Modeling Race/Ethnic Differences in Infant Mortality

婴儿死亡率的种族/民族差异建模

• 批准号: 6470146
• 负责人: W. PARKER FRISBIE
• 金额: $ 23.27万
• 依托单位: UNIVERSITY OF TEXAS AT AUSTIN
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-06-01 至 2004-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6470146
• 关键词: clinical research; disease /disorder proneness /risk; female; gender difference; gestational age; health behavior; human birth weight; human data; infant mortality; mathematical model; mother /infant health care; perinatal; public health; racial /ethnic difference; socioeconomics

As we enter the 21st century, race/ethnic disparities in infant mortality remain a poorly understood phenomenon. Inconclusiveness of results is partially attributable to use of century-old indicators of birth outcomes based on White standards which "may result, for other ethnic groups, in invalid risk assessments and the misidentification of infants in need of intervention services". A central task is to better document how birth weight and gestational age, independently and conjointly, differentially affect infant mortality risk across race/ethnic populations. Another general objective is to determine the extent to which there are race/ethnic and sex differences in the way the effects of other risk factors for on infant mortality work through, or outside of, the mediating effects of birth outcomes. Specifically, we propose to: (1) formulate models of infant mortality for 24 race/ethnic- and sex-specific populations using both main and conjoint effects of birth weight and gestational age in order to specify birth outcome optimums for infant survival and evaluate the "one-size-fits-all" assumption; (2) determine the extent to which it is possible to explain race/ethnic differentials in infant mortality based on progressive adjustment of models that contain race/ethnicity, sex, the continuous birth outcome measures, and a wide range of demographic, SES, behavioral and maternal health covariates; (3) estimate race/ethnic- and sex-specific models to determine the extent to which birth outcomes mediate the effects of demographic, SES, behavioral, maternal health, and other covariates on infant mortality risk; (4) utilize earlier NCHS linked files (1989-91) in conjunction with the most recent files (1995-98) to examine changes that have occurred in the relationships of interest over a time period in which a number of profound alterations in infant mortality occurred in the US; (5) inasmuch as infant mortality risk varies substantially by age of infant, incorporate the nonproportional effect of infant age into the analyses. Data will be drawn from the 1989-91 and 1995-98 NCHS Linked Birth/Infant Death cohort files which contain a sufficient number of cases to support the analysis.

当我们进入21世纪世纪，婴儿死亡率的种族/民族差异仍然是一个知之甚少的现象。结果的不确定性部分归因于使用基于白色标准的百年出生结果指标，这“可能导致对其他族裔群体的无效风险评估和错误识别需要干预服务的婴儿”。 一项中心任务是更好地记录出生体重和胎龄如何独立和联合地对不同种族/民族人群的婴儿死亡风险产生差异性影响。 另一个总的目标是确定其他危险因素通过或不通过出生结果的中介作用对婴儿死亡率产生影响的方式中种族/族裔和性别差异的程度。 具体而言，我们建议：（1）利用出生体重和胎龄的主要效应和联合效应，为24个种族/族裔和性别特定人群制定婴儿死亡率模型，以具体说明婴儿存活的最佳出生结果，并评估“一刀切”假设;（2）确定在何种程度上可以解释种族/婴儿死亡率的种族差异，基于对包含种族/种族、性别、连续出生结果指标以及广泛的人口统计学、社会经济地位、行为和孕产妇健康协变量的模型的逐步调整;（3）估计种族/民族和性别特异性模型，以确定出生结果在多大程度上介导人口统计学、社会经济地位、行为、孕产妇健康和其他协变量对婴儿死亡风险的影响;（4）结合最新的档案（1995-98），利用早期的NCHS链接档案（1989-91）研究在美国婴儿死亡率发生重大变化的一段时间内，相关关系发生的变化;（5）鉴于婴儿死亡风险因婴儿年龄而有很大差异，在分析中应考虑到婴儿年龄的非比例影响。 数据将来自1989-91年和1995-98年NCHS关联出生/婴儿死亡队列文件，其中包含足够数量的病例以支持分析。