Carmichael Suzan L, Kan Peiyi, Padula Amy M, Rehkopf David H, Oehlert John W, Mayo Jonathan A, Weber Ann M, Wise Paul H, Shaw Gary M, Stevenson David K
Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States of America.
Division of Maternal-Fetal Medicine, University of California San Francisco School of Medicine, San Francisco, CA, United States of America.
PLoS One. 2017 Aug 11;12(8):e0182862. doi: 10.1371/journal.pone.0182862. eCollection 2017.
We examined the contribution of social disadvantage to the black-white disparity in preterm birth. Analyses included linked vital and hospital discharge records from 127,358 black and 615,721 white singleton California births from 2007-11. Odds ratios (OR) were estimated by 4 logistic regression models for 2 outcomes: early (<32 wks) and moderate (32-36 wks) spontaneous preterm birth (ePTB, mPTB), stratified by 2 race-ethnicity groups (blacks and whites). We then conducted a potential impact analysis. The OR for less than high school education (vs. college degree) was 1.8 (95% confidence interval 1.6, 2.1) for ePTB among whites but smaller for the other 3 outcome groups (ORs 1.3-1.4). For all 4 groups, higher census tract poverty was associated with increased odds (ORs 1.03-1.05 per 9% change in poverty). Associations were less noteworthy for the other variables (payer, and tract percent black and Gini index of income inequality). Setting 3 factors (education, poverty, payer) to 'favorable' values was associated with lower predicted probability of ePTB (25% lower among blacks, 31% among whites) but a 9% higher disparity, compared to probabilities based on observed values; for mPTB, respective percentages were 28% and 13% lower probability, and 17% lower disparity. Results suggest that social determinants contribute to preterm delivery and its disparities, and that future studies should focus on ePTB and more specific factors related to social circumstances.
我们研究了社会弱势群体对早产方面黑人与白人差异的影响。分析纳入了2007年至2011年加利福尼亚州127,358例黑人单胎出生和615,721例白人单胎出生的生命记录与医院出院记录。通过4个逻辑回归模型对2种结局进行了比值比（OR）估计：早期（<32周）和中期（32 - 36周）自发性早产（ePTB，mPTB），按2个种族 - 族裔组（黑人和白人）分层。然后我们进行了潜在影响分析。白人中，ePTB方面，高中以下学历（相对于大学学历）的OR为1.8（95%置信区间1.6, 2.1），但在其他3个结局组中该比值较小（OR为1.3 - 1.4）。对于所有4组，人口普查区贫困程度越高，比值比越高（贫困率每变化9%，OR为1.03 - 1.05）。其他变量（付款人、人口普查区黑人百分比和收入不平等基尼系数）的关联不太显著。将3个因素（教育、贫困、付款人）设定为“有利”值与ePTB的预测概率降低相关（黑人降低25%，白人降低31%），但与基于观察值的概率相比，差异增加了9%；对于mPTB，相应的百分比分别为概率降低28%和13%，差异降低17%。结果表明，社会决定因素导致了早产及其差异，未来的研究应关注ePTB以及与社会环境相关的更具体因素。
