Al-Kassab-Córdova Ali, Intimayta-Escalante Claudio, Robles-Valcarcel Pamela, Urrunaga-Pastor Diego, Cabieses Baltica
Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Peru.
Facultad de Medicina de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru.
Lancet Reg Health Am. 2025 May 23;47:101117. doi: 10.1016/j.lana.2025.101117. eCollection 2025 Jul.
Maternal socioeconomic status (SES) is closely linked to children's health outcomes. However, the marginalization-related diminished returns theory suggests that increases in SES yield smaller health gains for marginalized populations-such as Afro-Peruvian and Indigenous groups-compared to majority groups like Mestizos, largely due to systemic barriers and social disadvantage. Therefore, the current study aimed to explore ethnic disparities in the association between maternal SES on childhood anemia in Peru.
Using data from the 2017 to 2023 Peruvian Demographic and Health Survey, we conducted a cross-sectional study including children aged 6-59 months with their respective mothers. Ethnicity was grouped into Mestizo, Afro-Peruvian, and Indigenous (Quechua, Aimara, and native of the Amazon). Three proxies of SES were used: wealth index, level of education, and years of education. After stratifying by ethnicity, we estimated prevalence ratios (PR) with their respective 95% confidence intervals (95% CI) using generalized linear models with family. Interaction was assessed on multiplicative and additive scales.
Among 234,364 Peruvian mothers, 45.7% (n = 107,118) identified as Mestizo, 12.6% (n = 29,557) as Afro-Peruvian, and 41.7% (n = 97,689) as Indigenous. The overall prevalence of anemia in children was 32.2%. The association between a very rich wealth index and lower prevalence of anemia was weaker among Indigenous (PR = 0.63, 95% CI: 0.56-0.72) compared to Mestizo individuals (PR = 0.46, 95% CI: 0.42-0.50). Similarly, the association between higher maternal education and lower anemia prevalence was less pronounced for Afro-Peruvian (PR = 0.70, 95% CI: 0.62-0.79) and Indigenous groups (PR = 0.81, 95% CI: 0.77-0.86) than for Mestizos (PR = 0.63, 95%CI: 0.59-0.67). A similar pattern was noted with maternal years of education (Mestizos [PR = 0.95, 95% CI: 0.94-0.96], Afro-Peruvian [PR = 0.97, 95% CI: 0.96-0.98], and Indigenous [PR = 0.98, 95% CI: 0.98-0.99]). Interaction analysis confirmed significantly weaker associations for Afro-Peruvian and Indigenous individuals compared to Mestizos.
Maternal SES is associated with lower prevalence of childhood anemia, with stronger associations observed among Mestizo populations compared to Afro-Peruvian and Indigenous groups. This pattern aligns with the marginalization-related diminished returns theory. Maximizing SES alone does not preclude ethnic disparities but rather, may even widen them, highlighting the need for equity-focused interventions that address underlying structural and systemic barriers.
Self-funded.
母亲的社会经济地位（SES）与儿童的健康状况密切相关。然而，边缘化相关收益递减理论表明，与梅斯蒂索人等多数群体相比，SES的提高给边缘化群体（如非裔秘鲁人和原住民群体）带来的健康改善较小，这主要是由于系统性障碍和社会劣势。因此，本研究旨在探讨秘鲁母亲的SES与儿童贫血之间关联的种族差异。
利用2017年至2023年秘鲁人口与健康调查的数据，我们开展了一项横断面研究，纳入了6至59个月大儿童及其各自的母亲。种族分为梅斯蒂索人、非裔秘鲁人以及原住民（克丘亚人、艾马拉人以及亚马逊地区原住民）。使用了SES的三个代理指标：财富指数、教育水平和受教育年限。按种族分层后，我们使用带族别的广义线性模型估计患病率比（PR）及其各自的95%置信区间（95%CI）。在乘法和加法尺度上评估交互作用。
在234,364名秘鲁母亲中，45.7%（n = 107,118）为梅斯蒂索人，十二点六%（n = 29,557）为非裔秘鲁人，41.7%（n = 97,689）为原住民。儿童贫血的总体患病率为32.2%。与梅斯蒂索人（PR = 0.46，95%CI：0.42 - 0.50）相比，非常富裕的财富指数与较低贫血患病率之间的关联在原住民中较弱（PR = 0.63，95%CI：0.56 - 0.72）。同样，与梅斯蒂索人（PR = 0.63，95%CI：0.59 - 0.67）相比，母亲受教育程度较高与贫血患病率较低之间的关联在非裔秘鲁人（PR = 0.70，95%CI：0.62 - 0.79）和原住民群体中不太明显（PR = 0.81，95%CI：0.77 - 0.86）。母亲受教育年限也呈现类似模式（梅斯蒂索人[PR = 0.95，95%CI：0.94 - 0.96]、非裔秘鲁人[PR = 0.97，95%CI：0.96 - 0.98]、原住民[PR = 0.98，95%CI：0.98 - 0.99]）。交互分析证实，与梅斯蒂索人相比，非裔秘鲁人和原住民个体的关联明显较弱。
母亲的SES与儿童贫血患病率较低相关，与非裔秘鲁人和原住民群体相比，梅斯蒂索人群体中的关联更强。这种模式与边缘化相关收益递减理论一致。仅最大化SES并不能消除种族差异，反而可能会扩大这些差异，这凸显了需要采取以公平为重点的干预措施来解决潜在的结构和系统性障碍。
自筹资金。
