Kleinman J C, Fingerhut L A, Prager K
Division of Analysis, National Center for Health Statistics, Centers for Disease Control, Hyattsville, Md 20782.
Am J Dis Child. 1991 Feb;145(2):194-9. doi: 10.1001/archpedi.1991.02160020086023.
The objective of this study was to examine the effects of nativity status (native vs foreign born) and other maternal characteristics (age, parity, education, and marital status) on infant, neonatal, and postneonatal mortality among white and black mothers. The design of this nonrandomized cohort study was based on birth and death certificates. The setting involved live births among US residents (excluding California, Texas, and Washington) in 1983 and 1984. The participants included white mothers with 4.4 million births and black mothers with 926,000 births in single deliveries. There were no interventions. With regard to measurements (the main results), after adjusting for other risk factors, neonatal mortality risk was 22% lower among the black foreign-born mothers than among the black native-born mothers, while among white infants, there was no risk difference by nativity. Relative risks were more similar for postneonatal mortality, ie, 24% lower among black foreign-born mothers and 20% lower among white foreign-born mothers. Combining the several categories of risk factors into three broad maternal risk groups, there was a near-doubling of black and near-tripling of white infant mortality rates between the low and high levels of maternal risk. We concluded that if the infant mortality rate in the low-risk groups could be achieved by the moderate- and high-risk groups, there would be a 30% reduction in infant deaths within each race. Since the black infant mortality rate is twice the white infant mortality rate and black foreign-born mothers have much lower rates than black native-born mothers, it is likely that further improvement is possible among black infants.
本研究的目的是考察出生地状况（本土出生与外国出生）以及其他母亲特征（年龄、胎次、教育程度和婚姻状况）对白人及黑人母亲的婴儿、新生儿和新生儿后期死亡率的影响。这项非随机队列研究的设计基于出生证明和死亡证明。研究背景涉及1983年和1984年美国居民（不包括加利福尼亚州、得克萨斯州和华盛顿州）的活产情况。研究对象包括单胎分娩的440万例白人母亲分娩和92.6万例黑人母亲分娩。未进行干预。关于测量指标（主要结果），在对其他风险因素进行调整后，外国出生的黑人母亲的新生儿死亡风险比本土出生的黑人母亲低22%，而对于白人婴儿，出生地状况不存在风险差异。新生儿后期死亡率的相对风险更为相似，即外国出生的黑人母亲降低24%，外国出生的白人母亲降低20%。将几类风险因素合并为三个宽泛的母亲风险组后，母亲风险水平低和高的组之间，黑人婴儿死亡率几乎翻倍，白人婴儿死亡率几乎增至三倍。我们得出结论，如果中风险组和高风险组能够达到低风险组的婴儿死亡率水平，那么每个种族的婴儿死亡数将减少30%。由于黑人婴儿死亡率是白人婴儿死亡率的两倍，且外国出生的黑人母亲的死亡率远低于本土出生的黑人母亲，因此黑人婴儿死亡率很可能有进一步改善的空间。
