母亲健康的县级结构脆弱性和婴儿死亡率的地理差异
Daria C Murosko1, Josh Radack2, Alejandra Barreto2
1Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
影响孕妇健康的社区因素与婴儿死亡率差异有关. 在县级解决母亲的脆弱性可能有助于减少美国各地的婴儿死亡.
科学领域:
- 公共卫生 公共卫生
- 社会医学科学 社会医学科学
- 孕产妇和儿童的健康
背景情况:
- 在美国,婴儿死亡率的地理差异仍然存在.
- 社区层面的因素对母亲和婴儿的健康结果有很大的影响.
- 了解这些因素对于制定有针对性的干预措施至关重要.
研究的目的:
- 调查社区层面的孕产妇脆弱性与婴儿死亡率之间的联系.
- 评估社会,身体和医疗保健决定因素是否有助于婴儿死亡的地理差异.
- 为评估这些风险,引入和利用母亲脆弱性指数 (MVI).
主要方法:
- 对11,456,232名单身婴儿 (2012-2014) 的回顾性队列研究.
- 使用了县级的母亲脆弱性指数 (MVI) 数据.
- 采用多变量混合效应物流回归,对共变量进行调整,并按县分组.
主要成果:
- 母亲脆弱性最高的县的婴儿死亡率较高 (0.62%对0.32%).
- 每增加20点的MVI与婴儿死亡率增加6%有关 (aOR:1.06).
- 心理健康和药物滥用脆弱性与增加婴儿死亡风险的最强相关性.
结论:
- 导致母亲脆弱的社区层面因素似乎解释了婴儿死亡率的一些地理差异.
- 针对特定县的母亲脆弱性的有针对性的干预措施有望减少婴儿死亡率.
- 孕产妇脆弱性指数是识别风险人群的一个有价值的工具.
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