Mediators of socioeconomic inequalities in preterm birth: a systematic review.
Mediators of socioeconomic inequalities in preterm birth: a systematic review.
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DOI：
10.1186/s12889-022-13438-9
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发表时间：
2022-06-07
影响因子：
4.5
通讯作者：
Taylor-Robinson, David
中科院分区：
文献类型：
--
作者：
McHale, Philip;Maudsley, Gillian;Pennington, Andy;Schluter, Daniela K.;Barr, Ben;Paranjothy, Shantini;Taylor-Robinson, David
早产率很高，存在严重的不平等。了解风险因素在从母亲社会经济地位（SES）到早产的途径中的作用，可以帮助为干预措施和政策提供信息。因此，本研究的目的是确定产妇SES和早产之间的关系的调解人，评估证据的强度，并评估用于评估调解的方法的质量。使用Scopus、Medline奥维德、“Medline In Process & Other Non-Indexed Citation”、PsycINFO和Social Science Citation Index（通过Web of Science），检索词结合了中介、社会经济地位和早产的变化。引用和高级谷歌搜索补充了这一点。入选标准指导了2000年1月至2020年7月观察性研究的筛选和选择。提取的指标是由每个中介解释的早产中社会经济不平等的比例（例如，“消除比例”）。纳入的研究是以叙事方式综合的。在纳入的22项研究中，超过一半使用队列设计。大多数研究对介质有潜在的测量偏倚，只有两项研究完全校正了关键混杂因素。18项研究发现，早产存在严重的社会经济不平等。研究评估了六组潜在的介质：产妇吸烟;产妇心理健康;产妇身体健康（包括体重指数（BMI））;产妇生活方式（包括饮酒）;医疗保健;工作和环境条件。有很高的信心，在怀孕期间吸烟（最经常检查的调解人）和产妇的身体健康调解早产的不平等。严重的残余不平等现象往往依然存在。模型之间的系数差异是最常见的中介分析方法，只有六项研究评估了中介交互作用，只有两个考虑了因果假设。在早产的重大社会经济不平等只是部分解释了六组介质已被研究，特别是母亲在怀孕期间吸烟。然而，在大多数研究中，SES明显存在较大的残留直接影响。尽管使用的中介分析方法限制了我们进行因果推理的能力，但这些发现突出了干预以减少这种不平等的潜在方法。关注可改变的社会经济决定因素，如减少贫困和教育不平等，可能是解决早产不平等问题所必需的，同时采取调解途径。在线版本包含补充材料，可通过10.1186/s12889-022-13438-9获得。
Rates of preterm birth are substantial with significant inequalities. Understanding the role of risk factors on the pathway from maternal socioeconomic status (SES) to preterm birth can help inform interventions and policy. This study therefore aimed to identify mediators of the relationship between maternal SES and preterm birth, assess the strength of evidence, and evaluate the quality of methods used to assess mediation. Using Scopus, Medline OVID, “Medline In Process & Other Non-Indexed Citation”, PsycINFO, and Social Science Citation Index (via Web of Science), search terms combined variations on mediation, socioeconomic status, and preterm birth. Citation and advanced Google searches supplemented this. Inclusion criteria guided screening and selection of observational studies Jan-2000 to July-2020. The metric extracted was the proportion of socioeconomic inequality in preterm birth explained by each mediator (e.g. ‘proportion eliminated’). Included studies were narratively synthesised. Of 22 studies included, over one-half used cohort design. Most studies had potential measurement bias for mediators, and only two studies fully adjusted for key confounders. Eighteen studies found significant socioeconomic inequalities in preterm birth. Studies assessed six groups of potential mediators: maternal smoking; maternal mental health; maternal physical health (including body mass index (BMI)); maternal lifestyle (including alcohol consumption); healthcare; and working and environmental conditions. There was high confidence of smoking during pregnancy (most frequently examined mediator) and maternal physical health mediating inequalities in preterm birth. Significant residual inequalities frequently remained. Difference-of-coefficients between models was the most common mediation analysis approach, only six studies assessed exposure-mediator interaction, and only two considered causal assumptions. The substantial socioeconomic inequalities in preterm birth are only partly explained by six groups of mediators that have been studied, particularly maternal smoking in pregnancy. There is, however, a large residual direct effect of SES evident in most studies. Despite the mediation analysis approaches used limiting our ability to make causal inference, these findings highlight potential ways of intervening to reduce such inequalities. A focus on modifiable socioeconomic determinants, such as reducing poverty and educational inequality, is probably necessary to address inequalities in preterm birth, alongside action on mediating pathways. The online version contains supplementary material available at 10.1186/s12889-022-13438-9.
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DOI：
10.1016/j.ejogrb.2014.02.035
发表时间：
2014-05-01
影响因子：
2.6
作者：
Auger, Nathalie;Abrahamowicz, Michal;Lo, Ernest
通讯作者：
Lo, Ernest
影响因子：
7.7
作者：
Ferguson, Karl D.;McCann, Mark;Lewsey, James D.
通讯作者：
Lewsey, James D.
影响因子：
3.7
作者：
Amegah, Adeladza K.;Damptey, Obed K.;Jaakkola, Jouni J. K.
通讯作者：
Jaakkola, Jouni J. K.
影响因子：
6.3
作者：
Gissler, M;Meriläinen, J;Hemminki, E
通讯作者：
Hemminki, E
影响因子：
4.9
作者：
Auger, Nathalie;Authier, Marie-Andree;Daniel, Mark
通讯作者：
Daniel, Mark