Area-level risk factors for adverse birth outcomes: trends in urban and rural settings.
Area-level risk factors for adverse birth outcomes: trends in urban and rural settings.
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DOI：
10.1186/1471-2393-13-129
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发表时间：
2013-06-10
影响因子：
3.1
通讯作者：
Gohlke JM
中科院分区：
文献类型：
--
作者：
Kent ST;McClure LA;Zaitchik BF;Gohlke JM
在美国，出生结果存在显著和持续的种族和收入差异。本文分析了不良出生结局的时间趋势以及地区变量与不良出生结局之间的关联是否因城乡状况而异。亚拉巴马州的出生记录与邮政编码级别的种族，贫困和农村人口普查措施合并。B样条被用来确定农村的长期早产（PTB）和低出生体重（LBW）趋势。Logistic回归模型被用来研究邮政编码水平的贫困率或非洲裔美国人与PTB或LBW之间的关系的差异。与农村的相互作用进行了研究。与其他地区相比，人口密集地区的不良出生结果发生率较高。就出生体重不足而言，人口密集地区与其他地区之间的差距在1991-2005年期间有所扩大，这种差距的幅度一直维持到2010年。自2006年以来，除偏远农村地区外，肺结核和出生不足婴儿的总体发病率有所下降。个人层面的社会经济或种族风险因素的增加大大削弱了这些地理差异，但孤立的农村地区保持不良出生结果的几率增加。邮政编码水平的贫困率和非洲裔美国人的百分比都与不良出生结果有显着关系。在人口最密集的地区，对模型进行个人风险因素调整后，贫穷关联仍然很明显。人口密集的城市地区的不良出生结果发生率较高。与农村地区相比，高度贫困的非洲裔美国人地区的不良出生结果几率更高。这些结果表明，在服务不足的社区，城市特有的社会或环境因素增加了不良出生结果的风险。另一方面，PTB和LBW的趋势表明，在其他地方减少不良出生结果的干预措施可能没有到达偏远的农村地区。
Significant and persistent racial and income disparities in birth outcomes exist in the US. The analyses in this manuscript examine whether adverse birth outcome time trends and associations between area-level variables and adverse birth outcomes differ by urban–rural status. Alabama births records were merged with ZIP code-level census measures of race, poverty, and rurality. B-splines were used to determine long-term preterm birth (PTB) and low birth weight (LBW) trends by rurality. Logistic regression models were used to examine differences in the relationships between ZIP code-level percent poverty or percent African-American with either PTB or LBW. Interactions with rurality were examined. Population dense areas had higher adverse birth outcome rates compared to other regions. For LBW, the disparity between population dense and other regions increased during the 1991–2005 time period, and the magnitude of the disparity was maintained through 2010. Overall PTB and LBW rates have decreased since 2006, except within isolated rural regions. The addition of individual-level socioeconomic or race risk factors greatly attenuated these geographical disparities, but isolated rural regions maintained increased odds of adverse birth outcomes. ZIP code-level percent poverty and percent African American both had significant relationships with adverse birth outcomes. Poverty associations remained significant in the most population-dense regions when models were adjusted for individual-level risk factors. Population dense urban areas have heightened rates of adverse birth outcomes. High-poverty African American areas have higher odds of adverse birth outcomes in urban versus rural regions. These results suggest there are urban-specific social or environmental factors increasing risk for adverse birth outcomes in underserved communities. On the other hand, trends in PTBs and LBWs suggest interventions that have decreased adverse birth outcomes elsewhere may not be reaching isolated rural areas.
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影响因子：
5
作者：
Chang, Howard H.;Reich, Brian J.;Miranda, Marie Lynn
通讯作者：
Miranda, Marie Lynn
DOI：
10.1111/j.1552-6909.2012.01409.x
发表时间：
2012-11-01
影响因子：
1.8
作者：
Giurgescu, Carmen;Zenk, Shannon N.;Block, Richard
通讯作者：
Block, Richard
影响因子：
5
作者：
Messer, Lynne C.;Oakes, J. Michael;Mason, Susan
通讯作者：
Mason, Susan
DOI：
10.1111/j.1748-0361.1989.tb00997.x
发表时间：
1989-10-01
期刊：
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association
影响因子：
--
作者：
Moore, M L;Buescher, P A;Sharp, P
通讯作者：
Sharp, P
影响因子：
6.3
作者：
Pickett, KE;Pearl, M
通讯作者：
Pearl, M