减少围产期健康不平等的循证决策需要准确衡量社会差距。我们的目的是评估两个市级剥夺指数(DI)的相关性,法国剥夺指数(FDep)和法国-欧洲剥夺指数(FEDI)在围产期健康中的两个关键结局:早产(PTB)和小于胎龄儿(SGA).
我们使用了两个数据源:法国国家围产期调查(NPS)和法国国家健康数据系统(SNDS)。使用前者,我们比较了个人社会经济特征(教育水平和收入)与“PTB和SGA”之间的关联梯度,以及市政级DI(Q1:最不贫困;Q5:最贫困)与“PTB和SGA”之间的关联梯度。使用SNDS,然后,我们研究了两个DI的每个组成部分之间的关联(人口普查数据,2015年)和“PTB和SGA”。调整后的赔率比(aOR)是使用多级逻辑回归在城市一级随机截距估计的。
在NPS(N=26,238)中,PTB和SGA与两个个体社会经济特征相关:母亲的教育水平(≤初中与≥学士学位或同等学历,PTB:aOR=1.43[1.22-1.68],SGA:(1.31[1.61-1.49])和家庭收入(<1000€vs.≥3000€,PTB:1.55[1.25-1.92],SGA:1.69[1.45-1.98])。对于FDep和FEDI,PTB和SGA在贫困城市中更为频繁(Q5:7.8%vs.Q1:6.3%和9.0%与PTB为5.9%,分别,和12.0%与10.3%和11.9%与SGA的10.2%,分别)。然而,调整后,FDep和FEDI均未显示PTB或SGA的显着梯度。在SNDS(N=726,497)中,没有FDep组件,只有三个FEDI成分显着相关(具体来说,具有两种结果的≤初中教育水平的人口的百分比(PTB:1.5[1.15-1.96]);SGA:1.25[1.03-1.51]),过度拥挤的百分比(即,每个房间>1人)仅含PTB的房屋(1.63[1.15-2.32]),以及仅使用SGA的非熟练农场工人(1.52[1.29-1.79])。
FDep和FEDI的某些组成部分在捕获PTB和SGA中的生态不平等方面的相关性不如其他组成部分。研究的每个DI和围产期结局的结果各不相同。这些发现强调了在检查围产期健康不平等之前测试DI相关性的重要性,并建议需要开发适合孕妇的DI。.
Evidence-based policy-making to reduce perinatal health inequalities requires an accurate measure of social disparities. We aimed to evaluate the relevance of two municipality-level deprivation indices (DIs), the French-Deprivation-Index (FDep) and the French-European-Deprivation-Index (FEDI) in perinatal health through two key perinatal outcomes: preterm birth (PTB) and small-for-gestational-age (SGA).
We used two data sources: The French National Perinatal Surveys (NPS) and the French national health data system (SNDS). Using the former, we compared the gradients of the associations between individual socioeconomic characteristics (educational level and income) and \"PTB and SGA\" and associations between municipality-level DIs (Q1:least deprived; Q5:most deprived) and \"PTB and SGA\". Using the SNDS, we then studied the association between each component of the two DIs (census data, 2015) and \"PTB and SGA\". Adjusted odds ratios (aOR) were estimated using multilevel logistic regression with random intercept at the municipality level.
In the NPS (N = 26,238), PTB and SGA were associated with two individual socioeconomic characteristics: maternal educational level (≤ lower secondary school vs. ≥ Bachelor\'s degree or equivalent, PTB: aOR = 1.43 [1.22-1.68], SGA: (1.31 [1.61-1.49]) and household income (< 1000 € vs. ≥ 3000 €, PTB: 1.55 [1.25-1.92], SGA: 1.69 [1.45-1.98]). For both FDep and FEDI, PTB and SGA were more frequent in deprived municipalities (Q5: 7.8% vs. Q1: 6.3% and 9.0% vs. 5.9% for PTB, respectively, and 12.0% vs. 10.3% and 11.9% vs. 10.2% for SGA, respectively). However, after adjustment, neither FDep nor FEDI showed a significant gradient with PTB or SGA. In the SNDS (N = 726,497), no FDep component, and only three FEDI components were significantly associated (specifically, the % of the population with ≤ lower secondary level of education with both outcomes (PTB: 1.5 [1.15-1.96]); SGA: 1.25 [1.03-1.51]), the % of overcrowded (i.e., > 1 person per room) houses (1.63 [1.15-2.32]) with PTB only, and unskilled farm workers with SGA only (1.52 [1.29-1.79]).
Some components of FDep and FEDI were less relevant than others for capturing ecological inequalities in PTB and SGA. Results varied for each DI and perinatal outcome studied. These findings highlight the importance of testing DI relevance prior to examining perinatal health inequalities, and suggest the need to develop DIs that are suitable for pregnant women. .