Article Text
Abstract
Background Real-world evaluations of complex interventions are scarce. We evaluated the effect of the Salut Programme, a universal child health promotion intervention in northern Sweden, on income-related inequalities in positive birth outcomes and healthcare utilisation up to 2 years after delivery.
Methods Using the mother’s place of residence at delivery, the child and the mother were classified as belonging to either the control area (received care-as-usual) or the intervention area (where the intervention was implemented from 2006) and either the premeasure (children born between 2002 and 2004) or the postmeasure (children born between 2006 and 2008) period. Parents’ earned income was used as the socioeconomic ranking variable. The Relative Concentration Index was computed for six binary birth outcome indicators and for inpatient and day patient care for children and their mothers. Changes in inequality over time were compared using a difference-in-difference approach.
Results Income-related inequalities in birth outcomes and child healthcare utilisation were absent, except that full-term pregnancies were concentrated among the poor at premeasure in the intervention area. In contrast, mothers’ healthcare utilisation was significantly pro-poor in the control area. The extent of inequality changed differentially between premeasure and postmeasure for two birth outcomes: full-term pregnancies and infants with normal birth weight. Inequalities in healthcare utilisation did not change significantly in either area over time.
Conclusion In northern Sweden, income-related inequalities in birth outcomes and child healthcare utilisation are largely absent. However, relative inequalities in mothers’ healthcare utilisation are large. We found no evidence that the Salut Programme affected changes in inequality over time.
- public health
- health promotion
- income
- pregnancy outcome
- registries
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
Footnotes
Contributors A−MP-B, ML and IF conceived and designed the work. AI acquired the data as the principal investigator for the Umeå SIMSAM Lab. JH prepared the data for analysis. A−MP-B, ML and JH analysed the data. A−MP-B lead the interpretation of the results and drafting of the manuscript. ML, EE, JH, AI, FS and IF contributed to the interpretation of results and drafting of the manuscript. A−MP-B, AI and IF made substantial critical revisions to the manuscript. All authors approved the final version. A−MP-B is responsible for the overall content as guarantor.
Funding This work was supported by the Swedish Research Council for Health, Working Life and Welfare (FORTE) grant number 2017-00912. The Umeå SIMSAM Lab data infrastructure used in this study was developed with support from the Swedish Research Council and by strategic funds from Umeå University.
Competing interests None declared.
Patient consent for publication The study used register data, and therefore the question of patient consent was not applicable.
Ethics approval The Regional Ethical Review Board in Umeå gave clearance for the Salut Programme research (2010-63-31M) and for the Umeå SIMSAM Lab research (2010-157-31Ö).
Data sharing statement Data may be obtained from a third party and are not publicly available. This study used data from the Umeå SIMSAM Lab. Access is restricted to a secure data Lab, and data cannot be removed from the Lab. Further information about data access is available at: www.simsam.org.umu.se.
Provenance and peer review Not commissioned; externally peer review.ed