Impact of socioeconomic circumstances on risks and life-course consequences of preterm birth: studies into differential exposure and susceptibility

相关性：早产是一个重大的公共卫生问题。影响到近十分之一的新生儿，早产儿童更有可能面临发育问题、健康和行为问题，以及较差的教育结果。早产是全球儿童死亡率、发病率和医疗保健使用的主要原因，进一步加剧这一问题的是，社会经济地位较低的孕妇比富裕妇女更有可能早产。考虑到在较不利的社会经济条件下长大的儿童的健康和教育结果更差，而且他们更有可能早产，显然早产是造成健康不平等的一个重要因素。减少健康不平等是政策利益的一个关键领域。然而，除了他们可能需要的健康服务外，目前还没有政策或干预措施来支持在英国早产的儿童。即使早产儿没有早期健康问题，他们的结局也会更差。因此，有一群儿童需要支持，但没有得到支持。这种情况的一个挑战是，我们没有完全了解从母亲的社会经济地位到早产的复杂途径，或者早产和儿童社会经济状况之间的关系，以及它们对以后生活结果的影响。这限制了通过政策行动进行有效干预的能力。假设：本研究基于两个假设。首先，通过了解母亲的行为(怀孕期间吸烟)或母亲的健康状况等母亲风险因素如何影响从母亲的社会经济地位到早产的途径，我们可以更好地解释早产分布的不平等。第二，早产对以后生活健康和教育结果的影响取决于童年的社会经济环境。目的：为了检验我的假设，我对这项研究有三个目的：-确定导致早产分布不平等的复杂路径。-了解早产和童年社会经济状况如何相互作用，导致以后的生活不平等。-评估这两个政策切入点的政策和干预措施对晚年健康不平等的潜在影响。为此，我将使用两个丰富的英国数据集。英国千禧年队列研究是一项大型跟踪研究，对儿童从2000年至2001年出生到17岁期间进行跟踪研究。SAIL数据库是一个世界领先的数据链接，收集有关威尔士整个人口的数据，涵盖健康、教育和社会环境。我将对这些数据应用最先进的统计技术来实现我的目标。成果和好处：我的研究将增加对早产不平等的途径的理解，以及早产如何与社会经济条件相互作用影响未来生活不平等。它将确定哪些儿童面临与早产和社会经济状况有关的不良晚年后果的风险最大。它还将展示在与早产相关的特定政策点进行干预对减少晚年生活中的不平等的潜在好处。我将与当地政策制定者和临床医生合作，确保将这项研究转化为减少早产负面影响的有效行动。我的研究产生的知识有可能减少不平等，改善人口健康，并具有更广泛的社会和经济效益。

Relevance:Preterm birth is a significant public health problem. Affecting almost one in ten births, children born preterm are significantly more likely to face developmental problems, health and behavioural issues, and poorer educational outcomes. Preterm birth is a leading cause of mortality, morbidity and healthcare use among children globally, and to further exacerbate the issue, pregnant women who are of a lower socioeconomic status are significantly more likely to give birth preterm than more affluent women. Considering that health and educational outcomes are worse for children who grow up more disadvantaged socioeconomic conditions, and they are more likely to be born preterm, it evident that preterm birth is an important contributor to the generation of health inequalities. Reducing health inequalities is a key area of policy interest. However, there are currently no policies or interventions to support children born preterm in the UK beyond the health services they may require. Children born preterm have worse outcomes even when they do not have an early life health problem. Thus, there is a cohort of children that needs support but do not receive it. A challenge for this situation is that we do not fully understand the complex pathways from maternal socioeconomic status to preterm birth, or the relationships between preterm birth and childhood socioeconomic conditions, and their influence on outcomes in later life. This limits the ability to intervene effectively through policy action.Hypotheses:This research is founded on two hypotheses. First, we can better explain inequalities in the distribution of preterm birth through understanding of how maternal risk factors, such as maternal behaviours (smoking while pregnant), or maternal health status, influence the pathway from maternal socioeconomic status to preterm birth. Second is that the impacts that preterm birth have on later life health and education outcomes is dependent on the childhood socioeconomic circumstances.Aims:To test my hypotheses, I have three aims for this research:- Identify the complex pathways that lead to inequalities in the distribution of preterm birth.- Understand how preterm birth and childhood socioeconomic conditions interact to lead to inequalities in later life. - Evaluate the potential impact of policies and interventions at these two policy entry points on health inequalities in later life. To do this, I will use two rich UK datasets. The UK Millennium Cohort Study is a large follow-up study of children from birth, between 2000 and 2001, through to age seventeen. The SAIL databank is a world leading data linkage capturing data on the entire population of Wales covering health, education and social circumstances. I will apply state of the art statistical techniques to these data to meet my aims.Outcomes and Benefits: My research will increase understanding of pathways to inequalities in preterm birth, and how preterm birth interacts with socioeconomic conditions to influence later life inequalities. It will identify children who are most at risk of negative later life outcomes related to preterm birth and socioeconomic conditions. It will also show the potential benefits of intervening at select policy points associated with preterm birth on reducing inequalities in later life. I will work with local policymakers and clinicians to ensure this research is translated into effective action to reduce the negative impacts of preterm birth. The knowledge generated by my research has the potential to reduce inequalities, improve the health of the population, and have wider social and economic benefits.