Socioeconomic gradients and low birth-weight: Empirical and policy considerations
Socioeconomic gradients and low birth-weight: Empirical and policy considerations
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DOI：
10.1111/j.1475-6773.2003.00204.x
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发表时间：
2003-12-01
影响因子：
3.4
通讯作者：
Finch, BK
中科院分区：
文献类型：
--
作者：
Finch, BK
目标。研究社会经济地位（SES）梯度是否早在出生时就出现在健康结果中，并研究任何观察到的SES梯度的大小、潜在来源和解释。数据源。1988年进行的全国母婴健康调查。研究设计。对正常出生体重（2,500-5,500 g）和低出生体重（LBWT; 5,500 g）进行三分体出生体重分类的多项logistic回归。关键变量包括收入、受教育程度、职业等级、州级收入不平等以及孕妇参与妇女-婴儿-儿童（WIC）的时间长短。主要的发现。低出生体重的社会经济梯度被发现为一个调整后的家庭收入措施，净所有的协变量在无限制的模型。母亲吸烟行为解释了母亲受教育程度的总体影响，而职业等级对家庭收入的净影响没有观察到。任何模型都没有显著的州一级收入不平等效应（基尼系数）。此外，研究发现，参与WIC可以使短期参与者的收入梯度趋于平缓，并消除长期参与者的收入梯度。尽管早期社会地位梯度的唯物主义解释似乎是最合理的（相对于社会心理和职业解释），但需要更多的研究来发现潜在的干预措施。此外，单调梯度的概念，即收入在整个分配范围内都是有益的，这些数据挑战了收入在给定阈值后可能不再有益的概念。最后，WIC参与的成功使SES梯度扁平化表明：(a) WIC的实验效果，或(b) WIC参与者的偏倚选择特征；这两种结论都表明，干预措施或参与者的特征值得进一步研究，作为早期生活健康结果（如LBWT）中社会经济差异的潜在补救措施。
Objective. To examine whether socioeconomic status (SES) gradients emerge in health outcomes as early as birth and to examine the magnitude, potential sources, and explanations of any observed SES gradients.Data Sources. The National Maternal and Infant Health Survey conducted in 1988.Study Design. A multinomial logistic regression of trichotomized birth-weight categories was conducted for normal birth-weight (2,500-5,500 grams), low birth-weight (LBWT; 5,500 grams). Key variables included income, education, occupational grade, state-level income inequality, and length of participation in Women-Infants-Children (WIC) for pregnant mothers.Principal Findings. A socioeconomic gradient for low birth-weight was discovered for an adjusted household income measure, net of all covariates in the unrestricted models. A gross effect of maternal education was explained by maternal smoking behaviors, while no effect of occupational grade was observed, net of household income. There were no significant state-level income inequality effects (Gini coefficient) for any of the models. In addition, participation in WIC was discovered to substantially flatten income gradients for short-term participants and virtually eliminate an income gradient among long-term participants.Conclusions. Although a materialist explanation for early-life SES gradients seems the most plausible (vis-a-vis psychosocial and occupational explanations), more research is needed to discover potential interventions. In addition, the notion of a monotonic gradient in which income is salutary across the full range of the distribution is challenged by these data such that income may cease to be beneficial after a given threshold. Finally, the success of WIC participation in flattening SES gradients argues for either: (a) the experimental efficacy of WIC, or (b) the biasing selection characteristics of WIC participants; either conclusion suggests that interventions or characteristics of participants deserves further study as a potential remedy for socioeconomic disparities in early-life health outcomes such as LBWT.