Mediation of Firearm Violence and Preterm Birth by Pregnancy Complications and Health Behaviors: Addressing Structural and Postexposure Confounding
Mediation of Firearm Violence and Preterm Birth by Pregnancy Complications and Health Behaviors: Addressing Structural and Postexposure Confounding
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DOI：
10.1093/aje/kwaa046
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发表时间：
2020-08-01
影响因子：
5
通讯作者：
Ahern, Jennifer
中科院分区：
文献类型：
--
作者：
Goin, Dana E.;Rudolph, Kara E.;Ahern, Jennifer
枪支暴力可能间接影响生活在枪支暴力流行社区的孕妇的健康。我们使用2007-2011年加州的出生、死亡、急诊科和住院数据来估计居住在枪支暴力频发的社区与早产之间的关系，并评估妊娠并发症诊断和妊娠期间的健康行为是否存在中介作用。我们使用了一种集成机器学习算法来预测社区被归类为高水平枪支暴力的倾向。使用目标最大似然估计总效应、随机直接效应和间接效应的风险差异。居住在高暴力社区与较高的早产患病率(风险差异（RD) = 0.46, 95%可信区间（CI）： 0.13, 0.80）、感染（RD = 1.34, 95% CI: -0.17, 2.86）、哮喘（RD = 0.76, 95% CI: 0.03, 1.48）和药物使用（RD = 0.74, 95% CI: 0.00, 1.47）相关。暴力与早产之间最大的间接影响是感染（随机间接影响= 0.04,95% CI: 0.00, 0.08）和药物使用（随机间接影响= 0.04,95% CI: 0.01, 0.06）。枪支暴力与早产风险相关，这种关联部分由感染和药物使用介导。
Firearm violence may indirectly affect health among pregnant women living in neighborhoods where it is endemic. We used birth, death, emergency department, and hospitalization data from California from 2007-2011 to estimate the association between living in a neighborhood with high firearm violence and preterm delivery, and assessed whether there was mediation by diagnoses of pregnancy complications and health behaviors during pregnancy. We used an ensemble machine learning algorithm to predict the propensity for neighborhoods to be classified as having a high level of firearm violence. Risk differences for the total effect and stochastic direct and indirect effects were estimated using targeted maximum likelihood. Residence in high-violence neighborhoods was associated with higher prevalence of preterm birth (risk difference (RD) = 0.46, 95% confidence interval (CI): 0.13, 0.80), infections (RD = 1.34, 95% CI: -0.17, 2.86), asthma (RD = 0.76, 95% CI: 0.03, 1.48), and substance use (RD = 0.74, 95% CI: 0.00, 1.47). The largest indirect effects for the association between violence and preterm birth were observed for infection (stochastic indirect effect = 0.04, 95% CI: 0.00, 0.08) and substance use (stochastic indirect effect = 0.04, 95% CI: 0.01, 0.06). Firearm violence was associated with risk of preterm delivery, and this association was partially mediated by infection and substance use.