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Racial disparities in preterm births and fetal losses

早产和胎儿丢失的种族差异

基本信息

批准号：
10731512
负责人：
Tim Allen Bruckner
金额：
$ 8.44万
依托单位：
UNIVERSITY OF CALIFORNIA-IRVINE
依托单位国家：
美国
项目类别：
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/10731512
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 Disparity Education 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 Quality of Care Race Records Research Research Priority Resource Allocation Resources Risk Sampling Steroids Stress Structural Racism Survivors Technology Testing Time Variant Work antenatal 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 infant morbidity/mortality innovation knowledge base neglect neonatal care perinatal health perinatal outcomes racial difference racial disparity response segregation structural determinants trend

项目摘要

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.

项目总结（30行）

项目成果

期刊论文数量（5）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Expectations of non-COVID-19 deaths during the pre-vaccine pandemic: a process-control approach.

DOI：
10.1186/s12889-022-14829-8
发表时间：
2023-01-23
期刊：
BMC public health
影响因子：
4.5
作者：
通讯作者：

Selection in utero against male twins in the United States early in the COVID-19 pandemic.

在 COVID-19 大流行初期，美国在子宫内选择男性双胞胎。

DOI：
10.1002/ajhb.23830
发表时间：
2023
期刊：
American journal of human biology : the official journal of the Human Biology Council
影响因子：
0
作者：
Bruckner,TimA;Bustos,Brenda;Margerison,Claire;Gemmill,Alison;Casey,Joan;Catalano,Ralph
通讯作者：
Catalano,Ralph

Disparities in preterm birth following the July 1995 Chicago heat wave.

1995 年 7 月芝加哥热浪之后早产的差异。

DOI：
10.1016/j.annepidem.2023.08.008
发表时间：
2023
期刊：
Annals of epidemiology
影响因子：
5.6
作者：
Gordon,Milo;Casey,JoanA;McBrien,Heather;Gemmill,Alison;Hernández,Diana;Catalano,Ralph;Chakrabarti,Suman;Bruckner,Tim
通讯作者：
Bruckner,Tim