Murthy Karna, Macheras Michelle, Grobman William A, Lorch Scott A
Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Am J Perinatol. 2015 Aug;32(10):952-9. doi: 10.1055/s-0035-1544191. Epub 2015 Mar 31.
To estimate the interhospital differences in induction of labor (IOL) from 34(0/7) to 38(6/7) weeks' gestation by race/ethnicity.
Women between 34 and 42 weeks' gestation during 1995 and 2009 in three states were identified using linked maternal and infant records. Women with prior cesarean delivery, premature rupture of membranes, gestational hypertension, who delivered at hospitals with < 100 annual births, or who had missing data were excluded. The outcomes were inductions at early-term (ETI: between 37(0/7) and 38(6/7) weeks') and late preterm (LPI: from 34(0/7)-36(6/7) weeks') gestations. Cox proportional hazard ratios (HR) were used to estimate the independent associations between race/ethnicity and hospital of delivery on ETI and LPI.
A total of 6.98 million eligible women delivered at 469 hospitals. ETI and LPI occurred in 3.20 and 0.40% of women, respectively. Non-Hispanic white women (3.99%) received ETI most commonly; conversely, LPI was highest among non-Hispanic black women (0.50%). In multivariable analyses, non-Hispanic black race was protective for ETI (HR = 0.89; p < 0.01) and was a risk factor for LPI (HR = 1.26; p < 0.01) after adjusting for patient factors and the delivery hospital.
Racial differences in ETI and LPI appear to be pervasive. Much of the unaccounted racial/ethnic variation remains seems secondary to within-hospital differences in selecting women for IOL.
评估妊娠34（0/7）至38（6/7）周时不同种族/族裔间引产（IOL）的医院间差异。
利用母婴关联记录确定1995年至2009年期间三个州妊娠34至42周的妇女。排除既往有剖宫产史、胎膜早破、妊娠期高血压、在年分娩量少于100例的医院分娩或有数据缺失的妇女。结局指标为早期妊娠引产（ETI：妊娠37（0/7）至38（6/7）周之间）和晚期早产引产（LPI：妊娠34（0/7）至36（6/7）周）。采用Cox比例风险比（HR）评估种族/族裔与分娩医院对ETI和LPI的独立关联。
共有698万符合条件的妇女在469家医院分娩。ETI和LPI分别发生在3.20%和0.40%的妇女中。非西班牙裔白人妇女接受ETI最为常见（3.99%）；相反，非西班牙裔黑人妇女的LPI发生率最高（0.50%）。在多变量分析中，调整患者因素和分娩医院后，非西班牙裔黑人种族对ETI具有保护作用（HR = 0.89；p < 0.01），且是LPI的危险因素（HR = 1.26；p < 0.01）。
ETI和LPI中的种族差异似乎普遍存在。许多无法解释的种族/族裔差异似乎继发于医院内部在选择IOL妇女方面的差异。
