Association of Women's Reproductive History With Long-term Mortality and Effect of Socioeconomic Factors.
Association of Women's Reproductive History With Long-term Mortality and Effect of Socioeconomic Factors.
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DOI：
10.1097/aog.0000000000001155
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发表时间：
2015-12
影响因子：
7.2
通讯作者：
Skjærven R
中科院分区：
文献类型：
--
作者：
Halland F;Morken NH;DeRoo LA;Klungsøyr K;Wilcox AJ;Skjærven R
评估社会经济因素对产次与长期孕产妇死亡率之间关系的影响。这是一项基于人群的队列研究，研究对象为1967年至2009年期间在挪威医学出生登记处（MBRN）登记出生的母亲。我们使用考克斯比例风险模型，通过出生人数估计年龄特异性（40至69岁）心血管和非心血管死亡率。为了评估母亲所受教育的影响，我们将低（<11年）和高（≥11年）教育水平分层。我们使用相同的分析方法进一步评估了按出生次数计算的父亲死亡率。受教育程度低的母亲死亡率较高（心血管：风险比（HR）2.62，95%置信区间（CI）2.34-2.93，非心血管：HR 1.67，95% CI 1.62-1.73）。在教育程度低的母亲中，心血管疾病死亡率随着每多生一个孩子而线性增加（p趋势=0.02）。相比之下，在受过高等教育的母亲中，心血管死亡率随着出生人数的增加而下降（p趋势=0.045）。对于非心血管死亡率，低教育程度的母亲之间没有关联，而高教育程度的母亲死亡率随着生育次数的增加而下降（p趋势<0.01）。父亲的死亡率显示出类似的协会与出生人数分层时，母亲的教育。妇女的长期死亡率随着生育次数的增加而上升，只是由于心血管原因死亡，而且只是在教育程度低的母亲中。受教育程度低的妇女的伴侣也有类似的风险随着生育次数的增加而增加。母亲的教育水平是产次与长期死亡率之间关系的一个强有力的修正因素。
To assess the effects of socioeconomic factors on the association between parity and long-term maternal mortality. This was a population-based cohort study of mothers with births registered in the Medical Birth Registry of Norway (MBRN) during the period 1967 to 2009. We estimated age-specific (40 to 69 years) cardiovascular and non-cardiovascular mortality ratios by number of births using Cox proportional-hazard models. To assess effect modification by mothers’ attained education we stratified on low (<11 years) and high (≥11 years) educational level. We further evaluated fathers’ mortality by number of births using the same analytical approach. Mothers with low education had higher mortality (cardiovascular: hazard ratio (HR) 2.62, 95% confidence interval (CI) 2.34–2.93, non-cardiovascular: HR 1.67, 95% CI 1.62–1.73). Among mothers with low education, cardiovascular mortality increased linearly with each additional birth above one, (p-trend=0.02). In contrast, among mothers with high education, cardiovascular mortality declined with added births, (p-trend=0.045). For non-cardiovascular mortality there was no association among mothers with low education, while mortality declined with increasing number of births among mothers with high education, (p-trend<0.01). Father’s mortality showed similar associations with number of births when stratified on maternal education. Women’s long-term mortality rose with number of births only for cardiovascular causes of death, and only among mothers with low education. Partners of women with low education had similar increasing risk with increasing number of births. Maternal educational level is a strong modifier of the association between parity and long-term mortality.