Racial disparities in preterm births and fetal losses

早产和胎儿丢失的种族差异

• 批准号: 10468994
• 负责人: Tim Allen Bruckner
• 金额: $ 50.44万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-15 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10468994
• 关键词: 37 weeks gestation; Affect; Area; Birth; Birth Rate; Black Populations; Black race; Childhood; Clinical; Conceptions; County; Data; Death Rate; Death Records; Developmental Delay Disorders; Ethnic Origin; Fetal Death; Fetus; Gestational Age; Health; Healthcare; High-Risk Pregnancy; Hospitalization; Imprisonment; Inequality; Infant; Infant Health; Infant Mortality; Intervention; Knowledge; Link; Live Birth; Measures; Medical; Methods; Morbidity - disease rate; Mothers; National Institute of Child Health and Human Development; Neonatal; Not Hispanic or Latino; Outcome; Pattern; Perinatal; Pregnancy; Premature Birth; Premature Infant; Public Health; Race; Records; Research; Research Priority; Resource Allocation; Resources; Risk; Sampling; Steroids; Stress; Structural Racism; Survivors; Technology; Testing; Time; Variant; Work; antenatal; base; black/white disparity; clinical practice; cohort; developmental disease; disparity reduction; ethnic difference; fetal; fetal loss; fetus at risk; health care availability; health care disparity; health disparity; high risk population; improved; in utero; infant death; infant morbidity; innovation; knowledge base; neglect; neonatal care; perinatal health; perinatal outcomes; racial and ethnic; racial difference; racial disparity; response; segregation; trend

Project Summary (30 lines) Preterm birth (<37 weeks of gestation) increases the risk infant death, hospitalization, developmental disorders, and low educational attainment. Although non-Hispanic (NH) Black mothers show an increased risk (vs. NH whites) of delivering preterm, NH Black infants historically show―at each gestational age before term―improved health and survival relative to NH white infants. The main explanation for this counterintuitive finding assumes greater selection against frail NH Black fetuses. According to the selection argument, excess fetal loss among frail NH Black gestations results in a hardier cohort of survivors to birth but who are delivered preterm. Prior work describing this racial survival advantage has three important limitations. First, it continues to infer the survival advantage from data now nearly two decades old. Second, it includes no test of the fetal selection argument. Third, it fails to utilize a structural racism framework to understand the potential causes of, and changes over time and place in, racial differences in fetal loss and infant survival. Rapid changes in neonatal technology suggest that decades-old estimates of the survival advantage may have, since 2000, diminished―or even transformed into a disparity. We will use the universe of live births, infant deaths, and fetal deaths among NH Blacks and NH whites in the US (~65 million records, 1995 to 2018) to rigorously examine race-specific trends in preterm birth and infant mortality rates. We will link these records longitudinally by conception cohort to achieve several research objectives. First, we will determine whether NH Blacks (vs. NH whites) born preterm show a survival advantage—or a disparity—in infant mortality in the US. Second, we will investigate how the NH Black / NH white difference in preterm birth rates and infant mortality rates has changed over time, in response to fluctuations in fetal death rates and exogenous changes in neonatal technology (e.g., use of antenatal steroids). Third, we will use a structural racism theoretical framework to examine the extent to which dynamic race-based spatial indicators of inequality (e.g., segregation, incarceration rates) affect patterns across place and time in NH Black (vs. NH white) fetal loss, selection in utero, and infant mortality among preterm births. Our work is significant because we focus on the entire spectrum of perinatal outcomes, including the often neglected but quite large racial disparity in fetal death. Results are expected to advance the knowledge base on NICHD's high-priority research area to better understand racial/ethnic differences in infant health. Our approach will also inform our understanding of the extent to which structural racism may have maintained―or exacerbated―perinatal health disparities. Lastly, our place-based analysis will identify regions with potentially large disparities in fetal loss and perinatal survival that may benefit from targeted healthcare and non-healthcare resources.

项目摘要(30行) 早产(妊娠37周)会增加婴儿死亡、住院、发育的风险 精神障碍，受教育程度低。尽管非西班牙裔(NH)黑人母亲表现出更多的 历史上每个孕龄的NH黑人婴儿早产的风险(与NH白人相比) 足月前-相对于NH白人婴儿，改善了健康和存活率。对此的主要解释是 违反直觉的发现假设对虚弱的NH Black胎儿有更大的选择。根据评选结果 争论，虚弱的NH Black妊娠中过多的胎儿丢失会导致更顽强的幸存者出生 而是那些早产的孩子。 之前描述这种种族生存优势的工作有三个重要的局限性。首先，它继续 从现在已经有近20年历史的数据中推断出生存优势。其次，它不包括对胎儿的测试 选择参数。第三，它没有利用结构性种族主义框架来理解潜在的原因 胎儿丧失和婴儿存活的种族差异，以及随时间和地点的变化。日新月异 新生儿技术表明，自2000年以来，几十年来对生存优势的估计可能已经， 缩小了--甚至转变成了差距。我们将利用活产、婴儿死亡和 美国NH黑人和NH白人的胎儿死亡(1995年至2018年，约6500万记录)到严格的 检查早产和婴儿死亡率的种族趋势。我们将链接这些记录 纵向上通过概念队列来实现几个研究目标。 首先，我们将确定早产的NH黑人(与NH白人相比)是否显示出生存优势-或者 差异--美国的婴儿死亡率。其次，我们将研究NH黑/NH白的差异 早产率和婴儿死亡率随着时间的推移而变化，以应对胎儿的波动 死亡率和新生儿技术的外源性变化(例如，产前类固醇的使用)。第三，我们将 使用结构性种族主义理论框架来检查基于种族的动态空间 不平等的指标(例如，隔离、监禁率)影响NH地区和时间的模式 在早产儿中，黑人(与NH白人)胎儿丢失、宫内选择和婴儿死亡率。 我们的工作意义重大，因为我们关注围产期结局的整个范围，包括经常 在胎儿死亡方面被忽视但相当大的种族差异。预计结果将推动知识库的发展 关于NICHD的高度优先研究领域，以更好地了解婴儿健康方面的种族/族裔差异。我们的 方法还将使我们了解结构性种族主义可能在多大程度上保持--或 加剧--围产期健康差距。最后，我们的基于地点的分析将确定具有 在胎儿丧失和围产期存活方面可能存在巨大差异，可能受益于有针对性的医疗保健和 非医疗保健资源。