英国皇家妇产科学院Jennifer Jardine团队研究了英国社会经济和族裔不平等导致的不良妊娠结局。2021年11月1日出版的《柳叶刀》杂志发表了这一最新研究成果。
社会经济贫困和少数族裔背景是不良妊娠结局的危险因素。该研究旨在量化这些社会经济和种族不平等在英格兰人口层面上的程度。
在这项队列研究中，研究组使用了由国家孕产妇和围产期审计汇编的数据，该数据基于来自英格兰132家国家卫生服务医院使用的孕产妇信息系统的出生记录，并与行政医院数据相关联。招募怀孕24-42周的单胎孕妇。终止妊娠被排除在外。该研究团队分析了英国死产、早产（<妊娠37周）和胎儿生长受限（FGR，英国定义为出生体重<最低3%的活产婴儿）的数据，并根据社会经济贫困五分位数和族裔群体对这些结果进行比较。研究组计算了整个人群和特定人群的归因比例，并与贫困程度最低的人群或白人女性进行比较，包括未校正的以及经吸烟、体重指数（BMI）和其他孕产妇风险因素校正后的结果。
研究组招募了2015年4月1日至2017年3月31日分娩的1233184名单胎孕妇，其中1155981名符合条件并被纳入分析。共有4505（0.4%）例死产。1151476名活产婴儿中，69175（6·0%）名早产，22679（2.0%）名FGR。社会经济贫困程度最低人群的死产风险为0.3%，早产风险为4.9%，FGR风险为1.2%，均显著低于贫困程度最高人群的0.5%、7.2%和2.2%。
人口归因分数表明，23.6%的死产、18.5%的早产和31.1%的FGR出生可归因于社会经济不平等，并且在校正种族、吸烟和体重指数后，这些分数显著降低（死产为11.6%，早产为11.9%，FGR为16.4%）。白人妇女的死产风险为0.3%，显著低于黑人妇女的0.7%；白人妇女的早产风险为6.0%，显著低于南亚妇女的6.5%和黑人妇女的6.6%；白人妇女的FGR风险为1.4%，显著低于南亚妇女的3.5%。
11.7%的死产、1.2%的早产和16.9%的FGR可归因于种族不平等。社会经济贫困、吸烟和体重指数的校正对这些种族群体归因分数的影响很小（死产为13.0%，早产为2.6%，FGR为19.2%），在社会经济最贫困的南亚妇女和黑人妇女中，死产（南亚妇女为53.5%，黑人妇女为63.7%）和FGR（南亚妇女为71.7%，黑人妇女为55.0%）的群体特异性归因分数特别高。
研究结果表明，社会经济和族裔不平等是造成英国死产、早产和FGR出生的主要原因。最大的不平等现象出现在社会经济最贫困五分位人口的黑人和南亚妇女身上。
附：英文原文
Title: Adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities in England: a national cohort study
Author: Jennifer Jardine, Kate Walker, Ipek Gurol-Urganci, Kirstin Webster, Patrick Muller, Jane Hawdon, Asma Khalil, Tina Harris, Jan van der Meulen
Issue&Volume: 2021-11-01
Abstract:
Background
Socioeconomic deprivation and minority ethnic background are risk factors for adverse pregnancy outcomes. We aimed to quantify the magnitude of these socioeconomic and ethnic inequalities at the population level in England.
Methods
In this cohort study, we used data compiled by the National Maternity and Perinatal Audit, based on birth records from maternity information systems used by 132 National Health Service hospitals in England, linked to administrative hospital data. We included women who gave birth to a singleton baby with a recorded gestation between 24 and 42 completed weeks. Terminations of pregnancy were excluded. We analysed data on stillbirth, preterm birth (<37 weeks of gestation), and fetal growth restriction (FGR; liveborn with birthweight <3rd centile by the UK definition) in England, and compared these outcomes by socioeconomic deprivation quintile and ethnic group. We calculated attributable fractions for the entire population and specific groups compared with least deprived groups or White women, both unadjusted and with adjustment for smoking, body-mass index (BMI), and other maternal risk factors.
Findings
We identified 1233184 women with a singleton birth between April 1, 2015, and March 31, 2017, of whom 1155981 women were eligible and included in the analysis. 4505 (0·4%) of 1155981 births were stillbirths. Of 1151476 livebirths, 69175 (6·0%) were preterm births and 22679 (2·0%) were births with FGR. Risk of stillbirth was 0·3% in the least socioeconomically deprived group and 0·5% in the most deprived group (p<0·0001), risk of a preterm birth was 4·9% in the least deprived group and 7·2% in the most deprived group (p<0·0001), and risk of FGR was 1·2% in the least deprived group and 2·2% in the most deprived group (p<0·0001). Population attributable fractions indicated that 23·6% (95% CI 16·7–29·8) of stillbirths, 18·5% (16·9–20·2) of preterm births, and 31·1% (28·3–33·8) of births with FGR could be attributed to socioeconomic inequality, and these fractions were substantially reduced when adjusted for ethnic group, smoking, and BMI (11·6% for stillbirths, 11·9% for preterm births, and 16·4% for births with FGR). Risk of stillbirth ranged from 0·3% in White women to 0·7% in Black women (p<0·0001); risk of preterm birth was 6·0% in White women, 6·5% in South Asian women, and 6·6% in Black women (p<0·0001); and risk of FGR ranged from 1·4% in White women to 3·5% in South Asian women (p<0·0001). 11·7% of stillbirths (95% CI 9·8–13·5), 1·2% of preterm births (0·8–1·6), and 16·9% of FGR (16·1–17·8) could be attributed to ethnic inequality. Adjustment for socioeconomic deprivation, smoking, and BMI only had a small effect on these ethnic group attributable fractions (13·0% for stillbirths, 2·6% for preterm births, and 19·2% for births with FGR). Group-specific attributable fractions were especially high in the most socioeconomically deprived South Asian women and Black women for stillbirth (53·5% in South Asian women and 63·7% in Black women) and FGR (71·7% in South Asian women and 55·0% in Black women).
Interpretation
Our results indicate that socioeconomic and ethnic inequalities were responsible for a substantial proportion of stillbirths, preterm births, and births with FGR in England. The largest inequalities were seen in Black and South Asian women in the most socioeconomically deprived quintile. Prevention should target the entire population as well as specific minority ethnic groups at high risk of adverse pregnancy outcomes, to address risk factors and wider determinants of health.
DOI: 10.1016/S0140-6736(21)01595-6
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01595-6/fulltext
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