{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T16:50:43Z","timestamp":1771692643260,"version":"3.50.1"},"reference-count":52,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T00:00:00Z","timestamp":1627516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nObjective<\/jats:title>\nTo examine socioeconomic inequalities in birth outcomes among infants born between 2008 and 2018 and assessed trends in inequalities during that period in Colombia, a middle-income country with high levels of inequality emerging from a long internal armed conflict.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nUsing birth certificate data in Colombia, we analysed the outcomes of low birth weight, an Apgar score <7 at 5 minutes after birth and the number of prenatal visits among full-term pregnancies. Maternal education and health insurance schemes were used as socioeconomic position (SEP) indicators. Inequalities were estimated using the prevalence\/mean of the outcomes across categories of the SEP indicators and calculating the relative and slope indices of inequality (RII and SII, respectively).<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nAmong the 5,433,265 full-term singleton births analysed, there was a slight improvement in the outcomes analysed over the study period (lower low-birth-weight and Apgar<7 prevalence rates and higher number of prenatal visits). We observed a general pattern of social gradients and significant relative (RII) and absolute (SII) inequalities for all outcomes across both SEP indicators. RII and SII estimates with their corresponding CIs revealed a general picture of no significant changes in inequalities over time, with some particular, time-dependent exceptions. When comparing the initial and final years of our study period, inequalities in low birth weight related to maternal education increased while those in Apgar score <7 decreased. Relative inequalities across health insurance schemes increased for the two birth outcomes but decreased for the number of prenatal visits.<\/jats:p>\n<\/jats:sec>\n\nConclusion<\/jats:title>\nThe lack of a consistent improvement in the magnitude of inequalities in birth outcomes over an 11-year period is a worrying issue because it could aggravate the cycle of inequality, given the influence of birth outcomes on health, social and economic outcomes throughout the life course. The findings of our analysis emphasize the importance of policies aimed at providing access to quality education and providing a health care system with universal coverage and high levels of integration.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0255150","type":"journal-article","created":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T18:26:47Z","timestamp":1627583207000},"page":"e0255150","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Socioeconomic inequalities in birth outcomes: An 11-year analysis in Colombia"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8781-2671","authenticated-orcid":true,"given":"Carol C.","family":"Guarnizo-Herre\u00f1o","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel","family":"Torres","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7466-8244","authenticated-orcid":true,"given":"Giancarlo","family":"Buitrago","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,7,29]]},"reference":[{"issue":"1","key":"pone.0255150.ref001","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1056\/NEJMra0708473","article-title":"Effect of in utero and early-life conditions on adult health and disease","volume":"359","author":"PD Gluckman","year":"2008","journal-title":"N Engl J Med"},{"issue":"3","key":"pone.0255150.ref002","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1093\/ije\/dyi048","article-title":"Size at birth as a predictor of mortality in adulthood: a follow-up of 350 000 person-years","volume":"34","author":"E Kajantie","year":"2005","journal-title":"Int J Epidemiol"},{"issue":"6","key":"pone.0255150.ref003","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1093\/ije\/31.6.1235","article-title":"Fetal origins of adult disease: Strength of effects and biological basis","volume":"31","author":"DJP Barker","year":"2002","journal-title":"Int J Epidemiol"},{"issue":"8","key":"pone.0255150.ref004","doi-asserted-by":"crossref","first-page":"574","DOI":"10.2471\/BLT.16.180273","article-title":"A cohort study of low birth weight and health outcomes in the first year of life, Ghana","volume":"95","author":"M O\u2019Leary","year":"2017","journal-title":"Bull World Health Organ"},{"issue":"6","key":"pone.0255150.ref005","doi-asserted-by":"crossref","first-page":"e1498","DOI":"10.1542\/peds.2010-3604","article-title":"Long-term impact of poor birth condition on social and economic outcomes in early adulthood","volume":"127","author":"DE Odd","year":"2011","journal-title":"Pediatrics"},{"issue":"8","key":"pone.0255150.ref006","doi-asserted-by":"crossref","first-page":"605","DOI":"10.2471\/BLT.13.127464","article-title":"A prospective study of maternal, fetal and neonatal deaths in low- and middle-income countries","volume":"92","author":"S Saleem","year":"2014","journal-title":"Bull World Health Organ"},{"issue":"6","key":"pone.0255150.ref007","doi-asserted-by":"crossref","first-page":"2296","DOI":"10.3390\/ijerph10062296","article-title":"The social determinants of infant mortality and birth outcomes in Western developed nations: a cross-country systematic review","volume":"10","author":"D Kim","year":"2013","journal-title":"Int J Environ Res Public Health"},{"issue":"7","key":"pone.0255150.ref008","doi-asserted-by":"crossref","first-page":"e849","DOI":"10.1016\/S2214-109X(18)30565-5","article-title":"National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: a systematic analysis","volume":"7","author":"H Blencowe","year":"2019","journal-title":"Lancet Glob Health"},{"issue":"9890","key":"pone.0255150.ref009","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/S0140-6736(13)60993-9","article-title":"Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis","volume":"382","author":"J Katz","year":"2013","journal-title":"Lancet"},{"issue":"3","key":"pone.0255150.ref010","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.amepre.2010.05.012","article-title":"Socioeconomic disparities in adverse birth outcomes: a systematic review","volume":"39","author":"P Blumenshine","year":"2010","journal-title":"Am J Prev Med"},{"issue":"1","key":"pone.0255150.ref011","doi-asserted-by":"crossref","first-page":"e002229","DOI":"10.1136\/bmjgh-2019-002229","article-title":"Are the poorest poor being left behind? 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