Article

Socio-economic differences in maternal and child health are well recognized,
but the role of individual-level and area-level determinants in cerebral palsy
(CP) phenotypes is debated.
We set out to examine
(1) the association between
area-level and individual-level measures of socio-economic deprivation and CP
phenotype among children, including subtype, severity,
and comorbidities ;
and (2) the direct effect of area-level deprivation not mediated through individual-level
deprivation. METHOD: Regional data from a provincial CP register were analyzed.
The outcome of interest was CP phenotype. The area-level exposure was measured
using the Pampalon Deprivation Index. Individual-level socio-economic status
(SES) was determined using maternal education. We conducted multiple regression
models, stratified by preterm birth, controlling for key covariates, and a
mediation analysis of area-level deprivation on the association between
individual SES and CP phenotype. RESULTS: A socio-economic gradient in mobility
was seen in our cohort, above and beyond differences in maternal and perinatal
factors. The added direct effect of area-level deprivation was seen only in
children whose mothers were educated to a higher level, suggesting no additional
contribution of area-level deprivation in children of mothers with a lower level
of education. INTERPRETATION: Contextual socio-economic factors can impact the
severity of CP. These findings indicate important areas for potential
community-level or area-level public health intervention (i.e. neighborhood
reinvestment, preventive measures), and suggest that neighborhood-level research
in maternal and perinatal health should continue to be pursued.
CI - (c) 2015 Mac Keith Press.

Langue : ANGLAIS