Racial disparity in previable birth
Racial disparity in previable birth
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DOI：
10.1016/j.ajog.2015.12.034
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发表时间：
2016-03-01
影响因子：
9.8
通讯作者：
Muglia, Louis J.
中科院分区：
文献类型：
--
作者：
DeFranco, Emily A.;Hall, Eric S.;Muglia, Louis J.
背景技术背景：活产新生儿在存活极限之前的极早产是罕见的，但对婴儿死亡率的贡献是一致的，因为基本上所有的病例都会导致新生儿死亡。目的：本研究的目的是量化可预见出生的种族差异及其对婴儿死亡率的贡献，并估计与活产阈值之前发生的活产相关因素的相对影响。这是一项基于人群的回顾性队列研究，研究对象为2006-2012年7年间俄亥俄州的所有活产婴儿。将妊娠16 0/7 ~ 22 6/7周的可预测活产的人口统计学、妊娠和分娩特征与妊娠37 0/7 ~ 42 6/7周的活产进行比较。研究人员比较了黑人和白色母亲妊娠期每周的出生率，并计算了相对风险比。Logistic回归估计的相对风险因素与先前的出生，调整伴随的风险factors.RESULTS：1,034,552活产在俄亥俄州在研究期间，2607（0.25%的所有活产）发生在可预见的16-22周期间。有一个显着的种族差异的比率和相对风险的可预见的出生，与3至6倍的相对风险增加，在黑人母亲在每一个星期的可预见的胎龄。白色母亲的预产期发生率为1.8/1000，黑人母亲为6.9/1000。与既往分娩最密切相关的因素，以校正的相对风险比表示（95%置信区间[CI]），是母亲的黑人种族调整的相对风险2.9（95% CI，2.6-3.2），年龄≥ 35岁1.3（95% CI，1.1-1.6），未婚2.1（95% CI，1.8-2.3）;胎儿特征，包括先天性异常，5.4（95% CI，3.4-8.1）和遗传性疾病，5.1（95% CI，2.5-10.1）;和妊娠特征，包括既往早产4.4（95% CI，3.7-5.2）和多胎妊娠，双胎，16.9（95% CI，14.4-19.8）或三胎，65.4（95% CI，32.9-130.2）。大多数（80%）可预见的分娩（16-22周）是自然分娩，而早期早产（23-33周）为73%，晚期早产（34-36周）为72%，足月分娩（37-42周）为65%（P < .001）。早产儿构成了约28%的总婴儿死亡率在白色新生儿和45%的婴儿死亡率在黑人婴儿在俄亥俄州.CONCLUSION：有一个显着的种族差异，在可预见的早产，与黑人母亲招致3- 6倍的相对风险增加相比，白色母亲，其中大部分是自发的性质。这可以解释婴儿死亡率的种族差异，因为所有活产的可预见的早产都会导致死亡。集中努力预防自发性可预见早产可能有助于减少婴儿死亡率的种族差异。
BACKGROUND: Extremely preterm birth of a live newborn before the limit of viability is rare but contributes uniformly to the infant mortality rate because essentially all cases result in neonatal death.OBJECTIVE: The objective of the study was to quantify racial differences in previable birth and their contribution to infant mortality and to estimate the relative influence of factors associated with live birth occurring before the threshold of viability.STUDY DESIGN: This was a population-based retrospective cohort of all live births in Ohio over a 7 year period, 2006-2012. Demographic, pregnancy, and delivery characteristics of previable live births at 16 0/7 to 22 6/7 weeks of gestation were compared with a referent group of live births at 37 0/7 to 42 6/7 weeks. Rates of birth at each week of gestation were compared between black and white mothers, and relative risk ratios were calculated. Logistic regression estimated the relative risk of factors associated with previable birth, with adjustment for concomitant risk factors.RESULTS: Of 1,034,552 live births in Ohio during the study period, 2607 (0.25% of all live births) occurred during the previable period of 16-22 weeks. There is a significant racial disparity in the rate and relative risk of previable birth, with a 3-to 6-fold relative risk increase in black mothers at each week of previable gestational age. The incidence of previable birth for white mothers was 1.8 per 1000 and for black mothers, 6.9 per 1000. Factors most strongly associated with previable birth, presented as adjusted relative risk ratio (95% confidence interval [CI]), were maternal characteristics of black race adjusted relative risk 2.9 (95% CI, 2.6-3.2), age >= 35 years 1.3 (95% CI, 1.1-1.6), and unmarried 2.1 (95% CI, 1.8-2.3); fetal characteristics including congenital anomaly, 5.4 (95% CI, 3.4-8.1) and genetic disorder, 5.1 (95% CI, 2.5-10.1); and pregnancy characteristics including prior preterm birth 4.4 (95% CI, 3.7-5.2) and multifetal gestation, twin, 16.9 (95% CI, 14.4-19.8) or triplet, 65.4 (95% CI, 32.9-130.2). The majority, 80%, of previable births (16-22 weeks) were spontaneous in nature, compared with 73% in early preterm births (23-33 weeks), 72% in late preterm births (34-36 weeks), and 65% of term births (37-42 weeks) (P < .001). Previable births constituted approximately 28% of total infant mortalities in white newborns and 45% of infant mortalities in black infants in Ohio during the study period.CONCLUSION: There is a significant racial disparity in previable preterm births, with black mothers incurring a 3-to 6-fold increased relative risk compared with white mothers, most of which are spontaneous in nature. This may explain much of the racial disparity in infant mortality because all live-born previable preterm births result in death. Focused efforts on the prevention of spontaneous previable preterm birth may help to reduce the racial disparity in infant mortality.