Socioeconomic Status, Preeclampsia Risk and Gestational Length in Black and White Women
Socioeconomic Status, Preeclampsia Risk and Gestational Length in Black and White Women
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DOI：
10.1007/s40615-019-00619-3
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发表时间：
2019-12-01
影响因子：
3.9
通讯作者：
Jelliffe-Pawlowski, Laura
中科院分区：
文献类型：
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作者：
Ross, Kharah M.;Schetter, Christine Dunkel;Jelliffe-Pawlowski, Laura
背景：与白人女性相比，较高的社会经济地位（SES）对黑人女性的心脏代谢疾病和早产风险的影响较小，这种效应被称为“收益递减”。目前还没有研究测试这是否也发生在妊娠期的心脏代谢疾病，特别是子痫前期，或者子痫前期的风险是否可以解释出生时间的种族ses差异。方法从加利福尼亚以人口为基础的单胎出生队列中抽取718604名黑人和白人妇女。从国家维护的出生队列数据库中提取教育程度、公共健康保险状况、妊娠长度和子痫前期诊断。年龄、产前护理、糖尿病诊断、孕期吸烟、孕前体重指数为协变量。结果在预测子痫前期风险的logistic回归模型中，种族与社会经济地位的相互作用（教育程度和保险状况）是显著的。白人女性患先兆子痫的风险较低，较高的社会经济地位进一步降低了风险。黑人妇女患先兆子痫的风险较高，而SES并没有降低风险。在预测妊娠长度的途径分析中，观察到种族- ses相互作用的间接影响。在白人女性中，较高的社会经济地位预示着较低的先兆子痫风险，进而预示着较长的妊娠期。在黑人女性中没有观察到同样的情况。结论：与白人妇女相比，黑人妇女子痫前期风险增加。较高的社会经济地位降低了白人妇女患先兆子痫的风险，但对黑人妇女没有影响。同样，较高的社会经济地位间接地通过降低白人妇女先兆子痫的风险来预测更长的妊娠长度，但对黑人妇女没有影响。这些发现与较高社会经济地位的黑人妇女在子痫前期的收益递减是一致的。
Background Higher socioeconomic status (SES) has less impact on cardio-metabolic disease and preterm birth risk among Black women compared to White women, an effect called "diminishing returns." No studies have tested whether this also occurs for pregnancy cardio-metabolic disease, specifically preeclampsia, or whether preeclampsia risk could account for race-by-SES disparities in birth timing. Methods A sample of 718,604 Black and White women was drawn from a population-based California cohort of singleton births. Education, public health insurance status, gestational length, and preeclampsia diagnosis were extracted from a State-maintained birth cohort database. Age, prenatal care, diabetes diagnosis, smoking during pregnancy, and pre-pregnancy body mass index were covariates. Results In logistic regression models predicting preeclampsia risk, the race-by-SES interaction (for both education and insurance status) was significant. White women were at lower risk for preeclampsia, and higher SES further reduced risk. Black women were at higher risk for preeclampsia, and SES did not attenuate risk. In pathway analyses predicting gestational length, an indirect effect of the race-by-SES interaction was observed. Among White women, higher SES predicted lower preeclampsia risk, which in turn predicted longer gestation. The same was not observed for Black women. Conclusions Compared to White women, Black women had increased preeclampsia risk. Higher SES attenuated risk for preeclampsia among White women, but not for Black women. Similarly, higher SES indirectly predicted longer gestational length via reduced preeclampsia risk among White women, but not for Black women. These findings are consistent with diminishing returns of higher SES for Black women with respect to preeclampsia.