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Geographical differences in preterm delivery rates in Sweden: A population‐based cohort study
INTRODUCTION: Preterm delivery is a major global public health challenge. The objective of this study was to determine how preterm delivery rates differ in a country with a very high human development index and to explore rural vs urban environmental and socioeconomic factors that may be responsible...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6492021/ https://www.ncbi.nlm.nih.gov/pubmed/30169899 http://dx.doi.org/10.1111/aogs.13455 |
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author | Murray, Sarah R. Juodakis, Julius Bacelis, Jonas Sand, Anna Norman, Jane E. Sengpiel, Verena Jacobsson, Bo |
author_facet | Murray, Sarah R. Juodakis, Julius Bacelis, Jonas Sand, Anna Norman, Jane E. Sengpiel, Verena Jacobsson, Bo |
author_sort | Murray, Sarah R. |
collection | PubMed |
description | INTRODUCTION: Preterm delivery is a major global public health challenge. The objective of this study was to determine how preterm delivery rates differ in a country with a very high human development index and to explore rural vs urban environmental and socioeconomic factors that may be responsible for this variation. MATERIAL AND METHODS: A population‐based study was performed using data from the Swedish Medical Birth Register from 1998 to 2013. Sweden was chosen as a model because of its validated, routinely collected data and availability of individual social data. The total population comprised 1 335 802 singleton births. A multiple linear regression was used to adjust gestational age for known risk factors (maternal smoking, ethnicity, maternal education, maternal age, height, fetal sex, maternal diabetes, maternal hypertension, and parity). A second and a third model were subsequently fitted allowing separate intercepts for each municipality (as fixed or random effects). Adjusted gestational ages were converted to preterm delivery rates and mapped onto maternal residential municipalities. Additionally, the effects of six rural vs urban environmental and socioeconomic factors on gestational age were tested using a simple weighted linear regression. RESULTS: The study population preterm delivery rate was 4.12%. Marked differences from the overall preterm delivery rate were observed (rate estimates ranged from 1.73% to 6.31%). The statistical significance of this heterogeneity across municipalities was confirmed by a chi‐squared test (P < 0.001). Around 20% of the gestational age variance explained by the full model (after adjustment for known variables described above) could be attributed to municipality‐level effects. In addition, gestational age was found to be longer in areas with a higher fraction of built‐upon land and other urban features. CONCLUSIONS: After adjusting for known risk factors, large geographical differences in rates of preterm delivery remain. Additional analyses to look at the effect of environmental and socioeconomic factors on gestational age found an increased gestational age in urban areas. Future research strategies could focus on investigating the urbanity effect to try to explain preterm delivery variation across countries with a very high human development index. |
format | Online Article Text |
id | pubmed-6492021 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-64920212019-05-06 Geographical differences in preterm delivery rates in Sweden: A population‐based cohort study Murray, Sarah R. Juodakis, Julius Bacelis, Jonas Sand, Anna Norman, Jane E. Sengpiel, Verena Jacobsson, Bo Acta Obstet Gynecol Scand Pregnancy INTRODUCTION: Preterm delivery is a major global public health challenge. The objective of this study was to determine how preterm delivery rates differ in a country with a very high human development index and to explore rural vs urban environmental and socioeconomic factors that may be responsible for this variation. MATERIAL AND METHODS: A population‐based study was performed using data from the Swedish Medical Birth Register from 1998 to 2013. Sweden was chosen as a model because of its validated, routinely collected data and availability of individual social data. The total population comprised 1 335 802 singleton births. A multiple linear regression was used to adjust gestational age for known risk factors (maternal smoking, ethnicity, maternal education, maternal age, height, fetal sex, maternal diabetes, maternal hypertension, and parity). A second and a third model were subsequently fitted allowing separate intercepts for each municipality (as fixed or random effects). Adjusted gestational ages were converted to preterm delivery rates and mapped onto maternal residential municipalities. Additionally, the effects of six rural vs urban environmental and socioeconomic factors on gestational age were tested using a simple weighted linear regression. RESULTS: The study population preterm delivery rate was 4.12%. Marked differences from the overall preterm delivery rate were observed (rate estimates ranged from 1.73% to 6.31%). The statistical significance of this heterogeneity across municipalities was confirmed by a chi‐squared test (P < 0.001). Around 20% of the gestational age variance explained by the full model (after adjustment for known variables described above) could be attributed to municipality‐level effects. In addition, gestational age was found to be longer in areas with a higher fraction of built‐upon land and other urban features. CONCLUSIONS: After adjusting for known risk factors, large geographical differences in rates of preterm delivery remain. Additional analyses to look at the effect of environmental and socioeconomic factors on gestational age found an increased gestational age in urban areas. Future research strategies could focus on investigating the urbanity effect to try to explain preterm delivery variation across countries with a very high human development index. John Wiley and Sons Inc. 2018-10-08 2019-01 /pmc/articles/PMC6492021/ /pubmed/30169899 http://dx.doi.org/10.1111/aogs.13455 Text en © 2018 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Pregnancy Murray, Sarah R. Juodakis, Julius Bacelis, Jonas Sand, Anna Norman, Jane E. Sengpiel, Verena Jacobsson, Bo Geographical differences in preterm delivery rates in Sweden: A population‐based cohort study |
title | Geographical differences in preterm delivery rates in Sweden: A population‐based cohort study |
title_full | Geographical differences in preterm delivery rates in Sweden: A population‐based cohort study |
title_fullStr | Geographical differences in preterm delivery rates in Sweden: A population‐based cohort study |
title_full_unstemmed | Geographical differences in preterm delivery rates in Sweden: A population‐based cohort study |
title_short | Geographical differences in preterm delivery rates in Sweden: A population‐based cohort study |
title_sort | geographical differences in preterm delivery rates in sweden: a population‐based cohort study |
topic | Pregnancy |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6492021/ https://www.ncbi.nlm.nih.gov/pubmed/30169899 http://dx.doi.org/10.1111/aogs.13455 |
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