加利福尼亚州非裔美国、西班牙裔和白人女性低出生体重的社区层面相关因素
Community Level Correlates of Low Birthweight Among African American, Hispanic and White Women in California.
作者信息
Herd Denise, Gruenewald Paul, Remer Lillian, Guendelman Sylvia
机构信息
School of Public Health, University of California, 50 University Hall, Berkeley, CA, 94720, USA.
Prevention Research Center, 180 Grand Avenue, Oakland, CA, 94612, USA.
出版信息
Matern Child Health J. 2015 Oct;19(10):2251-60. doi: 10.1007/s10995-015-1744-8.
OBJECTIVES
Racial and ethnic groups in the US exhibit major differences in low birthweight (LBW) rates. While previous studies have shown that community level social indicators associated with LBW vary by race and ethnicity, it is not known whether these differences exist among racial or ethnic groups who live in the same neighborhood or community. To address this question, we examined the association of community level features with LBW among African American, White and Hispanic women who live in similar geographic areas.
METHODS
The analysis is based on geocoded birth certificates for all singleton live births in the year 2000 to women residing in 805 California ZIP codes. Community level social and demographic data were obtained from U.S. Census data files for the year 2000 and surrogate indices of population level alcohol and drug abuse and dependence were derived from hospital discharge data (HDD). Tobit and bootstrap analyses were used to test associations with birth outcomes, maternal characteristics, and community level social and demographic features within and across the three groups of women living in similar geographic areas.
RESULTS
The results demonstrate major racial and ethnic differences in community level correlates of LBW. Rates of LBW among African Americans were lower if they lived in areas that were more densely populated, had greater income disparities, were more racially segregated, and had low rates of alcohol abuse or dependence. These associations were different or absent for Hispanic and White women.
CONCLUSIONS FOR PRACTICE
The results suggest that despite living in the same areas, major differences in neighborhood features and social processes are linked to birth outcomes of African American women compared to Hispanic and White women. Further research, especially using multilevel approaches, is needed to precisely identify these differences to help reduce racial and ethnic disparities in LBW.
目标
美国的种族和族裔群体在低体重儿（LBW）发生率上存在重大差异。虽然先前的研究表明，与低体重儿相关的社区层面社会指标因种族和族裔而异，但尚不清楚这些差异是否存在于居住在同一邻里或社区的种族或族裔群体之间。为了解决这个问题，我们研究了居住在相似地理区域的非裔美国女性、白人女性和西班牙裔女性中，社区层面特征与低体重儿之间的关联。
方法
分析基于2000年居住在加利福尼亚州805个邮政编码区域内所有单胎活产妇女的地理编码出生证明。社区层面的社会和人口数据来自2000年的美国人口普查数据文件，人口层面酒精和药物滥用及依赖的替代指标来自医院出院数据（HDD）。使用Tobit模型和自助法分析来检验与居住在相似地理区域的三组女性的出生结局、孕产妇特征以及社区层面社会和人口特征之间的关联。
结果
结果表明，在社区层面与低体重儿相关的因素上存在重大的种族和族裔差异。如果非裔美国人居住在人口更密集、收入差距更大、种族隔离更严重且酒精滥用或依赖率较低的地区，其低体重儿发生率较低。西班牙裔和白人女性的这些关联则不同或不存在。
实践结论
结果表明，尽管居住在相同地区，但与西班牙裔和白人女性相比，邻里特征和社会过程的重大差异与非裔美国女性的出生结局相关。需要进一步的研究，特别是采用多层次方法，来精确识别这些差异，以帮助减少低体重儿方面的种族和族裔差异。
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