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Socioeconomic gradients of adverse birth outcomes and related maternal factors in rural and urban Alberta, Canada: a concentration index approach

Ospina, Maria, Osornio-Vargas, Álvaro Román, Nielsen, Charlene C, Crawford, Susan, Kumar, Manoj, Aziz, Khalid, Serrano-Lomelin, Jesus·2020·BMJ Open
DOI 10.1136/bmjopen-2019-033296
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Abstract

Objective: Using a summary measure of health inequalities, this study evaluated the distribution of adverse birth outcomes (ABO) and related maternal risk factors across area-level socioeconomic status (SES) gradients in urban and rural Alberta, Canada. Design: Cross-sectional study using a validated perinatal clinical registry and an area-level SES. Setting: The study was conducted in Alberta, Canada. Data about ABO and related maternal risk factors were obtained from the Alberta Perinatal Health Program between 2006 and 2012. An area-level SES index derived from census data (2006) was linked to the postal code at delivery. Participants: Women (n=3 30 957) having singleton live births with gestational age ≥22 weeks. Primary and secondary outcome measures: We estimated concentration indexes to assess inequalities across SES gradients in both rural and urban areas (CIdx R and CIdx U , respectively) for spontaneous preterm birth (PTB), small for gestational age (SGA), large for gestational age (LGA), gestational hypertension, gestational diabetes, smoking and substance use during pregnancy and pre-pregnancy weight >91 kg. Results: The highest health inequalities disfavouring low SES groups were identified for substance abuse and smoking in rural areas (CIdx R −0.38 and −0.23, respectively). Medium inequalities were identified for LGA (CIdx R −0.08), pre-pregnancy weight >91 kg (CIdx R −0.07), substance use (CIdx U −0.15), smoking (CIdx U −0.14), gestational diabetes (CIdx U −0.10) and SGA (CIdx U −0.07). Low inequalities were identified for PTB (CIdx R −0.05; CIdx U −0.05) and gestational diabetes (CIdx R −0.04). Inequalities disfavouring high SES groups were identified for gestational hypertension (CIdx R +0.04), SGA (CIdx R +0.03) and LGA (CIdx U +0.03). Conclusions: ABO and related maternal risk factors were unequally distributed across the socioeconomic gradient in urban–rural settings, with the greatest concentrations in lower SES groups of rural areas. Future research is needed on underlying mechanisms driving SES gradients in perinatal health across the rural–urban spectrum.

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Metadata

Authors
Ospina, M., Osornio-Vargas, Á. R., Nielsen, C. C., Crawford, S., Kumar, M., Aziz, K., & Serrano-Lomelin, J.
Affiliations
  • Department of Obstetrics and Gynecology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
  • Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
  • Alberta Perinatal Health Program, Alberta Health Services, Calgary, Alberta, Canada
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2020-01
Volume
10
Issue
1
Pages
e033296
ISSN
2044-6055
DOI
10.1136/bmjopen-2019-033296
Cited by
26
References
4
Language
en
Licence
creativecommons.org/licenses/by-nc/4.0/ (unspecified, 30 d)
Funders
  • University of Alberta. Emerging Research Team Grant. (N/A)
  • Canadian Institutes of Health Research (FRN: 127789)
  • The Lois Hole Hospital for Women through the Women and Children’s Health Research Institute (N/A)
  • CONACyT Mexico (N/A)
  • Natural Sciences and Engineering Research Council of Canada (FRN: 127789)

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Ospina, M., Osornio-Vargas, Á. R., Nielsen, C. C., Crawford, S., Kumar, M., Aziz, K., & Serrano-Lomelin, J. (2020). Socioeconomic gradients of adverse birth outcomes and related maternal factors in rural and urban Alberta, Canada: a concentration index approach. BMJ Open. https://doi.org/10.1136/bmjopen-2019-033296

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