Association of Race/Ethnicity With Very Preterm Neonatal Morbidities
Association of Race/Ethnicity With Very Preterm Neonatal Morbidities
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DOI：
10.1001/jamapediatrics.2018.2029
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发表时间：
2018-11-01
期刊：
影响因子：
26.1
通讯作者：
Howell, Elizabeth A.
中科院分区：
文献类型：
--
作者：
Janevic, Teresa;Zeitlin, Jennifer;Howell, Elizabeth A.
重要性 极早产儿的严重发病对发育和生命全程健康具有深远的临床影响。然而，关于严重新生儿发病率的种族/民族差异的研究很少，表明这些差异是适度的或为零，这可能是由于所使用的分析方法而导致的低估。 目的 估计极早产儿严重发病率的种族/民族差异。 设计、环境和参与者 这项基于人群的回顾性队列研究是在纽约州纽约市进行的，使用了相关的出生证明、死亡率数据和2010年1月1日至2014年12月31日的出院数据。妊娠24周前出生、患有先天性异常和数据缺失的婴儿被排除在外。通过传统分析和胎儿风险分析两种方法来估计极早产发病率的种族/民族差异。传统分析使用对数二项式回归来估计种族/民族群体中 4 种严重新生儿发病的相对风险。对于风险胎儿分析，使用以死亡为竞争风险的 Cox 比例风险回归来估计将种族/民族与每个结果相关的亚风险比率。根据社会人口因素和孕产妇发病率对估计值进行了调整。数据分析时间为 2017 年 9 月 5 日至 2018 年 5 月 21 日。 主要结果和测量 采用国际疾病分类第九版修订版、诊断和程序代码定义了四种发病结果：坏死性小肠结肠炎、脑室内出血、支气管肺发育不良和早产儿视网膜病变。 结果 总共有 582 297 名婴儿接受了治疗。纳入本研究。其中，女性 285 006 名（48.9%），男性 297 291 名（51.0%）。在极早产亚队列中使用传统方法，与白人婴儿相比，黑人婴儿仅患支气管肺发育不良的风险增加（调整后风险比[aRR]，1.34；95% CI，1.09-1.64），并且坏死性小肠结肠炎的风险略有增加（aRR，1.39；95% CI，1.00-1.93）。西班牙裔婴儿患坏死性小肠结肠炎的风险略有增加（aRR，1.39；95% CI，0.98-1.96），亚洲婴儿患早产儿视网膜病变的风险增加（aRR，1.85；95% CI，1.15-2.97）。在胎儿风险分析中，黑人婴儿的坏死性小肠结肠炎发生率高出 4.40 倍（95% CI，2.98-6.51），脑室内出血发生率高出 2.73 倍（95% CI，1.63-4.57），支气管肺发育不良发生率高出 4.43 倍（95% CI， 2.88-6.81），早产儿视网膜病变发生率高出 2.98 倍（95% CI，2.01-4.40）。西班牙裔婴儿的所有结局发生率大约高出 2 倍，亚洲婴儿仅早产儿视网膜病变的风险增加（调整后的风险比，2.43；95% CI，1.43-4.11）。 结论和相关性 在这项研究中，极早产儿新生儿发病率的种族/民族差异似乎相当大，但在之前的研究中可能被低估了，并可能对未来产生影响。了解这些种族/民族差异很重要，因为它们可能会导致儿童以后的健康和发展不平等。
IMPORTANCE Severe morbidity in very preterm infants is associated with profound clinical implications on development and life-course health. However, studies of racial/ethnic disparities in severe neonatal morbidities are scant and suggest that these disparities are modest or null, which may be an underestimation resulting from the analytic approach used.OBJECTIVE To estimate racial/ethnic differences in severe morbidities among very preterm infants.DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study was conducted in New York City, New York, using linked birth certificate, mortality data, and hospital discharge data from January 1, 2010, through December 31, 2014. Infants born before 24 weeks' gestation, with congenital anomalies, and with missing data were excluded. Racial/ethnic disparities in very preterm birth morbidities were estimated through 2 approaches, conventional analysis and fetuses-at-risk analysis. The conventional analysis used log-binomial regression to estimate the relative risk of 4 severe neonatal morbidities for the racial/ethnic groups. For the fetuses-at-risk analysis, Cox proportional hazards regression with death as competing risk was used to estimate subhazard ratios associating race/ethnicity with each outcome. Estimates were adjusted for sociodemographic factors and maternal morbidities. Data were analyzed from September 5, 2017, to May 21, 2018.MAIN OUTCOMES AND MEASURES Four morbidity outcomes were defined using International Classification of Diseases, Ninth Revision, diagnosis and procedure codes: necrotizing enterocolitis, intraventricular hemorrhage, bronchopulmonary dysplasia, and retinopathy of prematurity.RESULTS In total, 582 297 infants were included in this study. Of these infants, 285 006 were female (48.9%) and 297 291 were male (51.0%). Using the conventional approach in the very preterm birth subcohort, black compared with white infants had an increased risk of only bronchopulmonary dysplasia (adjusted risk ratio [aRR], 1.34; 95% CI, 1.09-1.64) and a borderline increased risk of necrotizing enterocolitis (aRR, 1.39; 95% CI, 1.00-1.93). Hispanic infants had a borderline increased risk of necrotizing enterocolitis (aRR, 1.39; 95% CI, 0.98-1.96), and Asian infants had an increased risk of retinopathy of prematurity (aRR, 1.85; 95% CI, 1.15-2.97). In the fetuses-at-risk analysis, black infants had a 4.40 times higher rate of necrotizing enterocolitis (95% CI, 2.98-6.51), a 2.73 times higher rate of intraventricular hemorrhage (95% CI, 1.63-4.57), a 4.43 times higher rate of bronchopulmonary dysplasia (95% CI, 2.88-6.81), and a 2.98 times higher rate of retinopathy of prematurity (95% CI, 2.01-4.40). Hispanic infants had an approximately 2 times higher rate for all outcomes, and Asian infants had increased risk only for retinopathy of prematurity (adjusted hazard ratio, 2.43; 95% CI, 1.43-4.11).CONCLUSIONS AND RELEVANCE In this study, racial/ethnic disparities in neonatal morbidities among very preterm infants appear to be sizable, but may have been underestimated in previous studies, and may have implications for the future. Understanding these racial/ethnic disparities is important, as they may contribute to inequalities in health and development later in the child's life.