Amber A. Vos, Semiha Denktaş, Gerard JJM Borsboom, Gouke J. Bonsel, Eric AP Steegers
Abstract
In a national perinatal health programme, we observed striking heterogeneity in the explanation of the most prominent risks across municipalities. Therefore we explored the separate contribution of several socio-demographic risks on perinatal health inequalities between municipalities and neighbourhoods. The study aims to identify perinatal health inequalities on the neighbourhood level across the selected municipalities, and to objectify the contribution of socio-demographic risk factors on pregnancy outcomes in each municipality by the application of the population attributable risk concept.
Population based cohort study (2000-2008). Perinatal outcomes of 352,407 single pregnancies from 15 municipalities were analysed. Odds ratios and population attributable risks were calculated. Main outcomes were combined perinatal morbidity (small-for-gestational age, preterm birth, congenital anomalies, and low Apgar score), and perinatal mortality.
Perinatal health inequalities existed on both the municipal and the neighbourhood level. In municipalities, combined perinatal morbidity ranged from 17.3 to 23.6 %, and perinatal mortality ranges from 10.1 to 15.4 ‰. Considerable differences in low socio-economic status between municipalities were apparent, with prevalences ranging from 14.4 to 82.5 %. In seven municipalities, significant differences between neighbourhoods existed for perinatal morbidity (adjusted OR ranging from 1.33 to 2.38) and for perinatal mortality (adjusted OR ranging from 2.06 to 5.59). For some municipalities, socio-demographic risk factors were s a strong predictor for the observed inequalities, but in other municipalities these factors were very weak predictors. If all socio-demographic determinants were set to the most favourable value in a predictive model, combined perinatal morbidity would decrease with 15 to 39 % in these municipalities.
Substantial differences in perinatal morbidity and mortality between municipalities and neighbourhoods exist. Different patterns of inequality suggest differences in etiology. Policy makers and healthcare professionals need to be informed about their local perinatal health profiles in order to introduce antenatal healthcare tailored to the individual and neighbourhood environment.
This research output has an Altmetric Attention Score of 7. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 19 April 2016.
All research outputs
#4,079,964
of 23,577,654 outputs
Outputs from BMC Pregnancy and Childbirth
#1,099
of 4,333 outputs
Outputs of similar age
#51,252
of 268,530 outputs
Outputs of similar age from BMC Pregnancy and Childbirth
#26
of 102 outputs
Altmetric has tracked 23,577,654 research outputs across all sources so far. Compared to these this one has done well and is in the 82nd percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 4,333 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 9.0. This one has gotten more attention than average, scoring higher than 74% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 268,530 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 80% of its contemporaries.
We're also able to compare this research output to 102 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 74% of its contemporaries.
