Racial, Ethnic, and Socioeconomic Disparities in the Prevalence of Cerebral Palsy
Racial, Ethnic, and Socioeconomic Disparities in the Prevalence of Cerebral Palsy
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DOI：
10.1542/peds.2010-1656
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发表时间：
2011-03-01
期刊：
影响因子：
8
通讯作者：
Gilbert, William M.
中科院分区：
文献类型：
--
作者：
Wu, Yvonne W.;Xing, Guibo;Gilbert, William M.
目的：脑性瘫痪的种族和民族差异已有文献记载，但其潜在机制尚不清楚。我们确定了低出生体重是否导致脑性瘫痪患病率的种族差异，以及社会经济因素是否影响种族和民族之间的脑性瘫痪。方法：在1991年至2001年加州620万名新生儿的回顾队列中，我们比较了8397名符合加州卫生服务部服务条件的脑瘫婴儿和未受影响的婴儿的母婴和婴儿特征。结果：总体而言，黑人婴儿患脑瘫的可能性比白人婴儿高29%(相对风险：1.29[95%可信区间：1.19-1.39])。然而，出生体重极低或中等偏低的黑人婴儿患脑性瘫痪的可能性比出生体重相当的白人婴儿低21%至29%。在我们调整出生体重后，黑人和白人婴儿患脑瘫的风险没有差异。在多变量分析中，没有接受任何产前护理的所有种族的妇女生下脑性瘫痪的婴儿的可能性是早期产前护理的妇女的两倍。在白人和西班牙裔女性中，母亲教育与脑性瘫痪之间存在剂量反应关系。西班牙裔青春期母亲(18岁)生下脑性瘫痪孩子的风险增加。结论：黑人婴儿脑性瘫痪的风险增加主要与他们低出生体重的高风险有关。了解教育程度和产前护理的使用如何影响脑性瘫痪的风险，可能会为新的预防策略提供参考。儿科杂志2011；127：e674-e681
OBJECTIVE: Racial and ethnic disparities in cerebral palsy have been documented, but the underlying mechanism is poorly understood. We determined whether low birth weight accounts for ethnic disparities in the prevalence of cerebral palsy and whether socioeconomic factors impact cerebral palsy within racial and ethnic groups.METHODS: In a retrospective cohort of 6.2 million births in California between 1991 and 2001, we compared maternal and infant characteristics among 8397 infants with cerebral palsy who qualified for services from the California Department of Health Services and unaffected infants.RESULTS: Overall, black infants were 29% more likely to have cerebral palsy than white infants (relative risk: 1.29 [95% confidence interval: 1.19 -1.39]). However, black infants who were very low or moderately low birth weight were 21% to 29% less likely to have cerebral palsy than white infants of comparable birth weight. After we adjusted for birth weight, there was no difference in the risk of cerebral palsy between black and white infants. In multivariate analyses, women of all ethnicities who did not receive any prenatal care were twice as likely to have infants with cerebral palsy relative to women with an early onset of prenatal care. Maternal education was associated with cerebral palsy in a dose-response fashion among white and Hispanic women. Hispanic adolescent mothers (aged < 18 years) had increased risk of having a child with cerebral palsy.CONCLUSIONS: The increased risk of cerebral palsy among black infants is primarily related to their higher risk of low birth weight. Understanding how educational attainment and use of prenatal care impact the risk of cerebral palsy may inform new prevention strategies. Pediatrics 2011;127:e674-e681