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Canadian Journal of Public Health

, Volume 103, Issue 6, pp e443–e447 | Cite as

Neighbourhood Income Level and Outcomes of Extremely Preterm Neonates: Protection Conferred by a Universal Health Care System

  • Gary Ko
  • Prakesh Shah
  • Lajos Kovacs
  • Cecil Ojah
  • Patricia Riley
  • Shoo K. LeeEmail author
  • Canadian Neonatal Network
Quantitative Research
  • 1 Downloads

Abstract

Objectives: To determine the impact of neighbourhood income and maternal residence population density on mortality and various morbidities at discharge or transfer from the NICU among extremely preterm neonates (<27 weeks gestation) in Canada.

Methods: Neighbourhood income level and residential status was derived using a postal code conversion file and census data. Multivariable logistic regression analysis was used to estimate the risk-adjusted odds ratio (AOR) of mortality and survival without major morbidities (chronic lung disease, necrotizing enterocolitis, severe intraventricular hemorrhage, and retinopathy of prematurity) among 2,752 extremely preterm infants admitted to 25 tertiary level neonatal intensive care units in Canada between 2007 and 2008.

Results: There were no significant differences between mothers from different neighbourhood income quintiles (Q1 = low; Q5 = high) and neonatal mortality AOR (95% confidence interval): Q1: 1.10 (0.74–1.62), Q2: 1.00 (0.67–1.49), Q3: 1.39 (0.93–2.07), Q4: 1.01 (0.67–1.52), Q5: 1 (reference); or survival without major morbidity: Q1: 1.01 (0.70–1.44), Q2: 0.84 (0.58-–1.23), Q3: 0.85 (0.58–1.24), Q4: 0.92 (0.63–1.35), Q5: 1 (reference). There were no significant differences in mortality (AOR 1.14 [0.83–1.57]) or in survival without major morbidity (AOR 0.92 [0.67–1.26]) between infants of mothers residing in sparsely populated areas compared to densely populated areas.

Conclusion: Maternal residence in a low-income neighbourhood or sparsely populated area was not associated with higher odds of mortality or survival free of major morbidities in extremely preterm infants.

Résumé

Objectifs: Déterminer l’impact du revenu du quartier et de la densité de population du lieu de résidence maternel sur la mortalité et sur diverses morbidités lors du congé ou du transfert des unités néonatales de soins intensifs chez les grands prématurés (<27 semaines de gestation) au Canada.

Méthode: Le niveau de revenu du quartier et le statut résidentiel ont été dérivés à l’aide d’un fichier de conversion du code postal et des données du Recensement. Au moyen d’une analyse de régression logistique multivariée, nous avons estimé le rapport de cotes ajusté selon le risque (RCa) pour la mortalité et pour la survie sans morbidité grave (pneumopathie chronique, entérocolite nécrosante néonatale, hémorragie intraventriculaire grave, rétinopathie des prématurés) chez 2 752 grands prématurés hospitalisés dans 25 unités de soins néonatals intensifs de niveau tertiaire au Canada entre 2007 et 2008.

Résultats: Nous n’avons constaté aucun écart significatif entre les mères de différents quintiles de revenu du quartier (Q1=faible; Q5=élevé) dans la mortalité néonatale (intervalle de confiance de 95 %): Q1: 1,10 (0,74–1,62), Q2: 1,00 (0,67–1,49), Q3: 1,39 (0,93–2,07), Q4: 1,01 (0,67–1,52), Q5: 1 (référence), ni dans la survie sans morbidité grave: Q1: 1,01 (0,70–1,44), Q2: 0,84 (0,58–1,23), Q3: 0,85 (0,58–1,24), Q4: 0,92 (0,63–1,35), Q5: 1 (référence). Nous n’avons constaté aucun écart significatif non plus dans la mortalité (RCa 1,14 [0,83–1,57]) ou dans la survie sans morbidité grave (RCa 0,92 [0,67–1,26]) entre les nourrissons de mères habitant des zones à faible densité de population comparativement aux zones urbaines.

Conclusion: La résidence maternelle dans un quartier à faible revenu ou à faible densité de population n’était pas associée à une probabilité plus élevée de mortalité ou de survie sans morbidité grave chez les grands prématurés.

Key words

Neonatal mortality morbidity preterm birth neonatal intensive care unit socioeconomic status 

Mots clés

mortalité néonatale morbidité naissance prématurée unité soins intensifs nouveau-né statut socioéconomique 

References

  1. 1.
    Frohlich KL, Ross N, Richmond C. Health disparities in Canada today: Some evidence and a theoretical framework. Health Policy 2006;79(2-3):132–43.CrossRefGoogle Scholar
  2. 2.
    Demissie K, Rhoads GG, Ananth CV, Alexander GR, Kramer MS, Kogan MD, et al. Trends in preterm birth and neonatal mortality among blacks and whites in the United States from 1989 to 1997. Am J Epidemiol 2001;154(4):307–15.CrossRefGoogle Scholar
  3. 3.
    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):606–11.CrossRefGoogle Scholar
  4. 4.
    Ferguson SE, Smith GN, Salenieks ME, Windrim R, Walker MC. Preterm premature rupture of membranes. Nutritional and socioeconomic factors. Obstet Gynecol 2002;100(6):1250–56.Google Scholar
  5. 5.
    Pickett KE, Ahern JE, Selvin S, Abrams B. Neighborhood socioeconomic status, maternal race and preterm delivery: A case-control study. Ann Epidemiol 2002;12(6):410–18.CrossRefGoogle Scholar
  6. 6.
    Robinson JN, Regan JA, Norwitz ER. The epidemiology of preterm labor. Semin Perinatol 2001;25(4):204–14.CrossRefGoogle Scholar
  7. 7.
    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):263–72.CrossRefGoogle Scholar
  8. 8.
    Gazmararian JA, Adams MM, Pamuk ER. Associations between measures of socioeconomic status and maternal health behavior. Am J Prev Med 1996;12(2):108–15.CrossRefGoogle Scholar
  9. 9.
    Luo ZC, Kierans WJ, Wilkins R, Liston RM, Mohamed J, Kramer MS. Disparities in birth outcomes by neighborhood income: Temporal trends in rural and urban areas, British Columbia. Epidemiology 2004;15(6):679–86.CrossRefGoogle Scholar
  10. 10.
    Luo ZC, Wilkins R, Kramer MS. Effect of neighbourhood income and maternal education on birth outcomes: A population-based study. CMAJ 2006;174(10):1415–20.CrossRefGoogle Scholar
  11. 11.
    Joseph KS, Liston RM, Dodds L, Dahlgren L, Allen AC. Socioeconomic status and perinatal outcomes in a setting with universal access to essential health care services. CMAJ 2007;177(6):583–90.CrossRefGoogle Scholar
  12. 12.
    Luo ZC, Wilkins R, Heaman M, Martens P, Smylie J, Hart L, et al. Birth outcomes and infant mortality by the degree of rural isolation among first nations and non-first nations in Manitoba, Canada. J Rural Health 2010;26(2):175–81.CrossRefGoogle Scholar
  13. 13.
    Luo ZC, Wilkins R. Degree of rural isolation and birth outcomes. Paediatr Perinat Epidemiol 2008;22(4):341–49.CrossRefGoogle Scholar
  14. 14.
    Sparks PJ, McLaughlin DK, Stokes CS. Differential neonatal and postneo-natal infant mortality rates across US counties: The role of socioeconomic conditions and rurality. J Rural Health 2009;25(4):332–41.CrossRefGoogle Scholar
  15. 15.
    Larson EH, Hart LG, Rosenblatt RA. Is non-metropolitan residence a risk factor for poor birth outcome in the U.S.? Soc Sci Med 1997;45(2):171–88.CrossRefGoogle Scholar
  16. 16.
    Abdel-Latif ME, Bajuk B, Oei J, Vincent T, Sutton L, Lui K. Does rural or urban residence make a difference to neonatal outcome in premature birth? A regional study in Australia. Arch Dis Child Fetal Neonatal Ed 2006;91(4):F251–F256.CrossRefGoogle Scholar
  17. 17.
    Larson EH, Hart LG, Rosenblatt RA. Rural residence and poor birth outcome in Washington state. J Rural Health 1992;8(3):162–70.CrossRefGoogle Scholar
  18. 18.
    Guildea ZE, Fone DL, Dunstan FD, Cartlidge PH. Differences in risk of mortality under 1 year of age between rural and urban areas: An ecological study. Public Health 2005;119(5):442–47.CrossRefGoogle Scholar
  19. 19.
    Canadian Neonatal Network. Abstractor’s Manual. Toronto, ON: CNN, 2010.Google Scholar
  20. 20.
    Wilkins R, Health Analysis Division SC. PCCF+ Version 5F User’s Guide: Automated geographic coding based on the Statistics Canada Postal Conversion Files, Including postal codes through July 2009. [Catalogue 82F0086-XDB]. Ottawa. 2010.Google Scholar
  21. 21.
    Shennan AT, Dunn MS, Ohlsson A, Lennox K, Hoskins EM. Abnormal pulmonary outcomes in premature infants: Prediction from oxygen requirement in the neonatal period. Pediatrics 1988;82(4):527–32.Google Scholar
  22. 22.
    Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: A study of infants with birth weights less than 1,500 gm. J Pediatr 1978;92(4):529–34.CrossRefGoogle Scholar
  23. 23.
    An international classification of retinopathy of prematurity. Pediatrics 1984;74(1):127–33.Google Scholar
  24. 24.
    Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978;187(1):1–7.CrossRefGoogle Scholar
  25. 25.
    Richardson DK, Corcoran JD, Escobar GJ, Lee SK. SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risk scores. J Pediatr 2001;138(1):92–100.CrossRefGoogle Scholar
  26. 26.
    McIntyre E, Hiller JE, Turnbull D. Determinants of infant feeding practices in a low socio-economic area: Identifying environmental barriers to breastfeeding. Aust N Z J Public Health 1999;23(2):207–9.CrossRefGoogle Scholar
  27. 27.
    McIntyre E, Turnbull D, Hiller JE. Breastfeeding in public places. J Hum Lact 1999;15(2):131–35.CrossRefGoogle Scholar
  28. 28.
    Wang LW, Wang ST, Huang CC. Preterm infants of educated mothers have better outcome. Acta Paediatr 2008;97(5):568–73.CrossRefGoogle Scholar
  29. 29.
    Luu TM, Vohr BR, Allan W, Schneider KC, Ment LR. Evidence for catch-up in cognition and receptive vocabulary among adolescents born very preterm. Pediatrics 2011;128(2):313–22.CrossRefGoogle Scholar
  30. 30.
    Ghods E, Kreissl A, Brandstetter S, Fuiko R, Widhalm K. Head circumference catch-up growth among preterm very low birth weight infants: Effect on neurodevelopmental outcome. J Perinat Med 2011;39(5):579–86.Google Scholar

Copyright information

© The Canadian Public Health Association 2012

Authors and Affiliations

  • Gary Ko
    • 1
  • Prakesh Shah
    • 1
  • Lajos Kovacs
    • 2
  • Cecil Ojah
    • 3
  • Patricia Riley
    • 2
  • Shoo K. Lee
    • 1
    Email author
  • Canadian Neonatal Network
  1. 1.Department of PaediatricsUniversity of TorontoTorontoCanada
  2. 2.Department of Paediatrics, Faculty of MedicineMcGill UniversityMontrealCanada
  3. 3.Department of Paediatrics, Faculty of MedicineDalhousie UniversitySaint JohnCanada

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