Racial disparities in preterm births and fetal losses

项目摘要（30行） 早产（妊娠期<37周）会增加婴儿死亡、住院、发育不良的风险。 失调和教育程度低。虽然非西班牙裔（NH）黑人母亲显示出增加 早产风险（与NH白人相比），NH黑人婴儿历史上显示-在每个胎龄 足月前-相对于NH白色婴儿，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黑人胎儿有更大的选择。根据选择 一个论点，在虚弱的NH黑人妊娠中，过多的胎儿丢失导致了一个更坚强的幸存者出生队列 但是早产的孩子 先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 从近20年前的数据中推断出生存优势。第二，它不包括对胎儿的测试， 选择参数第三，它未能利用结构性种族主义框架来理解潜在的原因， 胎儿丢失和婴儿存活率的种族差异及其随时间和地点的变化。的快速变化 新生儿技术表明，自2000年以来， 缩小了，甚至变成了差距。我们将使用活产婴儿死亡和 美国NH黑人和NH白人的胎儿死亡（1995年至2018年约6500万记录）， 审查各种族早产和婴儿死亡率的趋势。我们会把这些记录 纵向通过概念队列，以实现几个研究目标。 首先，我们将确定是否NH黑人（与NH白人）早产显示生存率下降-或 在美国，婴儿死亡率。其次，我们将研究NH Black / NH白色差异 早产率和婴儿死亡率随着时间的推移而变化，这是对胎儿死亡率波动的反应。 死亡率和新生儿技术的外源性变化（例如，使用产前类固醇）。三是 使用结构性种族主义的理论框架，以审查在何种程度上动态种族为基础的空间 不平等指标（例如，隔离，监禁率）影响了NH中不同地点和时间的模式 早产儿中黑人（与NH白色）胎儿丢失、子宫内选择和婴儿死亡率。 我们的工作是重要的，因为我们专注于围产期结果的整个范围，包括经常 被忽视的，但相当大的种族差异在胎儿死亡。预计成果将促进知识基础 NICHD的高优先级研究领域，以更好地了解婴儿健康的种族/民族差异。我们 这种方法还将让我们了解结构性种族主义可能维持的程度--或者 围产期健康差距加剧。最后，我们基于地点的分析将确定具有以下特征的地区： 可能受益于有针对性的医疗保健， 非医疗资源。

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.