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Abstract
Background Socioeconomic inequalities in health outcomes are dynamic and vary over time. Differences between countries can provide useful insights into the causes of health inequalities. The study aims to compare the associations between two measures of socioeconomic position (SEP)—maternal education and family income—and maternal and infant health outcomes between ALSPAC and Pelotas cohorts.
Methods Birth cohort studies were started in Avon, UK, in 1991 (ALSPAC) and in the city of Pelotas, Brazil, in 1982, 1993 and 2004. Maternal outcomes included smoking during pregnancy, caesarean section and delivery not attended by a doctor. Infant outcomes were preterm birth, intra-uterine growth restriction (IUGR) and breast feeding for <3 months. The relative index of inequality was used for each measure of SEP so that results were comparable between cohorts.
Results An inverse association (higher prevalence among the poorest and less educated) was observed for almost all outcomes, with the exception of caesarean sections where a positive association was found. Stronger income-related inequalities for smoking and education-related inequalities for breast feeding were found in the ALSPAC study. However, greater inequalities in caesarean section and education-related inequalities in preterm birth were observed in the Pelotas cohorts.
Conclusions Mothers and infants have more adverse health outcomes if they are from poorer and less well-educated socioeconomic backgrounds in both Brazil and the UK. However, our findings demonstrate the dynamic nature of the association between SEP and health outcomes. Examining differential socioeconomic patterning of maternal and infant health outcomes might help understanding of mechanisms underlying such inequalities.
- Socioeconomic factors
- health status disparities
- cohort studies
- pregnancy
- infant
- longitudinal studies
- social inequalities
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Footnotes
Funding The 1982 Pelotas Birth Cohort study was financed by the International Development Research Centre, Canada, and the 1993 study was financed by the European Union and the Fundação de Amparo à Pesquisa do Rio Grande do Sul, Brazil. The 2004 Pelotas birth cohort study was financed by the Division of Child and Adolescent Health and Development of WHO, by the ‘Conselho Nacional de Desenvolvimento Científico e Tecnológico’, Brazil, and by the ‘Pastoral da Criança’ (Catholic non-governmental organisation, Curitiba, Brazil).This research was specifically funded by the The Wellcome Trust (Project: ‘Socioenomic & racial/ethnic inequalities in maternal and child health & healthcare in two populations: the Pelotas birth cohorts (1982, 1993 & 2004) & the 1991 ALSPAC cohort’, Wellcome Trust grant N° 082429/Z/07/Z.
Competing interests None.
Ethics approval Ethics approval for the study was obtained from the ALSPAC Law and Ethics Committee and the Local Research Ethics Committees. The study protocol of 1982, 1993 and 2004 Pelotas cohort studies was approved by the Medical Ethics Committee of the Federal University of Pelotas, affiliated with the Brazilian Federal Medical Council.
Provenance and peer review Not commissioned; externally peer reviewed.