An investigation of social and class differences in very-low birth weight outcomes: a continuing public health concern.
The objective of this study was to examine the relationship of nonmedical factors, including socioeconomic status, social class, education, race, and social support, to low birth weight. In a case-control study of all resident very-low-birth-weight births between December 1, 1989, and March 31, 1991, mothers completed an extensive survey related to their experience of pregnancy, including prenatal and postnatal care. Cases were defined as very-low-birth-weight (VLBW) infants and were matched to moderately-low-birth-weight and normal-birth-weight infants in race, age, and maternal residence. The hypothesis that social and class factors are more predictive of low birth weight than medical factors alone for women without chronic health problems was supported. Although the degree of the association varies depending on birth weight outcome, race even though addressed through matching--continued to play an important role in birth outcomes. A comparison of logistic model performance with and without the inclusion of social factors indicated the importance these variables play in prediction of birth outcomes. This is one of the few studies undertaken that explicitly investigates impact of patient factors on medical care.
Longo
D R
DR
School of Medicine, Family and Community Medicine, University of Missouri-Columbia, USA.
Kruse
R L
RL
LeFevre
M L
ML
Schramm
W F
WF
Stockbauer
J W
JW
Howell
V
V
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D008923:Missouri / Q000208:ethnology; D016017:Odds Ratio; D018743:Perinatal Care / Q000191:economics; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012923:Social Class; D012944:Social Support; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data*