Xu Xiao, Grigorescu Violanda, Siefert Kristine A, Lori Jody R, Ransom Scott B
Department of Obstetrics and Gynecology, University of Michigan, MI, USA.
J Health Care Poor Underserved. 2009 Aug;20(3):729-47. doi: 10.1353/hpu.0.0180.
This study examined the economic costs associated with racial disparity in preterm birth and preterm fetal death in Michigan. Linked 2003 Michigan vital statistics and hospital discharge data were used for data analysis. Thirteen percent of the singleton births among non-Hispanic Blacks were before 37 completed weeks of gestation, compared with only 7.7% among non-Hispanic Whites (risk ratio = 1.66, 95% confidence interval: 1.59-1.72; p<.0001). One thousand one hundred and eighty four (1,184) non-Hispanic Black, singleton preterm births and preterm fetal deaths would have been avoided in 2003 had their preterm birth rate been the same as Michigan non-Hispanic Whites. Economic costs associated with these excess Black preterm births and preterm fetal deaths amounted to $329 million (range: $148 million-$598 million) across their lifespan over and above the costs if they were born at term, including costs associated with the initial hospitalization, productivity loss due to perinatal death, and major developmental disabilities. Hence, racial disparity in preterm birth and preterm fetal death has substantial cost implications for society. Improving pregnancy outcomes for African American women and reducing the disparity between Blacks and Whites should continue to be a focus of future research and interventions.
本研究调查了密歇根州早产和早产胎儿死亡方面种族差异所带来的经济成本。分析数据采用了2003年密歇根州的关联生命统计数据和医院出院数据。非西班牙裔黑人单胎分娩中有13%发生在妊娠满37周之前，相比之下，非西班牙裔白人中这一比例仅为7.7%（风险比 = 1.66，95%置信区间：1.59 - 1.72；p <.0001）。如果2003年非西班牙裔黑人的早产率与密歇根州非西班牙裔白人相同，那么1184例非西班牙裔黑人单胎早产和早产胎儿死亡本可避免。这些额外的黑人早产和早产胎儿死亡所带来的经济成本在其整个生命周期内总计达3.29亿美元（范围：1.48亿美元 - 5.98亿美元），这超出了他们足月出生时的成本，包括初始住院费用、围产期死亡导致的生产力损失以及严重发育障碍相关的成本。因此，早产和早产胎儿死亡方面的种族差异给社会带来了巨大的成本影响。改善非裔美国女性的妊娠结局以及缩小黑人和白人之间的差距应继续成为未来研究和干预的重点。
