不同受教育程度早产妇女产前保健利用的公平状况及其变化

Extent and relative changes of equities in using the prenatal care services among premature delivery women with different educational levels

目的 了解早产妇女产前保健利用的公平性及其变化.方法 研究对象为1995-2000年江苏省和浙江省4县（市）分娩孕满28～41周的单胎活产儿的97 537名妇女,根据受教育程度,分别将早产妇女（4994名）和对照妇女即足月产妇女（92 543名）进行分组后,考察其孕早期检查率、产前检查次数达标率、住院分娩率及其率差（RD）、率比（RR）和集中指数（CI）,分析早产妇女的产前保健利用的不公平程度,采用单因素方差分析和x2检验法进行统计学检验.结果 不同教育程度早产妇女孕早期检查率低于足月产妇女（从小学、初中、高中到大学的孕早期检查率早产组分别为82.89%、91.06%、93.96%、93.11%;足月产组分别是86.36%、93.95%、95.65%、96.41%,P=0.008）.教育程度高的妇女孕早期检查率高于教育程度低的妇女（早产组RD=-10.22,RR=0.89,CI=0.0131;足月产组RD=-10.05,RR=0.90,CI=0.0104）;不同教育程度早产妇女产前检查次数达标率低于足月产妇女（从小学、初中、高中到大学的早产组分别为86.54%、93.17%、92.99%、96.49%;足月产组分别是94.60%、96.65%、96.15%、96.66%,P=0.005）.教育程度越高,产前检查次数达标率越高（早产组RD=-9.95,RR=0.90,CI=0.0077;足月产组RD=-2.06,RR=0.98,CI=0.0006）;住院分娩率在不同教育程度早产组与足月产组妇女之间存在差异（从小学、初中、高中到大学的早产组分别为98.42%、99.54%、99.61%、100.00%;足月产组分别是99.45%、99.75%、99.83%、99.77%,P=0.005）.无论早产组还是足月产组其教育程度较高的妇女住院分娩率也较高（早产组RD=-1.58,CI=0.0013;足月产组RD=-0.32,CI=0.0003）.结论 不同教育程度早产妇女在产前保健利用方面存在不公平.同等教育程度比较,足月产妇女的公平性要好于早产妇女.

Objective To understand the extent and relative changes of equities in using the prenatal care services among premature delivery women from 4 counties/cities in Jiangsu and Zhejiang provinces, from 1995 to 2000. Methods The study population consisted of 97 537women who delivered singleton live birth of 28 to 41 gestational weeks in 4 counties/cities of Jiangsu and Zhejiang provinces, from 1995 to 2000. The proportions of women with early prenatal visit, of those with at least five prenatal visits and the hospital delivery rates between premature and term delivery groups were calculated. Inequalities in the above indictors by comparing rate difference （ RD）, rate ratio （ RR ） and concentration index （ CI ） among women with different educational levels,were examined. Chi-square and One-way ANOVA were used to compare the differences. Results The proportions of having received early prenatal among those women with premature delivery in different education levels were 82.89%, 91.06%, 93.96%, 93.11% respectively, which were less than that of those with full term delivery （86.36%, 93.95%, 95.65%, 96.41%, P=0.008）. The proportions of having received early prenatal among the women with high educational levels were higher （RD=-10.05, RR=0.90, CI=0.0104） than those with low educational attainment （RD=-10.22, RR=0.89, CI=0.0131）; The proportions of having received at least five prenatal visits among those women with premature delivery in different education levels were 86.54%, 93.17%, 92.99%, 96.49%,respectively, which were less than those with full term delivery （94.60%, 96.65%, 96.15%, 96.66%,P=0.005）. The proportions of having had at least five prenatal visits among the women with high educational attainment were higher （RD=-2.06, RR=0.98, CI=0.0006） than those with lower educational attainment （RD=-9.95, RR=0.90, CI=0.0077）; The proportions of hospital delivery among the women with full term delivery in different education levels were significantly higher （99.45%, 99.75%, 99.83%, 99.77% ） than those with premature deliveries （98.42%, 99.54%, 99.61%,100.00%, P=0.005）. The proportions of hospital delivery among women with high educational attainment was higher （RD =-0.32, CI= 0.0003 ） than those with lower educational attainment （ RD =-1.58, CI=0.0013）. Conclusion Education related inequities in prenatal care utilization had not been improved among the Chinese women under our study. Inequities were seen in those women with full-term delivery the preterm delivery ones.