Hessol Nancy A, Fuentes-Afflick Elena
Department of Medicine, University of California, 405 Irving St, 2nd Floor, San Francisco, CA 94122, USA.
Pediatrics. 2005 Jan;115(1):e44-51. doi: 10.1542/peds.2004-0478.
Ethnic disparities in infant mortality have been consistently documented in the United States, but these disparities are poorly understood. Although the infant mortality rate in the United States has fallen to record low rates, since 1971 the ethnic disparity between black and white infants has remained unchanged or increased. In 2001, the infant mortality rate among black infants was approximately 2.5 times higher than the rate among white and Hispanic infants. The objective of this study was to identify ethnic differences in neonatal and postneonatal mortality as well as the causes and risk factors among infants born in California.
Secondary analysis was performed of 1,277,393 singleton infants live-born to black, Latina, and white women from the California linked birth-infant death certificate from 1995 to 1997. The dependent variables were infant death (defined as an infant who died in the first year of life [death <365 days]), neonatal death (death during the first 27 days of life), and postneonatal death (death between 28 and 364 days of life). Cause-specific neonatal and postneonatal infant mortality rates (per 100,000 live births) were calculated for each ethnic group. Chi(2) and exact test statistics were used to compare the distribution of maternal and infant characteristics and cause-of-death rates by maternal ethnicity. Logistic regression analysis was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) to estimate the relationship between maternal ethnicity, maternal and infant factors, and risk of infant mortality.
In both the neonatal and postneonatal periods, black women had higher infant mortality rates than Latina or white women for conditions originating in the perinatal period (including respiratory distress syndrome) and symptoms, signs, and ill-defined conditions (including sudden infant death syndrome). After adjusting for maternal and infant characteristics, there were no significant ethnic differences for neonatal mortality. For postneonatal mortality, black women had a higher risk (OR: 1.25; 95% CI: 1.10-1.42) and Latina women had a lower risk (OR: 0.80; 95% CI: 0.71-0.89) compared with white women after adjusting for maternal and infant factors. In analyses of all ethnic groups combined, as well as ethnic-specific analyses, the strongest predictors of neonatal and postneonatal death were infant birth weight of <2499 g and gestational age of <33 weeks.
Causes of infant mortality and risk factors for infant mortality differed by maternal ethnicity, indicating a need to tailor prevention and education efforts, especially during the postneonatal period. To achieve national infant mortality goals, health professionals and policy makers should continue to emphasize the importance of early and continuous prenatal care and develop new strategies to reduce the incidence of low birth weight and premature infants. Ethnic-specific approaches may be needed to further reduce infant mortality rates and achieve our national goal to eliminate ethnic disparities in perinatal outcomes.
美国一直存在婴儿死亡率方面的种族差异，但人们对这些差异了解甚少。尽管美国的婴儿死亡率已降至历史最低水平，但自1971年以来，黑人和白人婴儿之间的种族差异一直没有改变或有所增加。2001年，黑人婴儿的死亡率约为白人和西班牙裔婴儿死亡率的2.5倍。本研究的目的是确定加利福尼亚州出生婴儿的新生儿和新生儿后期死亡率的种族差异，以及死亡原因和风险因素。
对1995年至1997年加利福尼亚州出生-婴儿死亡证书关联数据库中1277393名单胎活产的黑人、拉丁裔和白人女性所生婴儿进行二次分析。因变量为婴儿死亡（定义为出生后第一年死亡的婴儿[死亡<365天]）、新生儿死亡（出生后前27天内死亡）和新生儿后期死亡（出生后28至364天内死亡）。计算每个种族群体特定原因的新生儿和新生儿后期婴儿死亡率（每100000例活产）。使用卡方检验和精确检验统计量比较按母亲种族划分的母亲和婴儿特征分布及死因发生率。采用逻辑回归分析计算比值比（OR）和95%置信区间（CI），以估计母亲种族、母亲和婴儿因素与婴儿死亡风险之间的关系。
在新生儿期和新生儿后期，黑人女性所生婴儿因围生期疾病（包括呼吸窘迫综合征）以及症状、体征和不明原因疾病（包括婴儿猝死综合征）导致的死亡率高于拉丁裔或白人女性。在调整母亲和婴儿特征后，新生儿死亡率没有显著的种族差异。对于新生儿后期死亡率，在调整母亲和婴儿因素后，与白人女性相比，黑人女性风险更高（OR：1.25；95%CI：1.10 - 1.42），拉丁裔女性风险更低（OR：0.80；95%CI：0.71 - 0.89）。在所有种族群体合并分析以及特定种族分析中，新生儿和新生儿后期死亡的最强预测因素是出生体重<2499克和孕周<33周。
婴儿死亡率的原因和风险因素因母亲种族而异，这表明需要调整预防和教育措施，尤其是在新生儿后期。为实现全国婴儿死亡率目标，卫生专业人员和政策制定者应继续强调早期和持续产前护理的重要性，并制定新策略以降低低出生体重和早产婴儿的发生率。可能需要采取特定种族的方法来进一步降低婴儿死亡率，并实现我们消除围生期结局种族差异的国家目标。
