Asunto(s)

Ambiente , Disparidades en el Estado de Salud , Sociología Médica , Niño , Protección a la Infancia , Femenino , Accesibilidad a los Servicios de Salud , Indicadores de Salud , Humanos , Esperanza de Vida/tendencias , Masculino , Factores Socioeconómicos , Estados Unidos

RESUMEN

The Robert Wood Johnson Foundation Commission to Build a Healthier America was charged to identify strategies beyond medical care to address health disparities in the U.S. related to social and economic disadvantage. Based on insights gained while providing scientific support for the commission's efforts, this paper presents an overview of major issues that arise when assessing evidence to inform policies and programs to address the social determinants of health. While many of the insights are not new, they have not been widely assimilated within medicine and public health. They have particular relevance now, given growing awareness of the important health influences of social factors. The discussion presented here is intended to highlight key considerations for researchers who study social determinants of health and policymakers whose decisions are shaped by research findings. Policies should be based on the best available knowledge, derived from diverse sources and methods. An array of tools and guidelines is now available to guide the assessment of evidence on the social determinants of health, building on--and going beyond--principles first articulated in the "Evidence-Based Medicine" movement. The central thesis of the current paper is that the standards for evidence to guide social policies must be equally rigorous but also more comprehensive than those traditionally used to inform clinical interventions, because social policies must deal with upstream factors that affect health through complex causal pathways over potentially long time periods.

Asunto(s)

Medicina Basada en la Evidencia/normas , Política de Salud , Disparidades en el Estado de Salud , Sociología Médica , Humanos , Factores Socioeconómicos , Estados Unidos

RESUMEN

To explore the association between paternal education and preterm birth, taking into account maternal social and economic factors. We analyzed data from a population-based cross-sectional postpartum survey, linked with birth certificates, of women who gave birth in California from 1999 through 2005 (n = 21,712). Women whose infants' fathers had not completed college had significantly higher odds of preterm birth than women whose infants' fathers were college graduates, even after adjusting for maternal education and family income [OR (95% CI) = 1.26 (1.01-1.58)]. The effect of paternal education was greater among unmarried women than among married women. Paternal education may represent an important indicator of risk for preterm birth, reflecting social and/or economic factors not measured by maternal education or family income. Researchers and policy makers committed to understanding and reducing socioeconomic disparities in birth outcomes should consider paternal as well as maternal socioeconomic factors in their analyses and policy decisions.

Asunto(s)

Escolaridad , Padre , Nacimiento Prematuro , Adolescente , Adulto , Certificado de Nacimiento , California/epidemiología , Estudios Transversales , Femenino , Humanos , Renta , Recién Nacido , Masculino , Madres , Vigilancia de la Población , Embarazo , Factores de Riesgo , Adulto Joven

RESUMEN

OBJECTIVE: To examine early postnatal care among healthy newborns during 2000 in 19 states. METHODS: Using data from the Pregnancy Risk Assessment Monitoring System, a multistate population-based postpartum survey of women, we calculated prevalences of early discharge (ED; stays of < or =2 days after vaginal delivery and < or =4 days after Cesarean delivery) and early follow-up (within 1 week) after ED. We used logistic regression to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) describing how ED and lack of early follow-up were associated with state legislation and maternal characteristics. RESULTS: While most healthy term newborns (83.5-93.4%) were discharged early, and most early-discharged newborns (51.5-88.5%) received recommended early follow-up, substantial proportions of early-discharged newborns did not. Compared with newborns in states where legislation covered both length of hospital stay (LOS) and follow-up, newborns in states without such legislation were more likely to have ED (aOR: 1.25; CI: 1.01-1.56). Lack of early follow-up was more likely among newborns in states with neither LOS nor follow-up legislation (aOR: 2.70, CI: 2.32-3.14), and only LOS legislation (aOR: 1.38, CI: 1.22-1.56) compared with those in states with legislation for both. ED was more likely among newborns born to multiparous women and those delivered by Cesarean section and less likely among those born to black and Hispanic mothers and mothers with less education. CONCLUSIONS: Lack of early follow-up among ED newborns remains a problem, particularly in states without relevant legislation. These findings indicate the need for continued monitoring and for programmatic and policy strategies to improve receipt of recommended care.

Asunto(s)

Atención Posnatal , Adulto , Femenino , Encuestas Epidemiológicas , Humanos , Recién Nacido , Tiempo de Internación , Alta del Paciente/legislación & jurisprudencia , Medición de Riesgo/métodos , Gobierno Estatal , Estados Unidos

RESUMEN

OBJECTIVE: We explored methods and potential applications of a systematic approach to studying and monitoring social disparities in health and health care. METHODS: Using delayed or no prenatal care as an example indicator, we (1) categorized women into groups with different levels of underlying social advantage; (2) described and graphically displayed rates of the indicator and relative group size for each social group; (3) identified and measured disparities, calculating relative risks and rate differences to compare each group with its a priori most-advantaged counterpart; (4) examined changes in rates and disparities over time; and (5) conducted multivariate analyses for the overall sample and "at-risk" groups to identify particular factors warranting attention. RESULTS: We identified at-risk groups and relevant factors and suggest ways to direct efforts for reducing prenatal care disparities. CONCLUSIONS: This systematic approach should be useful for studying and monitoring disparities in other indicators of health and health care.

Asunto(s)

Investigación sobre Servicios de Salud , Atención Prenatal , Calidad de la Atención de Salud , California , Estudios Transversales , Etnicidad , Femenino , Humanos , Embarazo , Grupos Raciales , Factores Socioeconómicos

RESUMEN

CONTEXT: Responding to safety concerns, federal and state legislation mandated coverage of minimum postnatal stays and state legislation in California mandated coverage of follow-up after early discharge. Little is known about the postnatal services newborns are receiving. OBJECTIVE: To describe rates of early discharge and of timely follow-up for early-discharged newborns. DESIGN AND SETTING: Retrospective, population-based cohort study using a 1999 postpartum survey in California. PARTICIPANTS: A total of 2828 infants of mothers with medically low-risk singleton births. MAIN OUTCOME MEASURES: Rates of early discharge (

Asunto(s)

Prestación Integrada de Atención de Salud/normas , Prestación Integrada de Atención de Salud/tendencias , Directrices para la Planificación en Salud , Alta del Paciente/normas , Alta del Paciente/tendencias , Vigilancia de la Población/métodos , Adolescente , Adulto , California , Cesárea/estadística & datos numéricos , Cesárea/tendencias , Estudios de Cohortes , Prestación Integrada de Atención de Salud/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Encuestas de Atención de la Salud/estadística & datos numéricos , Visita Domiciliaria/estadística & datos numéricos , Visita Domiciliaria/tendencias , Humanos , Recién Nacido , Tiempo de Internación/estadística & datos numéricos , Tiempo de Internación/tendencias , Alta del Paciente/estadística & datos numéricos , Atención Posnatal/normas , Atención Posnatal/estadística & datos numéricos , Atención Posnatal/tendencias , Valor Predictivo de las Pruebas , Embarazo , Estudios Retrospectivos , Factores Socioeconómicos