Pathways of neighbourhood-level socio-economic determinants of adverse birth outcomes
Pathways of neighbourhood-level socio-economic determinants of adverse birth outcomes
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DOI：
10.1186/1476-072x-12-32
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发表时间：
2013-06-20
影响因子：
4.9
通讯作者：
Hall, G. Brent
中科院分区：
文献类型：
--
作者：
Meng, Gang;Thompson, Mary E.;Hall, G. Brent
背景资料：虽然社会经济因素已被确定为影响生育结果的最重要的社区一级风险之一，但在这些风险如何转化为个别风险因素方面仍然存在不确定性。这就提出了一个挑战，制定优先事项，并制定适当的社区为导向的公共卫生干预措施和规划指导方针，以减少不利的出生outcome.Method的水平：本研究探讨潜在的直接和介导的途径，通过邻里一级的社会经济决定因素发挥其对不利的出生outcome. Method的影响。两个假设模型，即唯物主义和心理社会模型，以及相应的路径进行了测试，使用二进制结果的多层次中介分析。从加拿大安大略省的三个公共卫生单位获得了活产数据，包括不良出生结局和个人水平暴露变量。从2001年加拿大人口普查和前三个周期（2001年，2003年和2005年）的加拿大社区健康Surveys.Results：邻里水平的社会经济，心理社会和生活条件的变量提取或构建邻里水平的社会经济相关的风险被发现有直接影响低出生体重和早产。此外，总影响的20-30%是由个人风险介导的间接影响造成的。有证据表明，在个人层面存在四种途径，即通过个人的社会经济地位、心理社会压力、孕产妇健康和健康行为，所有这些途径同时发挥作用。心理社会途径和缓冲社会资本相关变量被发现有更多的影响，对低出生体重比早产birth.Conclusion：证据支持唯物主义和心理社会的概念化和描述他们的途径，虽然前者的幅度大于后者。
Background: Although socio-economic factors have been identified as one of the most important groups of neighbourhood-level risks affecting birth outcomes, uncertainties still exist concerning the pathways through which they are transferred to individual risk factors. This poses a challenge for setting priorities and developing appropriate community-oriented public health interventions and planning guidelines to reduce the level of adverse birth outcomes.Method: This study examines potential direct and mediated pathways through which neighbourhood-level socioeconomic determinants exert their impacts on adverse birth outcomes. Two hypothesized models, namely the materialist and psycho-social models, and their corresponding pathways are tested using a binary-outcome multilevel mediation analysis. Live birth data, including adverse birth outcomes and person-level exposure variables, were obtained from three public health units in the province of Ontario, Canada. Corresponding neighbourhood-level socio-economic, psycho-social and living condition variables were extracted or constructed from the 2001 Canadian Census and the first three cycles (2001, 2003, and 2005) of the Canadian Community Health Surveys.Results: Neighbourhood-level socio-economic-related risks are found to have direct effects on low birth weight and preterm birth. In addition, 20-30% of the total effects are contributed by indirect effects mediated through person-level risks. There is evidence of four person-level pathways, namely through individual socio-economic status, psycho-social stress, maternal health, and health behaviours, with all being simultaneously at work. Psychosocial pathways and buffering social capital-related variables are found to have more impact on low birth weight than on preterm birth.Conclusion: The evidence supports both the materialist and psycho-social conceptualizations and the pathways that describe them, although the magnitude of the former is greater than the latter.