Social determinants of health and disparities in prenatal care utilization during the Great Recession period 2005-2010
Social determinants of health and disparities in prenatal care utilization during the Great Recession period 2005-2010
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DOI：
10.1186/s12884-019-2486-1
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发表时间：
2019-10-29
影响因子：
3.1
通讯作者：
Zierler, Brenda K.
中科院分区：
文献类型：
--
作者：
Blakeney, Erin L.;Herting, Jerald R.;Zierler, Brenda K.
背景：早期、定期地利用产前护理是改善母婴健康结局的重要策略。这项研究的目的是为了更好地了解在大衰退(2007年12月至2009年6月)之前、期间和之后不同种族/民族和社会地位群体的妇女产前保健利用结果不同的影响因素。方法：将华盛顿州(华盛顿州)和佛罗里达州(FL)的678,235份出生证明数据与社区和州特征数据联系起来，在机构审查委员会批准人类受试者研究的情况下进行横断面合并时间序列分析。在孕妇中识别和比较准时与晚或不进入产前护理利用(晚/不产前护理利用)的预测因素。本研究还探讨了时间(衰退相关时期内)、社会特征和产前护理利用之间的模拟三元关系，将个体预测因子分成代表社会不利程度低、中等和高度的三种情景。结果：在经济衰退期间，个人和社区的需求指标(例如，孕产妇医疗补助登记人数、失业率)都有所增加。晚产/不利用产前护理与个人特征之间的关联(包括种族/族裔群体之间的不同关联)并没有随着年轻的产妇年龄而发生很大变化，高中以下教育程度仍然是晚产/不利用产前护理的最大贡献因素。相比之下，个别孕妇参加妇女、婴儿和儿童补充营养计划(WIC)显示出一种保护性关联，不受晚期/不使用产前护理的影响。社区一级的党派投票模式与一些孕产妇儿童保健计划支出之间的关联程度朝着无益的方向增加。模拟情景显示，在有多种不利条件的妇女中，产前保健利用的综合影响很高。结论：我们的发现提供了一个令人信服的图景，说明了个体特征--特别是低教育程度和年轻年龄--在晚期/无产前保健利用中所起的重要作用。有针对性地向具有高度不利特征的个人，特别是具有多种不利特征的个人进行宣传，可能有助于增加怀孕早期对产前护理的利用。最后，WIC可能在减少晚产/无产前护理利用方面发挥了有价值的作用，在大衰退期间，其作为减少晚产/无产前护理利用的一种基于政策的方法的有效性应得到进一步探讨。
Background: Early, regular prenatal care utilization is an important strategy for improving maternal and infant health outcomes. The purpose of this study is to better understand contributing factors to disparate prenatal care utilization outcomes among women of different racial/ethnic and social status groups before, during, and after the Great Recession (December 2007-June 2009).Methods: Data from 678,235 Washington (WA) and Florida (FL) birth certificates were linked to community and state characteristic data to carry out cross-sectional pooled time series analyses with institutional review board approval for human subjects' research. Predictors of on-time as compared to late or non-entry to prenatal care utilization (late/no prenatal care utilization) were identified and compared among pregnant women. Also explored was a simulated triadic relationship among time (within recession-related periods), social characteristics, and prenatal care utilization by clustering individual predictors into three scenarios representing low, average, and high degrees of social disadvantage.Results: Individual and community indicators of need (e.g., maternal Medicaid enrollment, unemployment rate) increased during the Recession. Associations between late/no prenatal care utilization and individual-level characteristics (including disparate associations among race/ethnicity groups) did not shift greatly with young maternal age and having less than a high school education remaining the largest contributors to late/no prenatal care utilization. In contrast, individual maternal enrollment in a supplemental nutrition program for women, infants, and children (WIC) exhibited a protective association against late/no prenatal care utilization. The magnitude of association between community-level partisan voting patterns and expenditures on some maternal child health programs increased in non-beneficial directions. Simulated scenarios show a high combined impact on prenatal care utilization among women who have multiple disadvantages.Conclusions: Our findings provide a compelling picture of the important roles that individual characteristics-particularly low education and young age-play in late/no prenatal care utilization among pregnant women. Targeted outreach to individuals with high disadvantage characteristics, particularly those with multiple disadvantages, may help to increase first trimester entry to utilization of prenatal care. Finally, WIC may have played a valuable role in reducing late/no prenatal care utilization, and its effectiveness during the Great Recession as a policy-based approach to reducing late/no prenatal care utilization should be further explored.