Differences in neonatal and postneonatal mortality by race, birth weight, and gestational age.
Differences in neonatal and postneonatal mortality by race, birth weight, and gestational age.
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不同种族、出生体重和胎龄的新生儿和新生儿后死亡率存在差异。
DOI：
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发表时间：
1987
期刊：
影响因子：
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通讯作者：
J. Smith
中科院分区：
文献类型：
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作者：
W. Sappenfield;J. Buehler;N. Binkin;C. Hogue;L. Strauss;J. Smith
近几十年来，美国新生儿和新生儿后期死亡率总体上有所下降。然而，黑人婴儿的死亡率仍然大约是白色婴儿的两倍。利用参加1980年全国婴儿死亡率监测项目的53个生命统计报告地区中的45个地区的数据，我们扩展了以前的国家分析，以描述全国范围内黑人和白色婴儿根据胎龄和出生体重的新生儿和新生儿后死亡风险的差异。在将我们的分析限制在胎龄为26周或以上且出生体重为500克或以上的已知和合理组合的单次分娩婴儿之后，新生儿死亡风险（NMR）-即每1,000名活产婴儿死亡不到28天的婴儿数量-黑人婴儿的NMR比白人高1.6倍。这种差异主要由两个发现来解释：第一，虽然对于胎龄小于38周、出生体重小于3,000克的婴儿，黑人的核磁共振值低于白色婴儿，但黑人中这类婴儿的比例更高，这一优势远远超过了这一优势，大约占黑人和白人之间核磁共振值总体差异的三分之二。第二，剩余的NMR差异大部分是由于胎龄为38周或更长时间、出生体重为3,000 g或更高的黑人婴儿的NMR较高。对出生体重和胎龄的任何组合的最低死亡风险的比较显示，黑色NMR比白色NMR高1.89倍。新生儿后期死亡风险-新生儿后期死亡风险等于每1 000名新生儿存活者中28天至不足1岁的婴儿死亡人数-黑人婴儿的死亡风险是白色婴儿死亡风险的2.09倍。在几乎所有的出生体重和胎龄组合中，黑人婴儿的PNMR均高于白色婴儿。胎龄在38周或以上、出生体重在2,500克或以上的婴儿的PNMR较高，占黑人婴儿和白色婴儿PNMR差异的43%。消除美国黑人与白人婴儿死亡率的差异不仅需要降低黑人婴儿中早产和低出生体重的频率，而且还需要提高出生体重正常的足月黑人婴儿的新生儿和新生儿后期的存活率。
In recent decades, neonatal and postneonatal mortality rates have declined overall in the United States. Yet, the mortality rates for black infants continue to be approximately twice those for white infants. With the use of data from 45 of the 53 vital statistics reporting areas that participated in the 1980 National Infant Mortality Surveillance project, we extended previous State analyses to describe differences, nationally, in neonatal and postneonatal mortality risks for black and white infants according to gestational age and birth weight. After restricting our analysis to single-delivery infants with known and plausible combinations of gestational age of 26 or more weeks and birth weights of 500 grams (g) or more, the neonatal mortality risk (NMR)--that is, the number of deaths to infants less than 28 days of life per 1,000 live births--for black infants was 1.6 times higher than the NMR for whites. This difference was largely explained by two findings: First, although the NMR was lower for black than for white infants with gestational ages of less than 38 weeks and birth weights less than 3,000 g, that advantage was heavily outweighed by the higher percentage of such births among blacks, accounting for roughly two-thirds of the overall difference in NMR between blacks and whites. Second, most of the remaining difference in NMR was accounted for by higher NMRs among black infants with gestational ages of 38 or more weeks and birth weights of 3,000 g or more. A comparison of the lowest mortality risk for any combination of birth weight and gestational age showed that the black NMR was 1.89 times higher than the white NMR. The postneonatal mortality risk (PNMR)--PNMR equals the number of deaths to infants 28 days to less than 1 year of life per 1,000 neonatal survivors--for black infants was 2.09 times the PNMR for white infants. Black infants had higher PNMRs than white infants for nearly all combinations of birth weight and gestational age. Higher PNMRs among infants with gestational ages of 38 or more weeks and birth weights of 2,500 g or more accounted for 43 percent of the difference in PNMR between black infants and white infants. Eliminating the U.S. black-white infant mortality disparity will require not only reducing the higher frequency of prematurity and low birth weight among black infants, but also improving the survival during both the neonatal and postneonatal periods of term black infants with normal birth weights.