The Association Between Rural-Urban Continuum, Maternal Education and Adverse Birth Outcomes in Quebec, Canada
The Association Between Rural-Urban Continuum, Maternal Education and Adverse Birth Outcomes in Quebec, Canada
复制标题
DOI：
10.1111/j.1748-0361.2009.00242.x
复制
发表时间：
2009-09-01
影响因子：
4.9
通讯作者：
Daniel, Mark
中科院分区：
文献类型：
--
作者：
Auger, Nathalie;Authier, Marie-Andree;Daniel, Mark
背景：农村地区相对于城市地区和较低的社会经济地位(SES)与不良生育结局有关。目前尚不清楚在整个城乡连续体中是否存在规模越来越大的分级关联，这一关联占到了社会保障体系的比重。我们研究了城乡连续体、SES和不良生育结局之间的关系。方法：根据人口和经济基础，将1999年至2003年出生的356,147名单胎婴儿与魁北克3个城市和4个农村地区的直辖市联系起来。母亲教育被用来代表自闭症患者。计算了早产(PTB)、低出生体重(LBW)和小于胎龄儿(SGA)的优势比(OR)，考虑了市政和个人层面的协变量。我们使用分层分析来检验社会经济和城乡连续体之间的相互作用。研究结果：相对于大都市地区的居住地，居住在小城市或农村地区与不良生育结局相关。居住在农村与SGA出生(OR 1.11，95%CI 1.05~1.17)和LBW(OR 1.15，95%CI 1.05~1.26)相关，居住在小城市与肺结核(OR 1.14，95%CI 1.08~1.20)相关。在按教育分层后，居住在相对于大都市地区的偏远农村地区只与受过大学教育的母亲的不良生育结果有关，而居住在小城市地区的母亲与受教育程度较低但没有受过高等教育的母亲的不良生育结果有关。所有农村-城市地区都存在SES梯度，特别是在SGA出生方面。结论：城乡围产期健康状况存在差异，母亲教育对围产期健康的影响具有一定的修复性。
Context: Rural relative to urban area and low socioeconomic status (SES) are associated with adverse birth outcomes. Whether a graded association of increasing magnitude is present across the urban-rural continuum, accounting for SES, is unclear. We examined the association between rural-urban continuum, SES and adverse birth outcomes. Methods: Singleton births from 1999 to 2003 (n = 356,147) were linked to Quebec municipalities ranked on a continuum of 3 urban and 4 rural areas based on population and economic base. Maternal education was used to represent SES. Odds ratios (OR) were calculated for preterm birth (PTB), low birth weight (LBW), and small-for-gestational-age (SGA) birth, accounting for municipality and individual-level covariates. We used stratified analyses to examine interaction between SES and rural-urban continuum. Findings: Relative to metropolitan area residence, living in small urban or rural areas was associated with adverse birth outcomes. Living in rural areas was associated with SGA birth (OR 1.11, 95% CI 1.05-1.17) and LBW (OR 1.15, 95% CI 1.05-1.26), and living in small urban areas was associated with PTB (OR 1.14, 95% CI 1.08-1.20). Upon stratification by education, living in remote rural relative to metropolitan areas was associated with adverse birth outcomes among university educated mothers only, and living in small urban areas was associated with adverse birth outcomes among mothers with lesser but not higher education. An SES gradient was present in all rural-urban areas, particularly for SGA birth. Conclusion: Differences in perinatal health exist across the rural-urban continuum, and maternal education has a modifying influence.