Salihu Hamisu M, Kornosky Jennifer L, Alio Amina P, Druschel Charlotte M
Department of Epidemiology, College of Public Health, University of South Florida, Tampa, FL 33613, USA.
J Natl Med Assoc. 2009 May;101(5):456-61. doi: 10.1016/s0027-9684(15)30932-9.
Congenital malformations are the major cause of infant mortality in the United States, but their contribution to overall racial disparity--a major public health concern--is poorly understood. We sought to estimate the contribution of a congenitally acquired central nervous system lesion, Dandy-Walker Syndrome (DWS), to black-white disparity in infant mortality.
Data were obtained from the New York State Congenital Malformations Registry, an ongoing population-based validated surveillance system. We compared black to white infants with respect to infant, neonatal, and postneonatal mortality using Cox proportional hazards regression models.
A total of 196 live-born neonates were diagnosed with DWS in the state from 1992 to 2005 inclusive. Of these, 53 were non-Hispanic black and 76 were non-Hispanic white. Neonatal mortality was similar for non-Hispanic blacks and non-Hispanic whites (adjusted hazards ratio [AHR], 1.42; 95% CI, 0.52-3.82), but non-Hispanic blacks had an 8-fold increased risk for postneonatal mortality (AHR, 8.26; 95% CI, 2.08-32.72). Adjustment for fetal growth and other maternal and infant characteristics resulted in a 10-fold increased risk of mortality for non-Hispanic black infants as compared to non-Hispanic whites. By contrast, adjustment for preterm birth attenuated the risk, but non-Hispanic black infants were still more than 6 times as likely to die during the postneonatal period than non-Hispanic whites (AHR, 6.36, 95% CI, 1.52-26.60).
DWS has one of the largest black-white disparities in postneonatal survival. This underscores the importance of evaluating racial disparities in infant mortality by specific conditions in order to formulate targeted interventions to reduce disparities.
先天性畸形是美国婴儿死亡的主要原因，但人们对其在整体种族差异（一个主要的公共卫生问题）中所起的作用了解甚少。我们试图评估先天性获得性中枢神经系统病变——丹迪-沃克综合征（DWS）对婴儿死亡率中黑白差异的影响。
数据来自纽约州先天性畸形登记处，这是一个持续运行的基于人群的经过验证的监测系统。我们使用Cox比例风险回归模型比较了黑人与白人婴儿在婴儿期、新生儿期和新生儿后期的死亡率。
1992年至2005年（含）期间，该州共有196例活产新生儿被诊断为DWS。其中，53例为非西班牙裔黑人，76例为非西班牙裔白人。非西班牙裔黑人和非西班牙裔白人的新生儿死亡率相似（调整后风险比[AHR]，1.42；95%可信区间，0.52 - 3.82），但非西班牙裔黑人在新生儿后期的死亡风险增加了8倍（AHR，8.26；95%可信区间，2.08 - 32.72）。对胎儿生长以及其他母婴特征进行调整后，非西班牙裔黑人婴儿的死亡风险比非西班牙裔白人增加了10倍。相比之下，对早产进行调整后风险有所降低，但非西班牙裔黑人婴儿在新生儿后期死亡的可能性仍是非西班牙裔白人的6倍多（AHR，6.36，95%可信区间，1.52 - 26.60）。
DWS在新生儿后期生存方面存在最大的黑白差异之一。这凸显了按特定情况评估婴儿死亡率中的种族差异以制定有针对性的干预措施来减少差异的重要性。
