Birth weight for gestational age as a health indicator: Birth weight and mortality measures at the local area level

Foetal growth is of interest not only as a predictor of pregnancyoutcome and of infant and child health, but also of subsequentadult disease. Birth weight (BW) standardized for gestationalage and sex (BWSDS) is a measure of foetal growth. The aim ofthis paper was to study the BWSDS as a health indicator in comparisonwith other pregnancy outcome measures such as crude BW, thelow birth weight (LBW) rate and the pre-term birth rate by correlationto mortality rates and to a socioeconomic area index, at localarea level in the city of Göteborg, Sweden 1973–1986.The results showed that BWSDS had a statistically significantcorrelation to mortality rates in the adult population (–0.58to 7minus;0.70) and to a socioeconomic area index (0.89) anda general pattern of closer relationship to these measures comparedto the other pregnancy outcome measures at the local area level.This indicates that BWSDS, in comparison with the BW, LBW rateand the pre-term birth rate, has at least as good (or better)properties as a health indicator. The BWSDS, representing themain perinatal population, has a broader representativity thanmerely being an indicator of foetal health in a restricted sense.Birth weight for gestational age is found to be suitable asa health indicator at the local area level.     

Associations between relative income and mortality in Norway: a register-based study

BACKGROUND: Current research on health inequalities suggests that not only an individual's absolute level of income but also his/her relative position in the income hierarchy could have health consequences. This study examines whether relative income was associated with individuals' mortality in Norway during the 1990s. METHODS: Data were formed by linkages of Norwegian administrative registers. This study analyses 1.68 million men and women (age group: 30-66 years) with disposable income (1993) in the range 60,000-210,000 Norwegian Kroner. Relative income was calculated as deviations in per cent from the median income in the surrounding residential area. The outcome variable was deaths in 1994-1999. Effects of relative income on mortality were estimated by multiple logistic regression analyses, separately in 13 narrow brackets of absolute income. Adjustments were made for sex, education, marital status, and other individual-level mortality predictors. RESULTS: Low relative income compared with the median in residential regions with populations above 20,000 inhabitants was associated with higher mortality among those with medium and lower absolute income. The excess risk increased progressively the lower the level of absolute income. Among those with higher absolute income, however, relative income was not associated with mortality. Moreover, when relative income was considered in relation to the median in small municipalities, almost no effect on mortality was observed. CONCLUSION: In Norway during the 1990s, having low relative income constituted an additional mortality risk among individuals with middle or lower absolute incomes and when relative income was calculated in relation to the average in medium-sized or larger regions.     

Economic and social factors associated with body mass index and obesity in the Spanish population aged 20-64 years

Many studies have shown how greatly body mass index (BMI) andobesity vary according to different socio-economic factors.The objective of this study is to study these variations ina representative sample of the adult population in a Mediterraneanarea. The data were taken from the 1987 Spanish National HealthSurvey carried out in a representative sample of the non-institutionalizedpopulation older than 1 year of age. Multivariate statisticaltechniques are used to analyse the relation between BMI andobesity and different social and economic factors in a sampleof 21,838 men and women between 20 and 64 years of age. BMIand obesity vary directly with age in both men and women. Aninverse relation is seen with regard to the levels of education:the lower the educational level, the higher the mean BMI andthe more frequently obesity is found. This association is strongerin women and shows a significant dose-response relation. Theconsistency of the resuits obtained with those observed in otherstudies carried out In countries with very different socio-culturalpatterns and lifestyles than Spain suggests that these variationsin BMI and obesity are independent of external factors.     

The social patterning of relative body weight and obesity in Denmark and Finland

BACKGROUND: Relative body weight is typically inversely associated with social status in affluent societies but studies comparing the social patterning of relative body weight and obesity in different countries have only seldom been conducted. The aim of this study was to analyse and compare the social patterning of relative weight and obesity by occupational status, educational attainment and marital status between Danish and Finnish women and men. METHODS: Data from the Finnish Survey on Living Conditions and the Danish Health and Morbidity Survey, both collected in 1994, were compared. Relative weight was studied by using body mass index (BMI), and those with BMI > or =30 kg/m(2) were regarded as obese. Logistic regression analysis was used to examine the social patterning of obesity in the pooled dataset. Two-variable interaction effects were tested separately. RESULTS: Compared with their Danish counterparts, Finnish women and men had higher average relative weight and they were more often obese. There were no country differences in the socio-economic patterning of obesity by educational attainment, but a stronger patterning of obesity by occupational status was found among Danish women. Moreover, non-married women in Denmark were more likely to be obese than their married counterparts. CONCLUSIONS: Finns have higher relative weight and they are more often obese than Danes. The social patterning of obesity was similar in both studied countries but stronger in Denmark.     

Pre-natal care and prevention of low birth weight: A case-control study in southern Spain

A national policy for improving pre-natal care was applied throughoutAndalusia (southern Spain) in 1984. We report the results ofan evaluation of this health care programme as regards the preventionof low birth weight. Two case-control studies in a hospitalsetting were performed: one before the programme was implemented(1981–1982) and the second one 6 years after the programme(1990–1993). A total of 179 cases and 395 controls forthe period 1981–1982 and 251 cases and 381 controls for1990–1993 were selected. Pre-natal care was assessed onthe basis of the number of pre-natal care visits, the date ofthe first visit and an American composite index to adjust forgestational age. Multiple-factor adjusted odds ratios (OR) andtheir 95% confidence intervals (CI) were estimated using logisticregression analysis. The use of pre-natal care significantlyimproved overtime: the proportion of women receiving no pre-natalcare decreased from over 30% to less than 5% and the proportionof women starting pre-natal care in the first trimester for1990–1993 was 3 times the figure for 1981–1982.In the 1981–1982 case-control study, pre-natal care wasnot related to low birth weight risk. In the 1990–1993case-control study, a clear and significant trend was observedbetween the number of pre-natal care visits and the adequacyof care according to the composite index and the risk of lowbirth weight. When these relationships were analysed stratifyingby gestational age, a significant trend was found between pre-natalcare and pre-term low birth weight. The results suggest thatthe present Andalusian programme helps prevent pre-term lowbirth weight.     

GP income in relation to workload in deprived urban areas in The Netherlands. Before and after the 1996 pay review

BACKGROUND: General practitioner workload is higher in deprived urban areas and for the elderly. This led to the introduction of additional GP payments regarding these patients, in the UK and in the Netherlands. This study examines whether this has resulted in more equal payment for work done in the Netherlands. METHODS: GP workload and income have been assessed on the basis of a survey among 1154 GPs (response: 62%). RESULTS: Suggest that total GP income is still lower in deprived areas, but per hour and per patient contact the additional payments gave equity. CONCLUSION: It is thus concluded that Dutch deprivation payments effectively compensate GPs in deprived areas for their higher workload.     

Socioeconomic status and smoking: analysing inequalities with multiple indicators

BACKGROUND AND AIMS: Socioeconomic differences in smoking have been well established. While previous studies have mostly relied on one socioeconomic indicator at a time, this study examined socioeconomic differences in smoking by using several indicators that reflect different dimensions of socioeconomic position. DATA AND METHODS: Data derive from Helsinki Health Study baseline surveys conducted among the employees of the City of Helsinki in 2000 and 2001. The data include 6243 respondents aged 40-60 years (response rate 68%). Six socioeconomic indicators were used: education, occupational status, household income per consumption unit, housing tenure, economic difficulties and economic satisfaction. Their associations with current smoking were examined by fitting sequential logistic regression models. RESULTS: All socioeconomic indicators were strongly associated with smoking among both men and women. When the indicators were examined simultaneously their associations with smoking attenuated, especially when education and occupational status were considered together, and when income and housing tenure were introduced into the models already containing education and occupational status. After mutual adjustment for all socioeconomic indicators, housing tenure and economic satisfaction remained associated with smoking in men. In women, all indicators except income and economic difficulties were inversely associated with smoking after adjustments. CONCLUSIONS: Smoking was associated with structural, material as well as perceived dimensions of socioeconomic disadvantage. Attempts to reduce smoking among the socioeconomically disadvantaged need to target several dimensions of socioeconomic position.     

Association between chronic diseases and disability in elderly subjects with low and high income: the Leiden 85-plus Study

Background: Disability in activities of daily living (ADL) mightbe more prevalent among elderly with low income due to higherprevalence of chronic diseases and impairments, as well as strongerassociations of these factors with ADL-disability. Methods:In the Leiden 85-plus Study, we defined disability as beingunable to perform one or more basic ADL activities. Presenceof chronic diseases was obtained from medical records, impairmentswere assessed with performance-tests. Results: Elderly withlow income had higher prevalence of ADL-disability (23% versus12%; odds ratio 2.0; 95% confidence interval 1.3–3.2),higher prevalence of impairments and equal prevalence of chronicdiseases, except for dementia and co-morbidity. Associationsof these factors with ADL-disability were not stronger. Conclusions:We conclude that ADL-disability is more prevalent in elderlywith low income. Neither prevalence of chronic diseases northe association with disability could explain this.     

Analyzing sibship correlations in birth weight using large sibships from Norway

Data from the Medical Birth Registry of Norway were used to estimate sibship correlations in large sibships (each with ≥5 infants among singleton live births surviving the first year of life), while adjusting for covariates such as infant gender, gestational age, maternal age, parity, and time since last pregnancy. This sample of 12,356 full sibs in 2,462 sibships born in Norway between 1968 and 1989 was selected to maximize the information on parity, and a robust approach to estimating both regression coefficients and the sibship correlation using generalized estimating equations (GEE) was employed. In concordance with previous studies, these data showed a high overall correlation in birth weight among full sibs (0.48 ± 0.01), but this sibship correlation was influenced by parity. In particular, the correlation between the firstborn infant and a subsequent infant was slightly lower than between two subsequent sibs (0.44 ± 0.01 vs. 0.50 ± 0.01, respectively). The effect of time between pregnancies was statistically significant, but its predicted impact was modest over the period in which most of these large families were completed. While these data cannot discriminate whether factors influencing birth weight are maternal or fetal in nature, this analysis does illustrate how robust statistical models can be used to estimate sibship correlations while adjusting for covariates in family studies. Genet. Epidemiol. 14:423–433,1997. © 1997 Wiley-Liss, Inc.     

Population health and the health system: a comparative analysis of avoidable mortality in three nations and their world cities

BACKGROUND: Access to timely and effective medical services can reduce rates of premature mortality attributed to certain conditions. We investigate rates of total and avoidable mortality (AM) and the percentage of avoidable deaths in France, England and Wales and the United States, three wealthy nations with different health systems, and in the urban cores of their world cities, Paris, Inner London and Manhattan. We examine the association between AM and an income-related variable among neighbourhoods of the three cities. METHODS: We obtained mortality data from vital statistics sources for each geographic area. For two time-periods, 1988-90 and 1998-2000, we assess the correlation between area of residence and age- and gender-adjusted total and AM rates. In our comparison of world cities, regression models are employed to analyse the association of a neighbourhood income-related variable with AM. RESULTS: France has the lowest mortality rates. The US exhibits higher total, but similar AM rates compared to England and Wales. Rates of AM are lowest in Paris and highest in London. Avoidable mortality rates are higher in poor neighbourhoods of all three cities; only in Manhattan is there a correlation between the percentage of deaths that are avoidable and an income related variable. CONCLUSIONS: Beyond the well-known association of income and mortality, persistent disparities in AM exist, particularly in Manhattan and Inner London. These disparities are disturbing and should receive greater attention from policy makers.     

The relative influence of individual and contextual socio-economic status on consumption of fruit and soft drinks among adolescents in Europe

BACKGROUND: The number of studies among children and adolescents that focus on socio-economic differences in food habits is limited. Moreover, most are done in only one country and often include a non-representative sample. The present study examines whether socio-economic differences in the consumption of fruit and soft drinks can be found among young adolescents in a wide range of European countries. METHODS: Multilevel statistical analysis of 114 558 school-pupils aged 11, 13 and 15 from 28 countries participating in the WHO collaborative cross-national study of Health Behaviours among School-aged Children 2001-2002. The individual outcomes were daily fruit and soft drink consumption and the socio-economic predictors at the individual level were occupation of the head of household and family material wealth. Family material wealth was aggregated at the country level to operationalize country-level socio-economic status. RESULTS: In general, girls and younger pupils consumed fruit more often and soft drinks less often. Significant between-school, between-country and between-region differences were found. Fruit consumption increased with family material wealth and higher parental occupational status. Soft drink consumption was lower among pupils of higher parental occupational status in Northern, Southern and Western European countries, but not in Central and Eastern European countries. Only in Central and Eastern European countries was a significant increase in soft drink consumption with increasing family affluence found. The country level of family affluence did not seem to have an effect on either outcome variable. CONCLUSION: The findings underscore the importance of socio-economic factors in relation to the food habits of young adolescents.     

Body mass index and weight change attempts among adult women. The Norwegian Women and Cancer Study.

BACKGROUND: Based on concern about the widespread increase in being overweight and obesity along with a substantial demand for leanness, we wanted to estimate body mass index (BMI) and the prevalence of weight change attempts in a population-based sample of Norwegian women. Furthermore, we wanted to examine how weight loss attempts are related to BMI and to age, socioeconomic status, reproductive factors, lifestyle and diet. METHODS: A nationwide, cross-sectional study applying a mailed questionnaire was used. Out of a random sample of 20,000 women aged 45-69 years 10,249 women participated. RESULTS: Based on self-reported data, the mean BMI was 24.6 kg m-2 and 40% of the women had a BMI of > or = 25 kg m-2. More than 50% of the women were trying to lose weight and weight loss attempts were very strongly associated with BMI. Age, education, income, smoking status and perception of diet's importance to health were also significant predictors of weight loss attempts. The effect of age, education and income on weight loss attempts was modified by the level of BMI. Women trying to lose weight reported a different diet than those not trying to lose weight, irrespective of BMI. CONCLUSION: A large proportion of middle-aged women are trying to lose weight. BMI is predominant in explaining weight loss attempts. After adjusting for BMI, age, lifestyle and socioeconomic status also contribute to explaining weight loss attempts.     

Birth Weight and Environmental Pollution in the County of Telemark,Norway

Abstract

The possible effect of environmental pollution on fetal growth was examined in 3,231 consecutively live born single infants (≥37 weeks' gestation) of Caucasian parents born between 1986 and 1988. The parents lived in an industrial area or in less polluted urban and rural residential areas. Information about lifestyle, health, and work exposures was collected from the parents. A significantly lower arithmetic mean birth weight was observed for newborns in the industrial residential area (3,517 g, SD, 482), compared with the urban (3,592 g, SD 495) and rural (3,618 g, SD 517) areas (P < 0.05). Even controlling for gestational age, sex, parity, maternal smoking habits, and social class, residential area still had a significant effect on birth weight. Among other factors examined, only maternal psychological stress at work had a significant effect on birth weight. If the observed association reflects a causal relationship, birth weight may represent a potential outcome parameter for surveillance of effects on humans of environmental exposures.     

The role of birth cohorts in studies of adult health: the New York women's birth cohort

Epidemiological studies investigating associations between early life factors and adult health are often limited to studying exposures that can be reliably recalled in adulthood or obtained from existing medical records. There are few US studies with detailed data on the pre‐ and postnatal environment whose study populations are now in adulthood; one exception is the Collaborative Perinatal Project (CPP). We contacted former female participants of the New York site of the CPP who were born from 1959 to 1963 and were prospectively followed for 7 years to examine whether the pre‐ and postnatal environment is associated with adult health in women 40 years after birth. The New York CPP cohort is particularly diverse; at enrolment, the race/ethnicity distribution of mothers was approximately 30% White, 40% Black and 30% Puerto Rican. Of the 841 eligible women, we successfully traced 375 women (45%) and enrolled 262 women (70% of those traced). Baseline data were available for all eligible women, and we compared those who participated with the remaining cohort (n = 579). Higher family socio‐economic status at age 7, availability of maternal social security number, and White race/ethnicity were statistically significantly associated with a higher probability of tracing. Of those traced, race/ethnicity was associated with participation, with Blacks and Puerto Ricans less likely to participate than Whites (OR = 0.5, 95% CI 0.3, 0.8, and OR = 0.5, 95% CI 0.3, 1.0, respectively). In addition, higher weight at 7 years was associated with lower participation (OR = 0.95, 95% CI 0.92, 0.99), but this association was observed only among the non‐White participants. None of the other maternal characteristics, infant or early childhood growth measures was associated with participation or with tracing, either overall or within each racial/ethnic subgroup. Daughters’ recall of early life factors such as pre‐eclampsia (sensitivity = 24%) and birthweight were generally poor, with the latter varying by category of birthweight with the highest sensitivity for the largest babies (81%) and the lowest sensitivity for the smallest babies (54%). These data reinforce the need to rejuvenate existing birth cohorts with prospective data for life course studies of adult health. Understanding the factors that are associated with tracing and participation in these existing cohorts will help in interpreting the validity and generalisability of the findings from these invaluable cohorts.     

江苏、浙江省4县(市)早产儿体重分布状况及相关社会因素

目的 了解早产儿体重分布状况及早产相关社会因素.方法 研究对象为1995-2000年江苏、浙江省4县(市)分娩孕满28～41周的单胎活产儿的97 537名妇女.采用X2检验比较各组率的差别,应用单因素方差分析比较两组第一次产前检查孕周及产前检查总次数的差异.运用两分类多元logistic回归分析早产的影响因素.结果 4县(市)≥t35岁妇女早产发生率(8.8%)高于＜24岁(5.6%)、25～29岁(4.6%)和30～34岁组(4.5%).身高＜149 cm的妇女早产发生率(6.8%)高于身高≥150 cm的妇女(5.0%).孕早、中期BMI≥28.0及BMI 24.0～28.0妇女的早产发生率(均为5.5%)高于BMI 18.5～24.0(5.0%)、BMI＜18.5的妇女(4.6%).初次怀孕妇女的早产发生率(6.0%)高于孕次≥4次(5.7%)、2次(4.3%)和3次的妇女(4.0%).产次≥2次妇女的早产发生率(9.3%)高于待产妇女(5.2%)和产1次的妇女(4.5%).孕早期没有接受早孕检查的妇女早产发生率(6.1%)高于进行早孕检查妇女(4.7%).早产妇女的产前检查总次数(8.53次)也低于足月产妇女(10.97次).产前检查次数＜4次妇女的早产发生率(18.9%)明显高于产前检查次数≥5次妇女(4.9%).生育年龄大、身材矮、体重指数大、初孕、多产次、孕早期检查少、产前检查次数少是过期妊娠的影响因素.结论 生育年龄大、身材矮、BMI大、初孕、多产次、孕早期检查少、产前检查次数少等与早产有关.     

梅县地区已婚育龄妇女二胎后避孕节育状况调查研究

目的探讨梅县地区已婚育龄妇女二胎后避孕节育状况。方法选取2017年10月至2018年10月625名梅县地区二胎后已婚育龄妇女,根据是否接受过避孕节育健康知识宣教分为对照组(312例,未接受过避孕节育健康知识宣教)与观察组(313例,接受过避孕节育健康知识宣教)。对受访者二胎后避孕节育保健知识掌握情况和避孕节育方式选择进行调查。结果两组避孕节育保健知识掌握情况方面,观察组显著优于对照组(P<0.05);两组避孕节育方法的选择情况,观察组显著优于对照组(P<0.05);观察组经避孕后非意愿妊娠发生率显著低于对照组(P<0.05)。结论梅县地区二胎后已婚育龄妇女避孕节育总体情况良好,进行避孕节育健康知识宣教能提高已婚育龄妇女的避孕知识水平,避免意外怀孕,保护妇女身心健康,提高生活质量。     

Trends in socio-economic differences in tobacco smoking among German schoolchildren, 1994-2002

BACKGROUND: While the graded relationship between socio-economic status (SES) and risk behaviour in adulthood has been the subject of intense research, far less is known about socio-economic differences in health-related behaviour among adolescents. The purpose of the present study is to examine socio-economic differences in adolescent tobacco use in Germany as well as changes in the relationship between 1994 and 2002. METHODS: Data were obtained from the 'Health Behaviour in School-aged Children' study conducted in the largest federal state of Germany, Northrhine-Westfalia, in 1994, 1998 and 2002. The analysis is based on 11.401 11- to 15-year old students. Socio-economic differences in regular smoking were studied in relation to both parental SES (family affluence) and students own SES (school type). Trends from 1994 to 2002 were analysed for each category of family affluence and school type separately. RESULTS: Family affluence only had a weak effect on regular smoking while for type of school a strong social gradient for smoking was found for both the genders. Trend analyses within the different family affluence and school-type categories showed that smoking has generally increased in all socio-economic groups. The level of socio-economic differences remained virtually unchanged in girls and boys in the past 10 years in Germany. CONCLUSIONS: The same relationships of family affluence and school type with smoking have persisted for almost a decade in Germany. Students own SES affects adolescent smoking substantially. Prevention programmes should focus on the school setting in order to tackle current as well as future health inequalities.     

上海市早产低体重儿与足月小样儿体重及增重速率比较

[目的 ]　比较上海市早产低体重儿及足月小样儿 0～ 12月龄的体重及增重情况。　 [方法 ]　收集上海市区1999～ 2 0 0 1年出生的 3 5 7例低出生体重婴儿 ( <2 5 0 0 g)的胎龄、出生体重及 0～ 12月随访体重等资料 ,对其中资料完整的14 9例 (男 5 0名 ,女 99名 )进行逐月分析。并按婴儿 10～ 12月龄时是否达到上海市婴儿年龄别体重标准 (P5 0 ) ,将男女婴分别分为达标组和未达标组 ,每组再分早产和足月两个亚组。采用差值平均法 ,计算男女婴 0～ 12月整月龄时的平均体重 ,及各月龄段的平均日增重速率。　 [结果 ]　①足月小样儿不论男女 ,其出生体重均高于早产低体重儿 (P均 <0 .0 1) ;②足月达标组男婴在第 5个月达标 (P <0 .0 1) ,而早产达标组男婴则至第 10个月才基本达标 ;早产与足月达标组女婴同时在第 8个月时体重达标 (P <0 .0 1)。③男女婴达标组第 1年增重模式相同 ,维持高、中、低增重速率均为 4、3、5个月 ,而未达标组也相同 ,均为 3、3、6个月。　 [结论 ]　早产儿和足月小样儿达标组男女婴儿的体重及增重模式与未达标组明显不同。     

Paternal contribution to birth weight

STUDY OBJECTIVE: Understanding causes of variation in birth weight has been limited by lack of sufficient sets of data that include paternal birth weight. The objective was to estimate risks of low birth weight dependent on parental birth weights and to estimate father-mother-offspring correlations for birth weight to explain the variability in birth weight in terms of effects of genes and environmental factors. DESIGN: A family design, using trios of father-mother-firstborn child. SETTING: The complete birth population in Norway 1967-98. PARTICIPANTS: 67 795 families. MAIN RESULTS: The birth weight correlations were 0.226 for mother-child and 0.126 for father-child. The spousal correlation was low, 0.020. The relative risk of low birth weight in the first born child was 8.2 if both parents were low birth weight themselves, with both parents being above 4 kg as the reference. The estimate of heritability is about 0.25 for birth weight, under the assumption that cultural transmission on the paternal side has no effect on offspring prenatal growth. CONCLUSIONS: Paternal birth weight is a significant and independent predictor of low birth weight in offspring. The estimate of the heritability of birth weight in this study is lower than previously estimated from data within one generation in the Norwegian population.