Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Pediatrics. 2012 Sep;130(3):e518-27. doi: 10.1542/peds.2011-3475. Epub 2012 Aug 20.
Birth defects are a leading cause of infant mortality in the United States. Previous reports have highlighted black-white differences in overall infant mortality and infant mortality attributable to birth defects (IMBD). We evaluated the impact of gestational age on US racial/ethnic differences in IMBD.
We estimated the rate of IMBD as the underlying cause of death using the period-linked birth/infant death data for US residents for January 2003 to December 2006. We excluded infants with missing gestational age, implausible values based on Alexander's index of birth weight for gestational age norms, or gestational ages <20 weeks or >44 weeks; we categorized gestational age into 3 groups: 20 to 33, 34 to 36, and 37 to 44 weeks. Using Poisson regression, we compared neonatal and postneonatal IMBD for infants of non-Hispanic black and Hispanic mothers with that for infants of non-Hispanic white mothers stratified by gestational age.
IMBD occurred in 12.2 per 10 000 live births. Among infants delivered at 37 to 44 weeks, blacks (and Hispanics, to a lesser degree) had significantly higher neonatal and postneonatal IMBD than whites; however, among infants delivered at 20 to 33 or 34 to 36 weeks, neonatal (but not postneonatal) IMBD was significantly lower among blacks compared with whites.
Racial/ethnic differences in IMBD were not explained in these data by differences in gestational age. Further investigation should include an assessment of possible racial/ethnic differences in severity and/or access to timely diagnosis and management of birth defects.
在美国，出生缺陷是导致婴儿死亡的主要原因。先前的报告强调了整体婴儿死亡率和因出生缺陷导致的婴儿死亡率（IMBD）的黑-白差异。我们评估了胎龄对美国出生缺陷种族/民族差异的影响。
我们使用美国居民 2003 年 1 月至 2006 年 12 月的与时期相关的出生/婴儿死亡数据，将 IMBD 的发生率作为死亡的根本原因进行估计。我们排除了胎龄缺失、基于亚历山大出生体重胎龄指数的出生体重不可信值、或胎龄<20 周或>44 周的婴儿；我们将胎龄分为 3 组：20 至 33 周、34 至 36 周和 37 至 44 周。使用泊松回归，我们比较了非西班牙裔黑人及西班牙裔母亲所产婴儿与非西班牙裔白人母亲所产婴儿在不同胎龄的新生儿期和后期 IMBD。
IMBD 发生率为每 10000 例活产 12.2 例。在 37 至 44 周分娩的婴儿中，黑人（以及西班牙裔，程度较轻）的新生儿期和后期 IMBD 明显高于白人；然而，在 20 至 33 周或 34 至 36 周分娩的婴儿中，黑人的新生儿期（而非后期）IMBD 明显低于白人。
在这些数据中，胎龄差异并不能解释 IMBD 的种族/民族差异。进一步的研究应包括评估种族/民族之间在出生缺陷的严重程度和/或及时诊断和管理方面可能存在的差异。
