Unemployment at municipality level is associated with an increased risk of small for gestational age births – a multilevel analysis of all singleton births during 2005–2010 in Finland

International Journal for Equity in Health

Seppo Heinonen³  Juho Saari⁵  Mika Gissler¹  Michael R Kramer²  Sari Räisänen⁴ 

[1] Nordic School of Public Health, Gothenburg, Sweden;Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, USA;School of Medicine, University of Eastern Finland, Kuopio FI-70211, Finland;Department of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio FI-70029 Kys, Finland;Kuopio Welfare Research Centre (KWRC) and Department of Social Sciences, University of Eastern Finland, Kuopio 70211, Finland

关键词: Small for gestational age;    Socioeconomic status;    Registries;    Preterm birth;    Outcome;    Multilevel analysis;    Childbirth;   

Others  :  1137598
DOI  :  10.1186/s12939-014-0095-1

 received in 2014-05-14, accepted in 2014-10-07,  发布年份 2014

【 摘 要 】

Introduction

Neighbourhood level deprivation has been shown to influence adverse perinatal outcomes independent of individual level socioeconomic status (SES) in countries with high income inequality, such as the United States. The present study evaluates whether municipality level deprivation defined based on education (proportion of inhabitants with university level education), income (mean income per capita) and unemployment were associated with the prevalence of preterm birth (<37 weeks) and small for gestational age (SGA, birth weight <2 standard deviations) after adjustment for individual level socio-demographics (age, parity, prior preterm births, smoking during pregnancy and SES defined based on maternal occupation at birth) in Finland.

Methods

The study design was cross-sectional. The data gathered from the Medical Birth Register included all singleton births (n = 345,952) in 2005–2010. We fitted Generalized Estimating Equations (GEE) models to account for correlation of preterm birth and SGA clustering within municipality.

Results

Of all the women with singleton pregnancies, 4.5% (n = 15,615) gave birth preterm and 3.8% (n = 13,111) of their newborns were classified as SGA. Individual level SES and smoking were important risk factors for each outcome in adjusted models. Controlling for individual level factors, women living in intermediate and high unemployment class municipalities were 6.0% (adjusted odds ratio (aOR) = 1.06; 95% confidence interval (CI) 1.01-1.12) and 13.0% (aOR = 1.13; 95% CI 1.06-1.20), respectively, more likely to give birth to an SGA newborn than women living in low unemployment class municipalities.

Conclusions

After adjustment for individual level socio-demographics, the prevalence of SGA was around 6-13% higher in municipalities with an intermediate or high unemployment rate than municipalities with the lowest unemployment rate. The results suggested that the unemployment rate has an important public health effect with clinical implications since SGA is associated with a higher risk of adverse long-term health outcomes.

【 授权许可】

   
2014 Räisänen et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Wilkinson R, Pickett KE: The Spirit of Level. The Bloomsbury Press, New York, USA; 2009.
• [2]Chaix B: Geographic life environments and coronary heart disease: a literature review, theoretical contributions, methodological updates, and a research agenda. Annu Rev Public Health 2009, 30:81-105.
• [3]Meijer M, Rohl J, Bloomfield K, Grittner U: Do neighborhoods affect individual mortality? A systematic review and meta-analysis of multilevel studies. Soc Sci Med 2012, 74(8):1204-1212.
• [4]Metcalfe A, Lail P, Ghali WA, Sauve RS: The association between neighbourhoods and adverse birth outcomes: a systematic review and meta-analysis of multi-level studies. Paediatr Perinat Epidemiol 2011, 25(3):236-245.
• [5]Kramer MS, Seguin L, Lydon J, Goulet L: Socio-economic disparities in pregnancy outcome: why do the poor fare so poorly? Paediatr Perinat Epidemiol 2000, 14(3):194-210.
• [6]Agyemang C, Vrijkotte TG, Droomers M, van der Wal MF, Bonsel GJ, Stronks K: The effect of neighbourhood income and deprivation on pregnancy outcomes in Amsterdam, The Netherlands. J Epidemiol Community Health 2009, 63(9):755-760.
• [7]Timmermans S, Bonsel GJ, Steegers-Theunissen RP, Mackenbach JP, Steyerberg EW, Raat H, Verbrugh HA, Tiemeier HW, Hofman A, Birnie E, Looman CW, Jaddoe VW, Steegers EA: Individual accumulation of heterogeneous risks explains perinatal inequalities within deprived neighbourhoods. Eur J Epidemiol 2011, 26(2):165-180.
• [8]Sellstrom E, Arnoldsson G, Bremberg S, Hjern A: Are there differences in birth weight between neighbourhoods in a Nordic welfare state? BMC Public Health 2007, 7:267. BioMed Central Full Text
• [9]Meng G, Thompson ME, Hall GB: Pathways of neighbourhood-level socio-economic determinants of adverse birth outcomes. Int J Health Geogr 2013, 12:1-16. 32-072X-12-32 BioMed Central Full Text
• [10]Nieminen T, Prattala R, Martelin T, Harkanen T, Hyyppa MT, Alanen E, Koskinen S: Social capital, health behaviours and health: a population-based associational study. BMC Public Health 2013, 13:1-11. 613-2458-13-613 BioMed Central Full Text
• [11]Pickett KE, Pearl M: Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. J Epidemiol Community Health 2001, 55(2):111-122.
• [12]Sankilampi U, Hannila ML, Saari A, Gissler M, Dunkel L: New population-based references for birth weight, length, and head circumference in singletons and twins from 23 to 43 gestation weeks. Ann Med 2013, 45(5–6):446-454.
• [13]Jaakkola N, Jaakkola MS, Gissler M, Jaakkola JJ: Smoking during pregnancy in Finland: determinants and trends, 1987–1997. Am J Public Health 2001, 91(2):284-286.
• [14][http://www.stat.fi/meta/luokitukset/ammatti/001-2001/index_en.html] webcite Statistics Finland: Classification of Occupations 2001. []
• [15]Gissler M, Rahkonen O, Arntzen A, Cnattingius S, Andersen AM, Hemminki E: Trends in socioeconomic differences in Finnish perinatal health 1991–2006. J Epidemiol Community Health 2009, 63(6):420-425.
• [16]Gissler M, Shelley J: Quality of data on subsequent events in a routine medical birth register. Med Inform Internet Med 2002, 27(1):33-38.
• [17]Gissler M, Merilainen J, Vuori E, Hemminki E: Register based monitoring shows decreasing socioeconomic differences in Finnish perinatal health. J Epidemiol Community Health 2003, 57(6):433-439.
• [18]Mortensen LH, Lauridsen JT, Diderichsen F, Kaplan GA, Gissler M, Andersen AM: Income-related and educational inequality in small-for-gestational age and preterm birth in Denmark and Finland 1987–2003. Scand J Public Health 2010, 38(1):40-45.
• [19]Morenoff JD: Neighborhood mechanisms and the spatial dynamics of birth weight. AJS 2003, 108(5):976-1017.
• [20]Juarez SP, Merlo J: Revisiting the effect of maternal smoking during pregnancy on offspring birthweight: a quasi-experimental sibling analysis in Sweden. PLoS One 2013, 8(4):e61734.
• [21]Manfredi C, Cho YI, Crittenden KS, Dolecek TA: A path model of smoking cessation in women smokers of low socio-economic status. Health Educ Res 2007, 22(5):747-756.
• [22]Ahern J, Galea S, Hubbard A, Syme SL: Neighborhood smoking norms modify the relation between collective efficacy and smoking behavior. Drug Alcohol Depend 2009, 100(1–2):138-145.
• [23]Negrato C, Gomes M: Low birth weight: causes and consequences. Diabetol Metab Syndr 2013, 5(1):49. BioMed Central Full Text
• [24]Räisänen S, Gissler M, Sankilampi U, Saari J, Kramer MR, Heinonen S: Contribution of socioeconomic status to the risk of small for gestational age infants--a population-based study of 1,390,165 singleton live births in Finland. Int J Equity Health 2013, 12:1-8. 28-9276-12-28 BioMed Central Full Text