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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2014

Open Access 01-12-2014 | Research article

Patterns of social inequalities across pregnancy and birth outcomes: a comparison of individual and neighborhood socioeconomic measures

Authors: Nihaya Daoud, Patricia O’Campo, Anita Minh, Marcelo L Urquia, Susie Dzakpasu, Maureen Heaman, Janusz Kaczorowski, Cheryl Levitt, Janet Smylie, Beverley Chalmers

Published in: BMC Pregnancy and Childbirth | Issue 1/2014

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Abstract

Background

This paper identifies patterns of health inequalities (consistency and magnitude) of socioeconomic disparities for multiple maternal and child health (MCH) outcomes that represent different health care needs of mothers and infants.

Methods

Using cross-sectional national data (unweighted sample = 6,421, weighted =76,508) from the Canadian Maternity Experiences Survey linked with 2006 Canadian census data, we categorized 25 health indicators of mothers of singletons into five groups of MCH outcomes (A. maternal and infant health status indicators; B. prenatal care; C. maternal experience of labor and delivery; D. neonatal medical care; and E. postpartum infant care and maternal perceptions of health care services). We then examined the association of these health indicators with individual socioeconomic position (SEP) (education and income), neighborhood SEP and combined SEP (a four-level measure of low and high individual and neighborhood SEP), and compared the magnitude (odds ratios and 95% confidence intervals) and direction of the associations within and between MCH outcome groups.

Results

We observed consistent positive gradients of socioeconomic inequalities within most groups and for 23/25 MCH outcomes. However, more significant associations and stronger gradients were observed for the MCH outcomes in the maternal and infant health status group as opposed to other groups. The neonatal medical care outcomes were weakly associated with SEP. The direction of associations was negative between some SEP measures and HIV testing, timing of the first ultrasound, caesarean section, epidural for vaginal births, infant needing non-routine neonatal care after discharge and any breastfeeding at 3 or 6 months.
Gradients were steep for individual SEP but moderate for neighborhood SEP. Combined SEP had no consistent gradients but the subcategory of low individual-high neighborhood SEP often showed the poorest health outcomes compared to the categories within this SEP grouping.

Conclusion

By examining SEP gradients in multiple MCH outcomes categorized into groups of health care needs, we identified large and consistent inequalities both within and between these groups. Our results suggest differences in pathways and mechanisms contributing to SEP inequalities across groups of MCH outcomes that can be examined in future research and inform prioritization of policies for reducing these inequalities.
Literature
1.
2.
Lynch J, Kaplan G: Socioeconomic position. In Social Epidemiology. 1st edition. Edited by Berkman L, Kawachi I. New York, USA: Oxford University Press; 2000.
3.
Mackenbach JP: The persistence of health inequalities in modern welfare states: the explanation of a paradox.Soc Sci Med 2012, 75(4):761–769.CrossRefPubMed
4.
Braveman P, Cubbin C, Egerter S, Chideya S, Marchi K, Metzler M, Posner S: Socioeconomic status in health research: one size does not fit all.JAMA 2005, 294:2879–2888.CrossRefPubMed
5.
O’Campo P, Urquia M: Aligning method with theory: a comparison of two approaches to modeling the social determinants of health.Matern Child Health J 2011, 16(9):1870–1878.CrossRefPubMedCentral
6.
Krieger N: Theories for social epidemiology in the 21st century: an ecosocial perspective.Int J Epidemiol 2001, 30(4):668–677.CrossRefPubMed
7.
Muntaner C, Lynch J: Income inequality, social cohesion, and class relations: a critique of Wilkinson’s neo-Durkheimian research program.Int J Health Serv 1999, 29(1):59–81.CrossRefPubMed
8.
Coburn D: Beyond the income inequality hypothesis: class, neo-liberalism, and health inequalities.Soc Sci Med 2004, 58(1):41–56.CrossRefPubMed
9.
O’Campo P, Dunn J: Rethinking Social Epidemiology: Towards a Science of Change. New York: Springer; 2012.CrossRef
10.
Parker J, Schoendorf K, Kiely J: Associations between measures of socioeconomic status and low birth weight, small for gestational age, and premature delivery in the United States.Ann Epidemiol 1994, 4:271–278.CrossRefPubMed
11.
Joseph K, Liston R, Dodds L, Dahlgren L, Allen A: Socioeconomic status and perinatal outcomes in a setting with universal access to essential health care services.CMAJ 2007, 177(6):583–590.CrossRefPubMedPubMedCentral
12.
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, 14:194–210.CrossRefPubMed
13.
Auger N, Giraud J, Daniel M: The joint influence of area income, income inequality, and immigrant density on adverse birth outcomes: a population-based study.BMC Public Health 2009, 9:237.CrossRefPubMedPubMedCentral
14.
Morgen CS, Bjork C, Andersen PK: Socioeconomic position and the risk of preterm birth a study within the Danish National Birth Cohort.Int J Epidemiol 2008, 37:1109–1120.CrossRefPubMed
15.
Mortensen HL, Helweg-Larsen K, Andersen AMN: Socioeconomic differences in perinatal health and disease.Scand J Public Health 2011, 39(Suppl 7):110–114.CrossRefPubMed
16.
Heaman M, Gupton A, Moffatt M: Prevalence and predictors of inadequate prenatal care: a comparison of aboriginal and non-aboriginal women in Manitoba.J Obstet Gynaecol Can 2005, 27(3):237–246.CrossRefPubMed
17.
Feijen-de Jong E, Jansen D, Baarveld F, van der Schans C, Schellevis F, Reijneveld S: Determinants of late and/or inadequate use of prenatal healthcare in high-income countries: a systematic review.Eur J Pub Health 2012, 22(6):904–913.CrossRef
18.
Blumenshine P, Egerter S, Barclay CJ, Cubbin C, Braveman PA: Socioeconomic disparities in adverse birth outcomes: a systematic review.Am J Prev Med 2010, 39(3):263–272.CrossRefPubMed
19.
Shavers V: Measurement of socioeconomic status in health disparities research.J Natl Med Assoc 2007, 99(9):1013–1023.PubMedPubMedCentral
20.
Braveman P, Cubbin C, Marchi K, Egerter S, Chavez G: Measuring socioeconomic status/position in studies of racial/ethnic disparities: maternal and infant health.Public Health Rep 2001, 116:449–463.CrossRefPubMedPubMedCentral
21.
World Health Organization (WHO): Guidelines on Optimal Feeding of Low Birth-Weight Infants in Low- and Middle-Income Countries. Geneva, Switzerland: World Health Organization; 2011.
22.
O’Campo P, Xue X, Wang M-C, O’Brien Caughey M: Neighborhood risk factors for low birthweight in Baltimore: a mutilvariate analysis.Am J Pub Health 1997, 87:1113–1118.CrossRef
23.
Collins JW, Simon DM, Jackson TA, David RJ: Advancing maternal age and infant birth weight among urban African-Americans: the effect of neighborhood poverty.Ethn Dis 2006, 16:180–186.PubMed
24.
Pickett K, Wakschlag L, Rathouza P, Leventhal B, Abrams B: The working-class context of pregnancy smoking.Health Place 2002, 8:167–175.CrossRefPubMed
25.
Rajaratnam J, Burke J, O’Campo P: Maternal and child health and neighborhood context: the selection and construction of area-level variables.Health Place 2006, 12(4):547–556.CrossRefPubMed
26.
Berkman LA, Kawachi I: Neighborhoods and Health. New York: Oxford University Press Inc.; 2003.
27.
Pampalon R, Hamel D, Gamache P: A comparison of individual and area-based socio-economic data for monitoring social inequalities in health.Health Rep 2009, 20(4):85–94.PubMed
28.
Kaufman JS, Dole N, Savitz DA, Herring AH: Modeling community-level effects on preterm birth.Ann Epidemiol 2003, 13(5):377–384.CrossRefPubMed
29.
Ahern J, Pickett KE, Selvin S, Abrams B: Preterm birth among African American and white women: a multilevel analysis of socioeconomic characteristics and cigarette smoking.J Epidemiol Community Health 2003, 57(8):606–611.CrossRefPubMedPubMedCentral
30.
Genereux M, Auger N, Goneau M, Daniel M: Neighbourhood socioeconomic status, maternal education and adverse birth outcomes among mothers living near highways.J Epidemiol Community Health 2008, 62(8):695–700.CrossRefPubMed
31.
Luo Z-C, Wilkins R: Kramer MS, and for the Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System: Effect of neighbourhood income and maternal education on birth outcomes: a population-based study.CMAJ 2006, 174(10):1415–1420.CrossRefPubMedPubMedCentral
32.
Auger N, Authier MA, Martinez J, Daniel M: The association between rural–urban continuum, maternal education and adverse birth outcomes in Quebec, Canada.J Rural Health 2009, 25(4):342–351.CrossRefPubMed
33.
Bambra C: Health inequalities and welfare state regimes: theoretical insights on a public health ‘puzzle’.J Epidemiol Community Health 2011, 65(9):740–745.CrossRefPubMed
34.
Lofters A, O’Campo P: Differences that matter. In Rethinking Social Epidemiology: Towards a Science of Change. 1st edition. Edited by O’Campo P, Dunn J. London, New York: Springer; 2012:93–109.CrossRef
35.
Public Health Agency of Canada: What Mothers Say: The Canadian Maternity Experiences Survey. Ottawa: Public Health Agency of Canada; 2009.
36.
Dzakpasu S, Kaczorowski J, Chalmers B, Heaman M, Duggan J, Neusy E: Maternity Experiences Study Group of the Canadian Prerinatal Surveillance System PHAOC: The Canadian Maternity Experiences Survey: design and methods.J Obstet Gynaecol Can 2008, 30(3):207–216.CrossRefPubMed
37.
Chalmers B, Dzakpasu S, Heaman M, Kaczorowski J: Maternity Experiences Study Group of the Canadian Prerinatal Surveillance System PHAOC: The Canadian Maternity Experiences Survey: an overview of findings.J Obstet Gynaecol Can 2008, 30(3):217–228.CrossRefPubMed
38.
39.
Daoud N, O’Campo P, Urquia M, Heaman M: Neighbourhood context and abuse among immigrant and non-immigrant women in Canada: findings from the Maternity Experiences Survey.Int J Pub Health 2012, 57(4):679–689.CrossRef
40.
Canada S: Census Dictionary Catalogue no.92-566-X 2010. Ottawa: Minister of Industry; 2006.
41.
Canada S: Public Health Agency of Canada: Microdata User Guide. Ottawa: Maternity Experiences Survey; 2006.
42.
Heaman M, Green C, Newburn-Cook C, Elliott L, Helewa M: Social inequalities in use of prenatal care in Manitoba.J Obstet Gynaecol Can 2007, 29:806–816.CrossRefPubMed
43.
Liu N, Wen SW, Manual DG, Katherine W, Bottomley J, Walker MC: Social disparity and the use of intrapartum epidural analgesia in a publicly funded healthcare system.Obstet Anesth Dig 2011, 31(2):120–121.CrossRef
44.
Leeb K, Baibergenova A, Wen E, Webster G, Zelmer J: Are there socio-economic differences in caesarean section rates in Canada?Healthc Policy 2005, 1(1):48–54.PubMedPubMedCentral
45.
Joseph K, Dodds L, Allen A, Jones D, Monterrosa L, Robinson H, Liston R, Young D: Socioeconomic status and receipt of obstetric services in Canada.Obstet Gynecol 2006, 107(3):641–650.CrossRefPubMed
46.
Lasser KE, Himmelstein DU, Woolhandler S: Access to care, health status, and health disparities in the United States and Canada: results of a cross-national population-based survey.Am J Pub Health 2006, 96(7):1300–1307.CrossRef
47.
Victora CG, Barros AJ, Axelson H, Bhutta ZA, Chopra M, Franca GV, Kerber K, Kirkwood BR, Newby H, Ronsmans C, Boerma JT: How changes in coverage affect equity in maternal and child health interventions in 35 Countdown to 2015 countries: an analysis of national surveys.Lancet 2012, 380(9848):1149–1156.CrossRefPubMed
48.
Barros AJ, Ronsmans C, Axelson H, Loaiza E, Bertoldi AD, Franca GV, Bryce J, Boerma JT, Victora CG: Equity in maternal, newborn, and child health interventions in Countdown to 2015: a retrospective review of survey data from 54 countries.Lancet 2012, 379(9822):1225–1233.CrossRefPubMed
49.
Einarsdottir K, Haggar F, Pereira G, Leonard H, de Klerk N, Stanley FJ, Stock S: Role of public and private funding in the rising caesarean section rate: a cohort study.BMJ open 2013, 3(5): doi:10.1136/bmjopen-2013-002789
50.
Roberts CL, Algert CS, Ford JB, Todd AL, Morris JM: Pathways to a rising caesarean section rate: a population-based cohort study.BMJ open 2012, 2(5): doi:10.1136/bmjopen-2012-001725
51.
Mortensen L: Socioeconomic inequality in birth weight and gestational age in Denmark 1996–2007: using a family-based approach to explore alternative explanations.Soc Sci Med 2013, 76(1):1–7.CrossRefPubMed
52.
van den Berg G, van Eijsden M, Vrijkotte TGM, Gemke RJBJ: Educational inequalities in perinatal outcomes: the mediating effect of smoking and environmental tobacco exposure.PLoS One 2012, 7(5):e37002.CrossRefPubMedPubMedCentral
53.
Collins JW Jr, Wambach J, David RJ, Rankin KM: Women’s lifelong exposure to neighborhood poverty and low birth weight: a population-based study.Matern Child Health J 2009, 13(3):326–333.CrossRefPubMed
54.
Lynch JW, Smith GD, Kaplan GA, House JS: Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions.BMJ 2000, 320(7243):1200–1204.CrossRefPubMedPubMedCentral
55.
Gallo LC, Matthews KA: Understanding the association between socioeconomic status and physical health: do negative emotions play a role?Psychol Bull 2003, 129(1):10–51.CrossRefPubMed
56.
Williams D: Race, socioeconomic status, and health: the added effects of racism and discrimination.Ann N Y Acad Sci 1999, 896:173–188.CrossRefPubMed
57.
58.
Smith G, Ben-Shlomo Y: Geographical and social class differentials in stroke mortality—the influence of early-life factors: comment on papers by Maheswaren and colleagues.J Epidemiol Community Health 1997, 51:134–137.CrossRefPubMedPubMedCentral
Metadata
Title
Patterns of social inequalities across pregnancy and birth outcomes: a comparison of individual and neighborhood socioeconomic measures
Authors
Nihaya Daoud
Patricia O’Campo
Anita Minh
Marcelo L Urquia
Susie Dzakpasu
Maureen Heaman
Janusz Kaczorowski
Cheryl Levitt
Janet Smylie
Beverley Chalmers
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2014
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-014-0393-z

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