家庭经济收入在孕产妇受教育程度与产前检查关系中的中介效应

Mediation effect of family income on the association between maternal education level and antenatal care

目的 探讨家庭经济收入在孕产妇受教育程度与产前检查关系中的中介作用。方法2011年1月随机选取广州市15家计划免疫接种单位,在每家单位随机选择产后1年内并在本市产检分娩的妇女进行面对面问卷调查,调查内容包括人口学特征、产次、产前检查次数等。对调查结果进行描述性分析,对家庭经济收入在受教育程度和产前检查的中介效应进行检验。结果 本次共调查749名孕产妇,平均年龄为（27.5±4.5）岁,受教育程度平均为（11.6±3.4）年,家庭月均收入以3 000∽7 999元为主,占49.1%,产检次数≥4次的占88.9%。控制调查对象的年龄、产次以及配偶有固定工作（半年及以上）后,标化后的受教育年限与家庭月均收入（偏回归系数a=1.105）、产前检查次数达标（偏回归系数c=1.405）均有关联,OR值分别为3.02（95%CI：2.57∽3.55）和4.07（95%CI：2.57∽6.45）。控制家庭月均收入后（偏回归系数b=0.419）,受教育年限对产前检查次数达标的直接效应变小（偏回归系数c＇=1.223,P〈0.01）,家庭月均收入在对受教育程度与产前检查次数达标关系中的部分中介效应比例为27.5%。结论 家庭经济收入在孕产妇受教育程度与产前检查次数达标关系中起部分中介作用,揭示改善产前检查服务利用,应同时考虑受教育程度的直接和间接效应。

Objective To investigate the mediation effect of family income on the relationship be- tween maternal education and frequency of antenatal care visits. Methods Women who had taken antenatal care visits and given birth in the past year in Guangzhou were selected randomly from 15 vaccination clinics in January 2011 for face - to - face questionnaire survey. The survey contents included demographic char- acteristics, times of giving birth, and frequency of antenatal care visits. Results A total of 749 women were recruited. The average age was （ 27.5 ＋ 4.5 ） years. Average education level was （ 11.6 ＋ 3.4 ） years. There was 49.1% respondents had family income of 3 000 -7 999 Yuan and 88. 9% had more than four times of antenatal care visits. Multivariate analysis showed that the standardized years of education was significantly associated with family income （a = 1. 105） and antenatal care（c = 1. 405） ; the adjusted OR were 3.02 （ 95 % CI： 2.57 - 3.55 ） and 4.07 （ 95 % CI：2.57 - 6.45 ）, respectively. After controlling the effect of family income （b = 0. 419）, the effect of standardized years of education on antenatal care was attenuated （ c＇ = 1. 223, P 〈0. 01 ）. There was 27.5% of the effect of maternal education on antenatal care was medicated by family income. Conclusion The association between maternal education and antenatal care was partially mediated by family income, suggesting the importance of direct and indirect effect of ma- ternal educational level on antenatal service utilization.