Socioeconomic status and perinatal outcomes in a setting with universal access to essential health care services
Socioeconomic status and perinatal outcomes in a setting with universal access to essential health care services
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DOI：
10.1503/cmaj.061198
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发表时间：
2007-09-11
影响因子：
14.6
通讯作者：
Allen, Alexander C.
中科院分区：
文献类型：
--
作者：
Joseph, K. S.;Liston, Robert M.;Allen, Alexander C.
背景：加拿大的卫生保健系统向所有妇女提供基本的卫生服务，不论其社会经济地位如何。我们的目标是确定围产期和婴儿的结局是否不同的家庭收入和其他社会经济因素在此setting.Methods：我们包括所有92 914名妇女谁交付在新斯科舍省之间的1988年和1995年以下的单胎妊娠。其中76 440名妇女的家庭收入是通过与所得税记录的保密联系获得的，并被分为5组。研究的结局包括妊娠并发症、早产、小于胎龄活产、围产期死亡、严重新生儿发病率、新生儿后期死亡和婴儿死亡。Logistic回归模型用于调整潜在的混杂因素。与最高家庭收入组的妇女相比，最低收入组的妇女妊娠期糖尿病的发病率明显更高（粗率比[RR] 1.44，95%置信区间[CI] 1.21-1.73），早产（粗RR 1.20，95% CI 1.06-1.35）、小于胎龄活产（粗RR 1.81，95% CI 1.66-1.97）和新生儿后期死亡（粗RR 5.54，95% CI 2.21-13.9）。而围产儿死亡率则相反（粗RR 0.74，95%CI 0.56-0.96），两组间围产儿死亡或新生儿严重发病率的复合指标无显著差异（粗RR 1.01，95%CI 0.82 - 1.24）。调整行为和生活方式的因素加重或减弱的socioeconomic differentiation.Interpretation：较低的家庭收入与妊娠期糖尿病，小于胎龄活产和新生儿后期死亡率的增加有关，尽管卫生保健服务广泛提供，无需自付费用。
Background: The health care system in Canada provides essential health services to all women irrespective of socioeconomic status. Our objective was to determine whether perinatal and infant outcomes varied by family income and other socioeconomic factors in this setting.Methods: We included all 92 914 women who delivered in Nova Scotia between 1988 and 1995 following a singleton pregnancy. Family income was obtained for 76 440 of these women through a confidential link to income tax records and was divided into 5 groups. Outcomes studied included pregnancy complications, preterm birth, small-for-gestational-age live birth, perinatal death, serious neonatal morbidity, postneonatal death and infant death. Logistic regression models were used to adjust for potential confounders.Results: Compared with women in the highest family income group, those in the lowest income group had significantly higher rates of gestational diabetes (crude rate ratio [RR] 1.44, 95% confidence interval [CI] 1.21-1.73), preterm birth (crude RR 1.20, 95% CI 1.06-1.35), small-for-gestational-age live birth (crude RR 1.81, 95% CI 1.66-1.97) and postneonatal death (crude RR 5.54, 95% CI 2.21-13.9). The opposite was true for rates of perinatal death (crude RR 0.74, 95% CI 0.56-0.96), and there was no significant difference between the 2 groups in the composite of perinatal death or serious neonatal morbidity (crude RR 1.01, 95% CI 0.82 1.24). Adjustment for behavioural and lifestyle factors accentuated or attenuated socioeconomic differences.Interpretation: Lower family income is associated with increased rates of gestational diabetes, small-for-gestational-age live birth and postneonatal death despite health care services being widely available at no out-of-pocket expense.