Relationship between Structural and Intermediary Determinants of Health and Preterm Delivery

Dolatian, Mahrokh; Mirabzadeh, Arash; Setareh Forouzan, Ameneh; Sajjadi, Homeira; Alavimajd, Hamid; Mahmoodi, Zohreh; Moafi, Farnoosh

Relationship between Structural and Intermediary Determinants of Health and Preterm Delivery

Authors

Mahrokh Dolatian ¹

Arash Mirabzadeh ²

Ameneh Setareh Forouzan ³

Homeira Sajjadi ¹

Hamid Alavimajd ⁴

Zohreh Mahmoodi ⁵

Farnoosh Moafi ⁶

¹ Social Determinant of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

² Social Determinant of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

³ Social Determinant of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Social Determinant of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran,

⁴ Department of Biostatistics, Faculty of Paramedical, Shahid Beheshti University of Medical Sciences, Tehran, Iran

⁵ Department of Midwifery, Faculty of Nursing and Midwifery, Alborz University of Medical Sciences, Karaj, Iran

⁶ Department of Midwifery, Faculty of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran

Abstract

Background: Preterm birth is a major health problem that leads to infant morbidity and mortality. The main goal of this study was to find the relationship between social determinants of health and preterm delivery. Methods: A prospective longitudinal cohort study was carried out on 500 pregnant women in their 24th to 28th gestational weeks in 2012. The pregnant women filled out a self-report questionnaire on the structural determinant, perceived stress, and perceived social support. The participants were followed up until labor and the data about mother and the newborn were collected after labor. The data were analyzed by SPSS 21 and Lisrel 8.8 software programs using pathway analysis. Results: The final path model fit well (CFI=0.96; RMSEA=0.060). Path analysis showed that among structural factors, income had a direct effect (β=0.06) and the factors of income (β=0.00594), number of children (family size) (β=-0.024), as well as mother’s education (β=-0.0084) had the greatest overall effect on gestational age at birth respectively. Also, the results showed that among intermediate factors of social determinants of health, stress in the direct path (β=-0.12) and among the overall effects, the perceived stress (β=-0.12) and perceived social support (β=0.0396) affected the gestational age at birth. Conclusion: The current study showed that some structural and intermediary determinants such as income and perceived stress had an effect on preterm labor.

Keywords

Intermediary determinants of health

perceived social support

Perceived stress

Structural determinants of health

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