地区贫困和不利的出生结果:改善质量的机会
Nigel Madden1, Samanvi Kanugula, Lynn M Yee
1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and the Program in Public Health, the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern Library Geospatial and Data Services, and the Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
邻居贫困与严重的孕产妇发病率和早产等不良分娩结果有关,即使考虑到个人风险因素. 这强调了需要社区层面的干预措施来改善母亲和婴儿的健康.
科学领域:
- 生殖健康 生殖健康
- 健康的社会决定因素
- 公共卫生政策 公共卫生政策
背景情况:
- 社会经济因素显著影响健康结果.
- 区域级贫困是影响母亲和婴儿健康的关键社会决定因素.
- 了解这些关联对于有针对性的公共卫生干预至关重要.
研究的目的:
- 调查邻里贫困与不良出生结果之间的关系.
- 评估控制个人级别风险因素对该协会的影响.
- 为医疗保健系统和社区内部的质量改善倡议提供信息.
主要方法:
- 使用电子健康记录和医院行政数据 (2018-2023) 的回顾性队列研究.
- 患者地址的地理编码,以根据人口普查区的贫困水平进行分类.
- 普森回归模型 (未调整和调整) 用于分析区域贫困和出生结果之间的关联.
主要成果:
- 地区贫困与社会人口统计学因素和并发症相关.
- 增加的地区贫困在双变量分析中显示了渐变效应,产生了不利的出生结果.
- 在调整后的模型中,严重的孕产妇发病率和新生儿重症监护室入院的关联仍然存在;早产和低出生体重的关联需要更高的贫困门 (≥12.0%).
结论:
- 邻里贫困独立地与不利的出生结果有关.
- 个人层面的因素可以部分减轻,但不能消除地区贫困的影响.
- 系统和社区层面的干预是必要的,以解决出生结果的差异.
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