Abstract
Objectives: The objective of this study was to describe whether the social environment of the territory of residence is associated with indicators of fœtal growth retardation.
Methods: All newborns (n=667,254) from 143 Centres locaux de services communautaires (CLSC) territories of Quebec, Canada, 2000–2008 were included in this study. Small for gestational age (SGA), very small for gestational age (VSGA) and SGA-preterm births were identified. Social characteristics and access to medical services of the population in the CLSCs were obtained from the Canadian Community Health Survey. Data on material deprivation, racial diversity and social isolation were obtained from the 2001 and 2006 Canadian censuses. A compromise between two methods, stepwise and best subset, was used to select variables for multivariate logistic modelling. The model was fitted on each studied outcome: SGA, VSGA and SGA among preterm births.
Results: When investigating material deprivation, racial diversity, social isolation, proportion of sedentary residents and proportion with fair or poor availability of health care services in the CLSC territories, material deprivation, racial diversity, social isolation and sedentary residents showed increased adjusted risk of SGA. Results of the model fit on VSGA birth and on SGA among preterm births were similar.
Conclusion: CLSC characteristics of material deprivation, racial diversity, social isolation as well as the contextual variable of sedentary lifestyle were associated with indicators of foetal growth retardation. Further work on features of the CLSCs could help understand how the outcome of SGA is associated with contextual factors and identify groups for intervention.
Keywords: Small for gestational age, fetal growth retardation, social environment, health behaviour, health surveys, logistic models
Résumé
Objectifs: L’objectif de cette étude était d’investiguer si l’environnement social délimité par le territoire de résidence est associé avec des indicateurs de retard de croissance fœtale.
Méthodes: Les nouveau-nés de 143 Centres locaux de services communautaires (CLSC) du Québec, Canada en 2000–2008 (n=667 254) ont été inclus. Les naissances de faible et de très faible poids pour leur âge gestationnel (SGA et VSGA) et les naissances prématurées ont été identifiées. Des caractéristiques de l’environnement social et d’accès aux services de santé sur les territoires de CLSC ont été obtenues à partir de l’Enquête sur la santé dans les collectivités canadiennes. Celles de défavorisation matérielle, d’isolement social et de diversité raciale ont été obtenues à partir des recensements canadiens de 2001 et 2006. Un compromis entre deux méthodes de sélection de variables, les méthodes pas-à-pas et du meilleur sous-ensemble, a été utilisé pour bâtir un modèle de régression logistique multivarié. Ce dernier a été ajusté sur le SGA, le VSGA et le SGA parmi les naissances prématurées.
Résultats: Lors de l’examen des variables du contexte matériel, social et racial ainsi que celles de sédentarité et d’accès aux services, les CLSC ayant une importante défavorisation matérielle, un important isolement social, une importante diversité raciale et ceux ayant une importante part de résidents sédentaires présentaient un risque ajusté de SGA accru. Les résultats sur le VSGA et sur le SGA parmi les naissances prématurées étaient similaires.
Conclusion: Les caractéristiques contextuelles de défavorisation matérielle, d’isolement social, de diversité raciale et de sédentarité ont été associées à des indicateurs de retard de croissance fœtale. Des travaux complémentaires sur les caractéristiques des CLSC pourraient aider à clarifier la façon dont le SGA est associé au contexte et à cibler des groupes prioritaires pour l’intervention.
Mots clés: faible poids pour l’âge gestationnel, retard de croissance fœtale, environnement social, comportements favorisant la santé, enquête sur la santé, modèle de régression logistique
Footnotes
Conflict of Interest: None to declare.
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