Spatial epidemiology of gestational age and birth weight in Switzerland: census-based linkage study.

Skrivankova, Veronika; Zwahlen, Marcel; Adams, Mark; Low, Nicola; Kuehni, Claudia; Egger, Matthias (2019). Spatial epidemiology of gestational age and birth weight in Switzerland: census-based linkage study. BMJ open, 9(10), e027834. BMJ Publishing Group 10.1136/bmjopen-2018-027834

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BACKGROUND Gestational age and birth weight are strong predictors of infant morbidity and mortality. Understanding spatial variation can inform policies to reduce health inequalities. We examined small-area variation in gestational age and birth weight in Switzerland. METHODS All singleton live births recorded in the Swiss Live Birth Register 2011 to 2014 were eligible. We deterministically linked the Live Birth Register with census and survey data to create data sets including neonatal and pregnancy-related variables, parental characteristics and geographical variables. We produced maps of 705 areas and fitted linear mixed-effect models to assess to what extent spatial variation was explained by these variables. RESULTS We analysed all 315 177 eligible live births. Area-level averages of gestational age varied between 272 and 279 days, and between 3138 and 3467 g for birth weight. The fully adjusted models explained 31% and 87% of spatial variation of gestational age and birth weight, respectively. Language region accounted for most of the explained variation (23% in gestational age and 62% in birth weight), with shorter gestational age (-0.6 days and -0.9 days) and lower birth weight (-1.1% and -1.8%) in French-speaking and Italian-speaking areas, respectively, compared with German-speaking areas. Other variables explaining variation were, for gestational age, the level of urbanisation (10%) and parental nationality (3%). For birth weight, they were gestational age (27%), parental nationality (27%), civil status (10%) and altitude (10%). In a random sample of 81 968 live births with data on parental education, levels of education were only weakly associated with gestational age (-0.9 days for compulsory vs tertiary maternal education) or birth weight (-0.7% for compulsory vs tertiary maternal education). CONCLUSIONS In Switzerland, small area variation in birth weight is largely explained, and variation in gestational age partially explained, by geocultural, sociodemographic and pregnancy factors.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Whitesell, Veronika; Zwahlen, Marcel; Low, Nicola; Kühni, Claudia and Egger, Matthias

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

2044-6055

Publisher:

BMJ Publishing Group

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

05 Nov 2019 16:20

Last Modified:

07 Nov 2019 09:55

Publisher DOI:

10.1136/bmjopen-2018-027834

PubMed ID:

31666260

Uncontrolled Keywords:

Switzerland birth weight education gestational age socio-economic position spatial epidemiology

BORIS DOI:

10.7892/boris.134577

URI:

https://boris.unibe.ch/id/eprint/134577

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