at a granular level using census block groups and a holistic measure of deprivation, which can inform targeted public health interventions. The lack of evidence of area deprivation on birth outcomes but significant spatial trends demonstrated continued geographic disparities in our health care systems.
美国母婴发病率和死亡率存在显著差异——这一差异在威斯康星州尤为重要，该州非西班牙裔黑人女性的死亡率是全国最高的。此前已证明社区社会经济地位和与产科护理结果的地理距离会产生不利影响，社区社会经济地位差与早产率和低体重儿出生率较高有关，这两者都会增加新生儿发病和死亡的风险。本研究的目的是调查地区贫困指数和地理位置对年龄匹配的出生体重z评分的影响。
我们对2016年1月至2018年6月在威斯康星州戴恩县所有孕周>22周的单胎分娩进行了一项回顾性队列研究。广义相加模型针对种族/族裔、吸烟情况、分娩途径、妊娠相关或慢性高血压、孕前和孕期糖尿病、产前检查次数、产妇年龄、总体重增加量以及孕前体重指数进行了调整。
有证据表明出生体重z评分与空间位置之间存在关联（中位数P值为0.006）。对于地区贫困情况，我们没有发现与出生体重z评分存在关联的证据（-0.01；95%置信区间，-0.03至0.01；P = 0.109）。麦迪逊市中心城区的平均出生体重z评分最低（-0.72），而在靠近东北、东南和西南县界的农村地区，平均出生体重z评分最高（0.18）。我们发现种族/族裔对出生体重有影响。
我们使用人口普查街区组和综合贫困指标在细粒度层面确定了出生体重的地理差异，这可为有针对性的公共卫生干预提供参考。虽然缺乏地区贫困对出生结局影响的证据，但显著的空间趋势表明我们的医疗保健系统中仍存在地理差异。
