Variations in low birth weight and preterm delivery among blacks in relation to ancestry and nativity: New York City, 1998-2002
Variations in low birth weight and preterm delivery among blacks in relation to ancestry and nativity: New York City, 1998-2002
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DOI：
10.1542/peds.2006-0665
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发表时间：
2006-11-01
期刊：
影响因子：
8
通讯作者：
Savitz, David A.
中科院分区：
文献类型：
--
作者：
Howard, David L.;Marshall, Susan S.;Savitz, David A.
目标。美国黑人妇女比白人妇女更有可能生出早产儿和低出生体重儿，但人们对黑人人口出生结果的差异知之甚少。本研究旨在检验黑人人群中低出生体重和早产风险因母亲血统和出生而异的假设。人群和方法。我们利用纽约市的出生记录进行了一项回顾性队列研究。 1998 年 1 月 1 日至 2002 年 12 月 31 日之间发生在纽约市的所有有记录的黑人妇女活产 (N=168 039)，均被分为以下自我报告的血统群体：非洲人、美国人、亚洲人、古巴人、欧洲人、波多黎各人、南美洲和中美洲人（不包括巴西人）以及西印度群岛和巴西人。为了估计低出生体重（出生时体重 < 2500 克）和早产（分娩胎龄 < 37 周，基于临床估计）的调整后风险比，我们使用负二项式回归和带有稳健 SE 估计的泊松回归，为每个结果运行 3 个模型。所有模型都使用具有美国血统的黑人作为参考群体。第一个模型将血统作为主要暴露变量，以及包括母亲年龄、胎次、吸烟和教育以及父亲教育和种族在内的协变量。第二个模型中包含出生地（美国或外国出生），第三个模型中包含代表血统和出生地之间相互作用效应的术语。结果。黑人亚组之间的早产和低出生体重风险存在显着差异，即使在调整了孕产妇风险因素和其他协变量后，所有群体的风险都低于美国黑人参考组。低出生体重的风险比率从南美/中美洲的 0.55 到古巴的 0.91 不等；早产的风险比率也显示出类似的模式。分娩也与低出生体重和早产有关。与美国出生的妇女相比，外国出生的妇女的早产或低出生体重的可能性较小。此外，出生效应因血统群体而异，在南美/中美洲中，外国出生的身份与不良出生结果呈负相关，但在西印度群岛/巴西人中则不然。结论。在将美国黑人女性视为同质群体并且不考虑种族差异和出生地的研究中，重要的健康差异可能被掩盖。
OBJECTIVES. Black women in the United States are more likely to give birth to preterm and low birth-weight infants than their white counterparts, but little is known about variation in birth outcomes within the black population. This study aimed to test the hypothesis that the risk of low birth weight and preterm birth within the black population varies by maternal ancestry and nativity.POPULATION AND METHODS. We conducted a retrospective cohort study using New York City birth records. All of the recorded live births to black women occurring in New York City between January 1, 1998, and December 31, 2002 (N=168 039), were divided into the following self-reported ancestry groups: African, American, Asian, Cuban, European, Puerto Rican, South and Central American ( excluding Brazilian), and West Indian and Brazilian. To estimate adjusted risk ratios for low birth weight (weight at birth < 2500g) and preterm birth (gestational age at delivery < 37 weeks, based on clinical estimate), we ran 3 models for each outcome, using negative binomial regression and Poisson regression with robust SE estimation. All of the models used blacks reporting American ancestry as the reference group. The first model included ancestry as the primary exposure variable along with covariates that included maternal age, parity, smoking, and education, as well as paternal education and race. Nativity (US-or foreign-born) was included in the second model, and terms representing interaction effects between ancestry and nativity were included in the third model.RESULTS. There was substantial variation in risks of preterm birth and low birth weight among the black subgroups, with all of the groups having lower risks than the American black reference group, even after adjusting for maternal risk factors and other covariates. Risk ratios for low birth weight ranged from 0.55 among South/Central Americans to 0.91 among Cubans; risk ratios for preterm birth showed a similar pattern. Nativity was also associated with low birth weight and preterm birth; births to foreign-born women were less likely to be preterm or lowbirth weight than births to US-born women. Furthermore, nativity effects varied by ancestry group, with foreign-born status inversely associated with poor birth outcomes among South/Central Americans but not among West Indians/Brazilians.CONCLUSIONS. Important health differences may be masked in studies that treat black women in America as a homogeneous group and do not take ethnic variation and nativity into account.