title: Patterns of social inequalities across pregnancy and birth outcomes: a comparison of individual and neighborhood socioeconomic measures.
abstract: BACKGROUND
  This paper identifies patterns of health inequalities (consistency and magnitude) of socioeconomic disparities for multiple maternal and child health (MCH) outcomes that represent different health care needs of mothers and infants.
  
  
  METHODS
  Using cross-sectional national data (unweighted sample = 6,421, weighted =76,508) from the Canadian Maternity Experiences Survey linked with 2006 Canadian census data, we categorized 25 health indicators of mothers of singletons into five groups of MCH outcomes (A. maternal and infant health status indicators; B. prenatal care; C. maternal experience of labor and delivery; D. neonatal medical care; and E. postpartum infant care and maternal perceptions of health care services). We then examined the association of these health indicators with individual socioeconomic position (SEP) (education and income), neighborhood SEP and combined SEP (a four-level measure of low and high individual and neighborhood SEP), and compared the magnitude (odds ratios and 95% confidence intervals) and direction of the associations within and between MCH outcome groups.
  
  
  RESULTS
  We observed consistent positive gradients of socioeconomic inequalities within most groups and for 23/25 MCH outcomes. However, more significant associations and stronger gradients were observed for the MCH outcomes in the maternal and infant health status group as opposed to other groups. The neonatal medical care outcomes were weakly associated with SEP. The direction of associations was negative between some SEP measures and HIV testing, timing of the first ultrasound, caesarean section, epidural for vaginal births, infant needing non-routine neonatal care after discharge and any breastfeeding at 3 or 6 months. Gradients were steep for individual SEP but moderate for neighborhood SEP. Combined SEP had no consistent gradients but the subcategory of low individual-high neighborhood SEP often showed the poorest health outcomes compared to the categories within this SEP grouping.
  
  
  CONCLUSIONS
  By examining SEP gradients in multiple MCH outcomes categorized into groups of health care needs, we identified large and consistent inequalities both within and between these groups. Our results suggest differences in pathways and mechanisms contributing to SEP inequalities across groups of MCH outcomes that can be examined in future research and inform prioritization of policies for reducing these inequalities.
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael Hospital, 209 Victoria Street, third floor, Toronto, ON, M5C 1 N8, Canada. daoud@bgu.ac.il.|Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheva, 84015, Israel. daoud@bgu.ac.il.
authors.forename: Nihaya
authors.initials: N
authors.lastname: Daoud
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael Hospital, 209 Victoria Street, third floor, Toronto, ON, M5C 1 N8, Canada. O'CampoP@smh.ca.|Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. O'CampoP@smh.ca.
authors.forename: Patricia
authors.initials: P
authors.lastname: O'Campo
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael Hospital, 209 Victoria Street, third floor, Toronto, ON, M5C 1 N8, Canada. anita.minh@gmail.com.
authors.forename: Anita
authors.initials: A
authors.lastname: Minh
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael Hospital, 209 Victoria Street, third floor, Toronto, ON, M5C 1 N8, Canada. UrquiaM@smh.ca.|Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. UrquiaM@smh.ca.
authors.forename: Marcelo L
authors.initials: ML
authors.lastname: Urquia
authors.affiliation: Maternal and Infant Health Section, Surveillance and Analysis Division, Public Health Agency of Canada, Ottawa, ON, Canada. susie.dzakpasu@phac-aspc.gc.ca.
authors.forename: Susie
authors.initials: S
authors.lastname: Dzakpasu
authors.affiliation: College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada. Maureen.Heaman@umanitoba.ca.
authors.forename: Maureen
authors.initials: M
authors.lastname: Heaman
authors.affiliation: Département de médecine de famille et de médecine d'urgence and CRCHUM, Université de Montréal, Hôtel-Dieu Hospital, Montréal, Québec, Canada. januszk@gmail.com.
authors.forename: Janusz
authors.initials: J
authors.lastname: Kaczorowski
authors.affiliation: Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. clevitt@mcmaster.ca.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Levitt
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael Hospital, 209 Victoria Street, third floor, Toronto, ON, M5C 1 N8, Canada. janet.smylie@utoronto.ca.|Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. janet.smylie@utoronto.ca.|Well Living House Action Research Centre for Indigenous Infant, Child and Family Health and Wellbeing, Saint Michael's Hospital, Toronto, ON, Canada. janet.smylie@utoronto.ca.
authors.forename: Janet
authors.initials: J
authors.lastname: Smylie
authors.affiliation: Department of Obstetrics and Gynaecology, Ottawa Hospital Research Unit, University of Ottawa, Ottawa, Canada. bevchalmers1@gmail.com.
authors.forename: Beverley
authors.initials: B
authors.lastname: Chalmers
mesh_terms: D000328:Adult; D002170:Canada; D003430:Cross-Sectional Studies; D005260:Female; D054624:Health Status Disparities; D006305:Health Status Indicators; D006801:Humans; D000068104:Infant Health; D007231:Infant, Newborn; D000068097:Maternal Health; D008875:Middle Aged; D016017:Odds Ratio; D011181:Postnatal Care / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011295:Prenatal Care / Q000706:statistics & numerical data; D012111:Residence Characteristics; D012923:Social Class; D012959:Socioeconomic Factors; D055815:Young Adult