摘要
目的探讨社会环境因素对不良出生结局的直接与间接作用。方法利用《陕西省出生缺陷现况及其危险因素调查》中有关育龄妇女及其生育子女的相关信息以及陕西卫生统计年鉴有关调查地区的卫生事业发展数据,采用验证性因子分析构建卫生事业发展状况、家庭特征、妇幼保健利用和叶酸服用、不良出生结局5个潜变量,建立潜变量间的假设结构模型,采用结构方程模型方法估计路径系数,并进行修正和评价,最终确定最佳结构方程模型。结果本研究共纳入28457名在2010—2013年间怀孕并有明确怀孕结局分娩且不良出生结局数据完整的育龄妇女,其分娩的新生儿有2.0%为出生缺陷,有2.7%为早产儿,有3.4%为低出生体重儿。结构方程模型显示,卫生事业发展状况主要是通过影响妇幼保健的利用和叶酸服用间接影响不良出生结局的发生,妇幼保健利用主要通过影响叶酸服用间接影响不良出生结局发生,家庭特征对不良出生结局既可产生直接影响也可产生间接影响,家庭特征的间接影响主要通过妇幼保健利用和叶酸服用实现,而叶酸服用则直接影响不良出生结局的发生。家庭特征的影响最大,占53.3%,其后依次是叶酸服用(30.0%)、妇幼保健利用(12.7%)和卫生事业发展(4.0%)。结论卫生事业发展、家庭特征、妇幼保健利用、叶酸服用等宏观社会环境因素会直接或间接地对不良出生结局产生影响,但家庭特征影响较大。不良出生结局的干预中应当重视以家庭为单位的社会干预措施。
Objective To explore direct and indirect effect of social environment factors on adverse birth outcomes.Methods The data on the women of childbearing age and their children were obtained through a survey on the status of birth defects and their risk factors in Shaanxi province and the information about health development in 30 districts and counties in Shaanxi province were extracted from health statistics yearbook of Shaanxi province-2010. Confirmatory factor analysis was used to construct five latent variables （health development, family characteristics, maternal and child health care utilization, folic acid supplement use, and adverse birth outcomes） and to establish a hypothesis structure model involving the latent variables. And then the best model was determined with modification and evaluation using structural equation model method.Results The participants of the study were 28 457 women aged 15-49 years and being pregnant and with definite pregnancy outcome during the period from 2010 through 2013. Of all the deliveries of the pregnant women, 2.0%, 2.7%, and 3.4% were birth defect, premature delivery, and low birth weight. The established structural equation model revealed that health service development affected the occurrence of adverse birth outcomes indirectly through the influence of maternal and child health care utilization and folic acid supplement use; maternal and child health care utilization influenced birth outcomes indirectly through folic acid supplement use. Family characteristics exerted direct and indirect effect on adverse birth outcomes mainly through maternal and child health care utilization and folic acid supplement use; whereas folic acid supplement use had a direct impact on the occurrence of adverse birth outcomes. The effect of family characteristics was the greatest （53.3%）, followed by that of folic acid supplement use （30.0%）, maternal and child health care utilization （12.7%）, and the development of health service （4.0%）.Conclusion Health service development, family characteristics, maternal and child health care utilization, and folic acid supplement use exert direct or indirect impact on adverse birth outcomes, and the effect of family characteristics is the greatest. The results suggest that family-based social interventions should be adopted in the intervention on adverse birth outcomes.
作者
王红丽
陈方尧
严惠
刘蓉
郭乐倩
赵豆豆
张丽
颜虹
党少农
WANG Hong-li;CHEN Fang-yao;YAN Hui(Department of Epidemiology and Health Statistics, School of Public Health, Xi＇an Jiaotong University, Xi＇an, Shaanxi Province 710061, China)
出处
《中国公共卫生》
CAS
CSCD
北大核心
2018年第7期972-976,共5页
Chinese Journal of Public Health
基金
国家自然科学基金(81230016)
陕西省卫计委出生缺陷防治课题研究(Sxwsjswzfcght2016-013)
关键词
不良出生结局
影响因素
结构方程模型
adverse birth outcome
influence factor
structural equation model
