Racial and Ethnic Differences in Use of Intubation for Periviable Neonates
Racial and Ethnic Differences in Use of Intubation for Periviable Neonates
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DOI：
10.1542/peds.2010-2608
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发表时间：
2011-05-01
期刊：
影响因子：
8
通讯作者：
Lorch, Scott
中科院分区：
文献类型：
--
作者：
Edmonds, Brownsyne Tucker;Fager, Corinne;Lorch, Scott
目的：种族/少数民族报告在生命结束时对复苏护理的偏好。本研究的主要目的是确定围产期新生儿插管使用是否存在种族/民族差异。我们假设黑人和西班牙裔妇女所生的婴儿比白色妇女所生的婴儿更容易复苏。我们对妊娠23.0 - 24.6周分娩妇女的州级母婴出院数据进行了回顾性队列研究，这些数据与加州、密苏里州、结果：78.9%的人口年龄在18 - 35岁之间，几乎一半的人是未生育的; 19.4%的妇女是黑人，36.6%是西班牙裔，33.4%是白色。大约30%的人受过高中以下教育，49.2%的人有联邦保险。总体而言，44.7%的围存活新生儿进行了插管。在调整社会人口学特征的多变量分析中，黑人和西班牙裔人种/种族与新生儿插管显著相关（比值比[OR]分别为：1.14 [95%置信区间（CI）：1.01-1.29]和1.22 [95% CI：1.10-1.36]）。在控制了分娩医院水平的聚集的模型中，黑人种族仍然是新生儿插管的预测因素（OR：1.25 [95%CI：1.07-1.46]），但西班牙裔之间的差异消失（OR：1.12 [95% CI：0.98-1.27]）。围复苏模式存在种族/民族差异，这可能反映了患者偏好的潜在差异。另外，体制做法或资源也可能是造成这些差异的原因。这些发现对患者护理和机构实践具有重要意义。我们的研究结果为进一步研究社会、文化和制度因素如何影响患者-提供者关于围手术期护理的决策奠定了基础。儿科2011;127：e1120-e1127
OBJECTIVE: Racial/ethnic minorities report preferences for resuscitative care at the end of life. The main objective of this study was to determine if there are racial/ethnic differences in use of intubation for periviable neonates. We hypothesized that infants born to black and Hispanic women are more likely to be resuscitated compared with infants born to white women.METHODS: We conducted a retrospective cohort study of state-level maternal and infant hospital discharge data of women who delivered between 23.0 and 24.6 weeks' gestation linked to birth and death certificate data for California, Missouri, and Pennsylvania from 1995 to 2005 (N = 9632).RESULTS: Overall, 78.9% of the population was aged 18 to 35 years, and almost half were nulliparous; 19.4% of the women were black, 36.6% were Hispanic, and 33.4% were white. Approximately 30% had less than a high school education, and 49.2% were federally insured. Overall, 44.7% of periviable neonates were intubated. In multivariable analyses adjusting for sociodemographic characteristics, black and Hispanic race/ethnicity was significantly associated with neonatal intubation (odds ratios [ORs]: 1.14 [95% confidence interval (CI): 1.01-1.29] and 1.22 [95% CI: 1.10-1.36], respectively). In models controlling for clustering at the level of the delivery hospital, black race remained a predictor of neonatal intubation (OR: 1.25 [95% CI: 1.07-1.46]), but differences among Hispanics dissipated (OR: 1.12 [95% CI: 0.98-1.27]).CONCLUSIONS: Racial/ethnic differences exist in patterns of periviable resuscitation, which may reflect underlying differences in patient preference. Alternatively, institutional practices or resources may account for these differences. These findings have important implications for patient care and institutional practice. Our results lay the foundation for additional work to investigate how social, cultural, and institutional factors influence patient-provider decision-making regarding periviable care. Pediatrics 2011;127:e1120-e1127