Ethnic disparities in stillbirth risk in Yunnan, China: a prospective cohort study, 2010-2018.
Ethnic disparities in stillbirth risk in Yunnan, China: a prospective cohort study, 2010-2018.
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中国云南死产风险的种族差异：一项前瞻性队列研究，2010-2018 年。
DOI：
10.1186/s12889-020-10102-y
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发表时间：
2021-01-14
影响因子：
4.5
通讯作者：
Wu Y
中科院分区：
文献类型：
--
作者：
Wu Y;Pan J;Han D;Li L;Wu Y;Liao R;Liu Z;You D;Chen P;Wu Y
在大多数西方国家，死产风险存在种族和族裔差异已有文献记载，但在中国这一情况尚不明确。本研究旨在确定中国大陆死产风险是否存在族裔差异。
妊娠结局和族裔数据来自国家免费孕前健康检查项目（NEPHEP），这是一项于2010年至2018年在中国云南开展的全国性前瞻性人群队列研究。分析中对汉族以及彝族、傣族、苗族、哈尼族这四个主要少数民族进行了调查。通过生命表分析评估死产风险。运用多变量逻辑回归计算中国少数民族的额外死产风险（ESR）。
与其他四个少数民族相比，汉族女性受教育程度往往更高，经产妇较少，从事农业工作的比例较低。研究发现，傣族女性在不同孕周的死产风险模式与其他族群不同，尤其是在孕20 - 23周，傣族女性的死产风险是汉族女性的3.2倍。傣族、哈尼族、苗族和彝族的额外死产风险分别为45.05%、18.70%、 - 4.17%和12.28%。在对产妇年龄、教育程度、生育顺序及其他一般风险因素进行调整后，傣族女性和汉族女性之间的族裔差异依然存在。进一步对早产（孕周<37周）进行调整后，傣族女性的额外死产风险可降低16.91%，且这种差异变得不显著。产妇疾病和先天性异常对族裔差异的解释作用不大。
我们发现傣族女性和汉族女性在死产风险上存在族裔差异。包括社会人口统计学因素和产妇疾病在内的一般风险因素对此解释作用不大。相当一部分族裔差异可归因于早产。
网络版包含补充材料，网址为10.1186/s12889 - 020 - 10102 - y。
BackgroundRacial and ethnic disparities in stillbirth risk had been documented in most western countries, but it remains unknown in China. This study was to determine whether exist ethnic disparities in stillbirth risk in mainland China.MethodsPregnancy outcomes and ethnicity data were obtained from the National Free Preconception Health Examination Project (NEPHEP), a nationwide prospective population-based cohort study conducted in Yunnan China from 2010-2018. The Han majority and other four main minorities including Yi, Dai, Miao, Hani were investigated in the analysis. The stillbirth hazards were estimated by life-table analysis. The excess stillbirth risk (ESR) was computed for Chinese minorities using multivariable logistic regression.ResultsCompared with other four minorities, women in Han majority were more likely to more educated, less multiparous, and less occupied in agriculture. The pattern of stillbirth hazard of Dai women across different gestation intervals were found to be different from other ethnic groups, especially in 20-23 weeks with 3.2 times higher than Han women. The ESR of the Dai, Hani, Miao, and Yi were 45.05, 18.70, -4.17 and 12.28%, respectively. Adjusted for maternal age, education, birth order and other general risk factors, the ethnic disparity still persisted between Dai women and Han women. Adjusted for preterm birth further (gestation age <37 weeks) can reduce 16.91% ESR of Dai women and made the disparity insignificant. Maternal diseases and congenital anomalies explained little for ethnic disparities.ConclusionsWe identified the ethnic disparity in stillbirth risk between Dai women and Han women. General risk factors including sociodemographic factors and maternal diseases explained little. Considerable ethnic disparities can be attributed to preterm birth.
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