Breastfeeding Trends by Race/Ethnicity Among US Children Born From 2009 to 2015
Breastfeeding Trends by Race/Ethnicity Among US Children Born From 2009 to 2015
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DOI：
10.1001/jamapediatrics.2019.3319
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发表时间：
2019-12-01
期刊：
影响因子：
26.1
通讯作者：
Elam-Evans, Laurie D.
中科院分区：
文献类型：
--
作者：
Li, Ruowei;Perrine, Cria G.;Elam-Evans, Laurie D.
问题 母乳喂养趋势存在哪些种族/民族差异？结果 在这项针对儿童国家免疫调查数据的研究中，从 2009 年到 2015 年，每个种族/族裔群体的母乳喂养率均有所增加。非西班牙裔黑人婴儿的母乳喂养率仍然低于白人婴儿，而白人婴儿和大多数其他非白人婴儿之间的差距较小，这与白人婴儿的母乳喂养率增幅较大有关。意味着似乎需要付出更多努力来提高黑人婴儿的母乳喂养率。重要性母乳喂养方面的巨大种族/民族差异与不良的健康结果相关。目的 研究 2009 年至 2015 年按种族/族裔划分的母乳喂养趋势，以及比较 2009-2010 年至 2014-2015 年期间各种族/族裔亚组与白人婴儿母乳喂养差距的变化。设计、背景和参与者本研究使用了来自全国儿童免疫调查 (NIS-Child) 的 167842 名婴儿的数据，这是一项随机数字拨号电话调查，对调查时有 19 至 35 个月儿童的美国家庭进行了复杂、分层、多阶段概率样本。本研究分析了 2011 年 1 月 1 日至 2017 年 12 月 31 日期间收集的 2009 年至 2015 年出生儿童的数据。暴露儿童的种族/民族被分类为西班牙裔或非西班牙裔白人、黑人、亚洲人、美洲印第安人或阿拉斯加原住民。主要成果和措施 母乳喂养率，包括曾经母乳喂养、6 个月内纯母乳喂养以及 12 个月内继续母乳喂养。结果 本研究纳入了 167842 名婴儿（平均 [SD] 年龄为 2.33 [0.45] 岁；86321 名男性 [51.4%] 名婴儿和 81521 名婴儿 [48.6%] 名女性）。从 2009 年到 2015 年，未经调整的总体母乳喂养率增加了 7.1 个百分点，纯母乳喂养率增加了 7.1 个百分点，纯母乳喂养率增加了 9.2 个百分点，持续母乳喂养率增加了 11.3 个百分点，不同种族/民族的差异很大。大多数种族/族裔群体的母乳喂养率显着增加。从2009-2010年到2014-2015年，黑人和白人婴儿调整后母乳喂养率的差异变得更大。例如，从 2009-2010 年到 2014-2015 年，黑人和白人婴儿 6 个月内纯母乳喂养的差异从 0.5 个百分点扩大到 4.5 个百分点，差异达 4.0% (P < .001)。相比之下，除了亚洲人在 12 个月时继续母乳喂养外，西班牙裔、亚洲人和美洲印第安人或阿拉斯加原住民婴儿与白人婴儿之间的母乳喂养差异变得较小或保持不变。例如，西班牙裔婴儿和白人婴儿在 12 个月时继续母乳喂养的差异在两个时期之间从 7.8 个百分点下降到 3.8 个百分点，产生 -4.0% 的差异 (P < .001)。由于所有种族/族裔之间的积极趋势，这些差异的减少可能与整个研究期间白人婴儿的更大增加有关。结论和相关性 尽管 2014 年至 2015 年，每个种族/族裔群体的母乳喂养情况均有所改善，但当黑人婴儿的母乳喂养改善进一步下降时，黑人和白人婴儿之间的母乳喂养差异变得更大。所有其他非白人群体中母乳喂养差距的缩小可能与白人婴儿中母乳喂养差距的更大增加有关。似乎需要做出更多努力来提高黑人婴儿的母乳喂养率。本研究使用调查数据来研究美国母乳喂养趋势中的种族/民族差异。
Question What are the racial/ethnic disparities in breastfeeding trends? Findings In this study of data from the National Immunization Survey-Child, breastfeeding rates were increased in each racial/ethnic group from 2009 to 2015. Non-Hispanic black infants continued to have lower breastfeeding rates than white infants, whereas the gaps between white infants and most other nonwhite infants were smaller in association with greater increases among white infants. Meaning More efforts appear to be needed to improve breastfeeding rates among black infants.Importance Large racial/ethnic disparities in breastfeeding are associated with adverse health outcomes. Objectives To examine breastfeeding trends by race/ethnicity from 2009 to 2015 and changes in breastfeeding gaps comparing racial/ethnic subgroups with white infants from 2009-2010 to 2014-2015. Design, Setting, and Participants This study used data from 167842 infants from the National Immunization Survey-Child (NIS-Child), a random-digit-dialed telephone survey among a complex, stratified, multistage probability sample of US households with children aged 19 to 35 months at the time of the survey. This study analyzed data collected from January 1, 2011, through December 31, 2017, for children born between 2009 and 2015. Exposures Child's race/ethnicity categorized as Hispanic or non-Hispanic white, black, Asian, or American Indian or Alaskan Native. Main Outcomes and Measures Breastfeeding rates, including ever breastfeeding, exclusive breastfeeding through 6 months, and continuation of breastfeeding at 12 months. Results This study included 167842 infants (mean [SD] age, 2.33 [0.45] years; 86321 [51.4%] male and 81521 [48.6%] female). Overall unadjusted breastfeeding rates increased from 2009 to 2015 by 7.1 percentage points for initiation, 9.2 percentage points for exclusivity, and 11.3 percentage points for duration, with considerable variation by race/ethnicity. Most racial/ethnic groups had significant increases in breastfeeding rates. From 2009-2010 to 2014-2015, disparities in adjusted breastfeeding rates became larger between black and white infants. For example, the difference for exclusive breastfeeding through 6 months between black and white infants widened from 0.5 to 4.5 percentage points with a 4.0% difference in difference (P < .001) from 2009-2010 to 2014-2015. In contrast, the breastfeeding differences between Hispanic, Asian, and American Indian or Alaskan Native infants and white infants became smaller or stayed the same except for continued breastfeeding at 12 months among Asians. For example, the difference in continued breastfeeding at 12 months between Hispanic and white infants decreased from 7.8 to 3.8 percentage points between 2 periods, yielding a -4.0% difference in difference (P < .001). Because of positive trends among all race/ethnicities, these reduced differences were likely associated with greater increases among white infants throughout the study years. Conclusions and Relevance Despite breastfeeding improvements among each race/ethnicity group, breastfeeding disparities between black and white infants became larger when breastfeeding improvements decreased even further among black infants in 2014-2015. The reduced breastfeeding gaps among all other nonwhite groups may be associated with greater increases among white infants. More efforts appear to be needed to improve breastfeeding rates among black infants.This study uses survey data to examine the racial/ethnic disparities in breastfeeding trends in the United States.