Modeling Race/Ethnic Differences in Infant Mortality

婴儿死亡率的种族/民族差异建模

• 批准号: 6623769
• 负责人: W. PARKER FRISBIE
• 金额: $ 23.26万
• 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 2005-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6623769
• 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世纪时，婴儿死亡率的种族/民族差异仍然是一个鲜为人知的现象。结果的不确定性部分归因于使用基于白人标准的百年历史的出生结果指标，这“可能导致其他种族的风险评估无效，以及对需要干预服务的婴儿的错误识别”。一项中心任务是更好地记录出生体重和胎龄如何单独和共同影响不同种族/民族人口的婴儿死亡率风险。另一个总体目标是确定其他风险因素对婴儿死亡率的影响通过或在出生结果的中介影响之外产生影响的方式上存在种族/民族和性别差异的程度。具体而言，我们建议：(1)利用出生体重和胎龄的主要和联合效应，建立24个种族/民族和性别特定人群的婴儿死亡率模型，以确定婴儿生存的最佳出生结局，并评估“一刀切”的假设；(2)根据包含种族/民族、性别、连续出生结果测量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逐步调整，确定在多大程度上可能解释婴儿死亡率中的种族/民族差异；(3)估计种族/民族和性别特定模型，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)利用早期的NCHS链接文件（1989-91）和最近的文件（1995-98）来检查在一段时间内利益关系中发生的变化，在这段时间内，美国婴儿死亡率发生了一些深刻的变化；(5)鉴于婴儿死亡风险因婴儿年龄的不同而有很大差异，应将婴儿年龄的非比例效应纳入分析。数据将取自1989-91年和1995-98年国家卫生统计中心关联出生/婴儿死亡队列文件，其中包含足够数量的病例来支持分析。