Prenatal Care Utilization in Mississippi: Racial Disparities and Implications for Unfavorable Birth Outcomes
Prenatal Care Utilization in Mississippi: Racial Disparities and Implications for Unfavorable Birth Outcomes
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DOI：
10.1007/s10995-009-0542-6
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发表时间：
2011-10-01
影响因子：
2.3
通讯作者：
Graham, Juanita
中科院分区：
文献类型：
--
作者：
Cox, Reagan G.;Zhang, Lei;Graham, Juanita
本研究的目的是确定种族差异在产前护理（PNC）的利用和检查PNC与早产（PTB），低出生体重（LBW）和婴儿死亡率在密西西比州。回顾性队列从1996年至2003年连接密西西比州出生和婴儿死亡档案。分析仅限于非西班牙裔白人和黑人妇女所生的活产单胎婴儿（n = 292,776）。采用Kotelchuck产前护理利用充分性指数对PNC进行分类。在控制了产妇年龄、教育程度、婚姻状况、居住地、烟草使用和医疗风险后，采用多元logistic回归方法确定与PTB、LBW和婴儿死亡相关的因素。大约五分之一的密西西比州妇女的PNC不足，并且在PNC的使用上存在种族差异。与白人妇女相比，黑人妇女延迟PNC，就诊次数太少，更有可能出现“PNC不足”（P < 0.0001）或“无护理”（P < 0.0001）。此外，在有疾病的妇女中，黑人妇女获得的PNC不足的可能性是白人妇女的两倍。无论种族如何，“无护理”和“不充分的PNC”是PTB、LBW和婴儿死亡的强烈危险因素。我们提供的经验证据支持种族差异的存在，在PNC的使用和婴儿出生结果在密西西比州。需要进一步的研究来解释PNC使用的种族差异。然而，这项研究表明，旨在提高妇女PNC利用率的公共卫生干预措施可能会减少不利的出生结果，尤其是婴儿死亡率。
The objective of the study is to identify racial disparities in prenatal care (PNC) utilization and to examine the relationship between PNC and preterm birth (PTB), low birth weight (LBW) and infant mortality in Mississippi. Retrospective cohort from 1996 to 2003 linked Mississippi birth and infant death files was used. Analysis was limited to live-born singleton infants born to non-Hispanic white and black women (n = 292,776). PNC was classified by Kotelchuck's Adequacy of Prenatal Care Utilization Index. Factors associated with PTB, LBW and infant death were identified using multiple logistic regression after controlling for maternal age, education, marital status, place of residence, tobacco use and medical risk. About one in five Mississippi women had less than adequate PNC, and racial disparities in PNC utilization were observed. Black women delayed PNC, received too few visits, and were more likely to have either "inadequate PNC" (P < 0.0001) or "no care" (P < 0.0001) compared to white women. Furthermore, among women with medical conditions, black women were twice as likely to receive inadequate PNC compared to white women. Regardless of race, "no care" and "inadequate PNC" were strong risk factors for PTB, LBW and infant death. We provide empirical evidence to support the existence of racial disparities in PNC utilization and infant birth outcomes in Mississippi. Further study is needed to explain racial differences in PNC utilization. However, this study suggests that public health interventions designed to improve PNC utilization among women might reduce unfavorable birth outcomes especially infant mortality.