Department of Pediatrics, Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
Am J Public Health. 2012 Oct;102(10):1902-10. doi: 10.2105/AJPH.2012.300852. Epub 2012 Aug 16.
We sought to determine the importance of socioeconomic factors, maternal comorbid conditions, antepartum and intrapartum complications of pregnancy, and fetal factors in mediating racial disparities in fetal deaths. METHODS. We undertook a mediation analysis on a retrospective cohort study of hospital-based deliveries with a gestational age between 23 and 44 weeks in California, Missouri, and Pennsylvania from 1993 to 2005 (n = 7,104,674).
Among non-Hispanic Black women and Hispanic women, the fetal death rate was higher than among non-Hispanic White women (5.9 and 3.6 per 1000 deliveries, respectively, vs 2.6 per 1000 deliveries; P < .01). For Black women, fetal factors mediated the largest percentage (49.6%; 95% confidence interval [CI] = 42.7, 54.7) of the disparity in fetal deaths, whereas antepartum and intrapartum factors mediated some of the difference in fetal deaths for both Black and Asian women. Among Hispanic women, socioeconomic factors mediated 35.8% of the disparity in fetal deaths (95% CI = 25.8%, 46.2%).
The factors that mediate racial/ethnic disparities in fetal death differ depending on the racial/ethnic group. Interventions targeting mediating factors specific to racial/ethnic groups, such as improved access to care, may help reduce US fetal death disparities.
我们旨在确定社会经济因素、孕产妇合并症、妊娠产前和产时并发症以及胎儿因素在介导胎儿死亡的种族差异中的重要性。
我们对 1993 年至 2005 年加利福尼亚州、密苏里州和宾夕法尼亚州的医院分娩进行了回顾性队列研究，纳入了妊娠 23 至 44 周的患者（n=7104674），并进行了中介分析。
在非西班牙裔黑人和西班牙裔女性中，胎儿死亡率高于非西班牙裔白种人（分别为每 1000 例分娩 5.9 和 3.6 例，而每 1000 例分娩 2.6 例；P<.01）。对于黑人女性，胎儿因素介导了胎儿死亡差异的最大比例（49.6%；95%置信区间[CI]：42.7，54.7），而产前和产时因素则部分介导了黑人女性和亚裔女性的胎儿死亡差异。对于西班牙裔女性，社会经济因素介导了胎儿死亡差异的 35.8%（95%CI：25.8%，46.2%）。
介导胎儿死亡种族/民族差异的因素因种族/民族群体而异。针对特定种族/民族群体的中介因素（如改善获得医疗服务的机会）的干预措施可能有助于减少美国胎儿死亡的差异。
