Disparities in Breastfeeding: Impact on Maternal and Child Health Outcomes and Costs
Disparities in Breastfeeding: Impact on Maternal and Child Health Outcomes and Costs
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DOI：
10.1016/j.jpeds.2016.10.028
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发表时间：
2017-02-01
影响因子：
5.1
通讯作者：
Stuebe, Alison M.
中科院分区：
文献类型：
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作者：
Bartick, Melissa C.;Jegier, Briana J.;Stuebe, Alison M.
目的估计非西班牙裔黑人（NHB）、西班牙裔和非西班牙裔白人（NHW）中因母乳喂养率不佳而造成的疾病负担和相关成本。研究设计使用有关母乳喂养与8种儿科疾病和5种孕产妇疾病的健康结果之间关系的现有文献，我们使用蒙特卡罗模拟来评估2个假设的美国妇女队列，她们的年龄从15岁到70岁，她们的婴儿从出生到20岁。考虑到产次、产妇年龄和出生体重的种族/民族差异，我们使用2012年母乳喂养率按种族/民族和预期结果检查了疾病结局和成本，如果90%的婴儿根据纯母乳喂养和持续母乳喂养持续时间的建议进行母乳喂养，则次优母乳喂养与NHB和西班牙裔人群中更大的疾病负担相关。与NHW人群相比，NHB人群中归因于次优母乳喂养的急性中耳炎病例数是NHW人群的1.7倍（95% CI 1.7-1.7），坏死性小肠结肠炎病例数是NHW人群的3.3倍（95% CI 2.9-3.7），儿童死亡数是NHB人群的2.2倍（95% CI 1.6-2.8）。与NHW人口相比，西班牙裔人口有1.4倍的胃肠道感染（95%CI 1.4-1.4）和1.5倍的数量过多的儿童死亡（95%CI 1.2-1.9）。结论种族/民族差异母乳喂养有重要的社会，经济和健康的影响，假设母乳喂养和健康结果之间的因果关系。
Objective To estimate the disease burden and associated costs attributable to suboptimal breastfeeding rates among non-Hispanic blacks (NHBs), Hispanics, and non-Hispanic whites (NHWs).Study design Using current literature on associations between breastfeeding and health outcomes for 8 pediatric and 5 maternal diseases, we used Monte Carlo simulations to evaluate 2 hypothetical cohorts of US women followed from age 15 to 70 years and their infants followed from birth to age 20 years. Accounting for differences in parity, maternal age, and birth weights by race/ethnicity, we examined disease outcomes and costs using 2012 breastfeeding rates by race/ethnicity and outcomes that would be expected if 90% of infants were breastfed according to recommendations for exclusive and continued breastfeeding duration.Results Suboptimal breastfeeding is associated with a greater burden of disease among NHB and Hispanic populations. Compared with a NHW population, a NHB population had 1.7 times the number of excess cases of acute otitis media attributable to suboptimal breastfeeding (95% CI 1.7-1.7), 3.3 times the number of excess cases of necrotizing enterocolitis (95% CI 2.9-3.7), and 2.2 times the number of excess child deaths (95% CI 1.6-2.8). Compared with a NHW population, a Hispanic population had 1.4 times the number of excess cases of gastrointestinal infection (95% CI 1.4-1.4) and 1.5 times the number of excess child deaths (95% CI 1.2-1.9).Conclusions Racial/ethnic disparities in breastfeeding have important social, economic, and health implications, assuming a causal relationship between breastfeeding and health outcomes.