BACKGROUND: Data on the health status of the Roma people in Central and Eastern Europe are sparse and the reasons for their poor health are not clear. The objective of this study was to quantify the differences in birth outcomes between Roma and non-Roma mothers in the Czech Republic and to investigate the potential causes of such differences. METHOD: A population-based study recruited 8938 non-Roma and 1388 Roma hospitalised singleton births that occurred in two Czech districts (Teplice and Prachatice) between 1995 and 2004. During their stay in hospital, mothers completed a questionnaire on their demographic and socioeconomic characteristics and maternal smoking and alcohol consumption. Data on maternal height and weight and on infants' birth weight and gestational age were taken from hospital records. RESULTS: Birth weight and gestational age of Roma infants was 373 (SE 15) g and 0.92 (0.05) weeks, respectively, lower than in non-Roma infants. Controlling for demographic, socioeconomic and behavioural factors reduced these differences to 133 (18) g and 0.57 (0.06) weeks, respectively (all p-values < 0.001). In terms of binary outcomes, the Roma vs. non-Roma odds ratios were 4.5 (95% CI 3.7-5.4) for low birth weight (< 2500 g), 2.8 (2.2-3.4) for preterm birth (< 37 weeks of gestation), and 2.9 (2.5-3.4) for intrauterine grown retardation (<10th percentile of birth weight for gestational age); controlling for all covariates reduced these odds ratios to 1.7 (1.3-2.2), 1.5 (1.1-2.0) and 1.3 (1.0-1.6), respectively. Maternal education made the largest contribution to the ethnic differences; the role of health behaviours was relatively modest. CONCLUSION: There are striking differences in birth outcomes between Roma and non-Roma mothers. The causes of these differences are complex but largely socioeconomic.

• MeSH
• White People statistics & numerical data   MeSH
• Adult MeSH
• Gestational Age MeSH
• Hospitalization MeSH
• Humans MeSH
• Adolescent MeSH
• Multivariate Analysis MeSH
• Infant, Newborn MeSH
• Odds Ratio MeSH
• Birth Weight MeSH
• Regression Analysis MeSH
• Risk Factors MeSH
• Roma statistics & numerical data   MeSH
• Socioeconomic Factors MeSH
• Educational Status MeSH
• Pregnancy MeSH
• Maternal Age MeSH
• Pregnancy Outcome ethnology   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Adolescent MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH
• Geographicals
• Czech Republic epidemiology   MeSH

OBJECTIVES: Infant and childhood mortality from injuries in Central and Eastern Europe is high but little is known about its determinants. This study examined whether maternal socioeconomic characteristics predict infant mortality from injuries in the Czech Republic. METHODS: Data on all live births registered in the Czech Republic 1989-91 (n=387 496) were linked with the national death register, 1989-92, using the unique national identification number. Effects of maternal socioeconomic characteristics, birth weight and gestational age, recorded in the birth register, on the risk of death from external causes (ICD-9 800-999) were estimated using logistic regression. RESULTS: Of the 195 linked infant deaths from external causes (rate 50/100000 live births), 73% were from suffocation. After controlling for other factors, the risk of death was higher in boys, declined with increasing maternal education (odds ratio for primary v university education 3.5, 95% confidence interval 1.5 to 8.6), maternal age, birth weight and gestational age, and was increased in infants of unmarried mothers and of mothers with higher parity. The effect of education appeared stronger in married mothers and in mothers of low parity. CONCLUSION: The risk of infant death from external causes in this population was strongly associated with maternal and family characteristics.

• MeSH
• Gestational Age MeSH
• Cohort Studies MeSH
• Infant MeSH
• Infant Mortality * trends   MeSH
• Humans MeSH
• Logistic Models MeSH
• Marital Status statistics & numerical data   MeSH
• Mothers * psychology   MeSH
• Infant, Newborn MeSH
• Parity MeSH
• Birth Weight MeSH
• Predictive Value of Tests MeSH
• Cause of Death MeSH
• Wounds and Injuries etiology   mortality   prevention & control   MeSH
• Registries MeSH
• Risk Factors MeSH
• Birth Certificates MeSH
• Sex Distribution MeSH
• Socioeconomic Factors MeSH
• Educational Status MeSH
• Population Surveillance MeSH
• Death Certificates MeSH
• Maternal Age MeSH
• Check Tag
• Infant MeSH
• Humans MeSH
• Male MeSH
• Infant, Newborn MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic epidemiology   MeSH

AIMS: To investigate the effects of parental smoking, socioeconomic characteristics, and indoor environment on the risk of invasive meningococcal disease in children. METHODS: Population based case-control study. A total of 68 incident cases of invasive meningococcal disease in children less than 15 years old were compared with 135 controls selected from the same school and matched for year of birth, sex, and place of residence. Information on exposures was obtained in interviews with parents. RESULTS: Invasive meningococcal disease was strongly associated with parental smoking; rate ratios adjusted for socioeconomic factors were 3.5 (95% confidence interval 1.4-8.7) for smoking of mother, 3.2 (1.5-6.9) for smoking of father, and 2.7 (1.3-5.4) for every 20 cigarettes smoked at home on an average day. The risk of the disease was strongly inversely related to maternal education and, less strongly, to ownership of a car and of a weekend house, father's education, crowding, and the number of siblings, but these associations were reduced or eliminated in multivariate models. The type of heating and cooking (used as proxies for indoor air pollution) were not associated with the disease. CONCLUSION: The risk of invasive meningococcal disease in children is strongly influenced by parental smoking and unfavourable socioeconomic circumstances.

• MeSH
• Family Characteristics MeSH
• Child MeSH
• Confidence Intervals MeSH
• Infant MeSH
• Humans MeSH
• Meningococcal Infections etiology   MeSH
• Adolescent MeSH
• Multivariate Analysis MeSH
• Crowding MeSH
• Infant, Newborn MeSH
• Child, Preschool MeSH
• Risk Factors MeSH
• Parents MeSH
• Socioeconomic Factors MeSH
• Case-Control Studies MeSH
• Educational Status MeSH
• Tobacco Smoke Pollution adverse effects   MeSH
• Check Tag
• Child MeSH
• Infant MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Infant, Newborn MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Names of Substances
• Tobacco Smoke Pollution MeSH

This study tested the hypothesis, suggested by several recent reports, that air pollution may increase the risk of adverse birth outcomes. This study analyzed all singleton live births registered by the Czech national birth register in 1991 in 67 districts where at least one pollutant was monitored in 1990-1991 (n = 108,173). Maternal exposures to sulfur dioxide (SO(2)), total suspended particles (TSP), and nitrous oxides (NO(x)) in each trimester of pregnancy were estimated as the arithmetic means of all daily measurements taken by all monitors in the district of birth of each infant. Odds ratios of low birth weight (< 2,500 g), prematurity (< 37 weeks of gestation), and intrauterine growth retardation (IUGR; < 10th percentile of birth weight for gestational age and sex) were estimated by robust logistic regression. The median (and 25th and 75th percentile) trimester exposures were 32 (18, 56) microg/m(3) for SO(2); 72 (55, 87) microg/m(3) for TSP; and 38 (23, 59) microg/m(3) for NO(x). Low birth weight (prevalence 5.2%) and prematurity (prevalence 4.8%) were associated with SO(2) and somewhat less strongly with TSP. IUGR was not associated with any pollutant. The effects on low birth weight and prematurity were marginally stronger for exposures in the first trimester, and were not attenuated at all by adjustment for socioeconomic factors or the month of birth. Adjusted odds ratios of low birth weight were 1.20 [95% confidence interval (CI), 1.11-1.30] and 1.15 (CI, 1.07-1.24) for a 50 microg/m(3) increase in SO(2) and TSP, respectively, in the first trimester; adjusted odds ratios of prematurity were 1.27 (CI, 1.16-1.39) and 1.18 (CI, 1.05-1.31) for a 50 microg/m(3) increase in SO(2) and TSP, respectively, in the first trimester. Low gestational age accounted for the association between SO(2) and low birth weight. These findings provide further support for the hypothesis that air pollution can affect the outcome of pregnancy.

• MeSH
• Air Pollutants MeSH
• Humans MeSH
• Maternal Exposure * MeSH
• Infant, Premature * MeSH
• Infant, Low Birth Weight * MeSH
• Infant, Newborn MeSH
• Nitrous Oxide MeSH
• Sulfur Dioxide MeSH
• Obstetric Labor, Premature epidemiology   MeSH
• Fetal Growth Retardation epidemiology   MeSH
• Pregnancy MeSH
• Pregnancy Trimesters MeSH
• Pregnancy Outcome * epidemiology   MeSH
• Air Pollution * MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic epidemiology   MeSH
• Names of Substances
• Air Pollutants MeSH
• Nitrous Oxide MeSH
• Sulfur Dioxide MeSH

OBJECTIVES: This study investigated social variation in birth outcome in the Czech Republic after the political changes of 1989. METHODS: Routinely collected records on singleton live births in 1989, 1990, and 1991 (n = 380,633) and 1994, 1995, and 1996 (n = 286,907) were individually linked to death records. RESULTS: Mean birthweight fell from 3,323 g to 3,292 g (P < .001) between 1989 and 1991 and then increased to 3,353 g by 1996. The gap in mean birthweight between mothers with a primary education and those with a university education, adjusted for age, parity, and sex of infants, widened from 182 g (95% confidence interval [CI] = 169, 19) in 1989 to 256 g (95% CI = 240, 272) in 1996. Similar trends were found for preterm births. Postneonatal mortality declined most among the better educated and the married. The odds ratio for postneonatal death for infants of mothers with a primary (vs university) education, adjusted for birthweight, increased from 1.99 (95% CI = 1.52, 2.60) in 1989 through 1991 to 2.39 (95% CI = 1.55, 3.70) in 1994 through 1995. CONCLUSIONS: Despite general improvement in the indices of fetal growth and infant survival in the most recent years, social variation in birth outcome in the Czech Republic has increased.

• MeSH
• Adult MeSH
• Fertility MeSH
• Infant Mortality trends   MeSH
• Humans MeSH
• Marital Status MeSH
• Infant, Newborn MeSH
• Odds Ratio MeSH
• Birth Weight * MeSH
• Reproducibility of Results MeSH
• Data Collection MeSH
• Social Class MeSH
• Educational Status MeSH
• Population Surveillance MeSH
• Pregnancy MeSH
• Pregnancy Outcome epidemiology   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Czech Republic epidemiology   MeSH