出生结局中黑人和白人差异的分解分析：加利福尼亚州空气污染和社会因素的相对贡献
Decomposition Analysis of Black-White Disparities in Birth Outcomes: The Relative Contribution of Air Pollution and Social Factors in California.
作者信息
Benmarhnia Tarik, Huang Jonathan, Basu Rupa, Wu Jun, Bruckner Tim A
机构信息
Department of Family Medicine and Public Health & Scripps Institution of Oceanography , University of California.
Institute for Health and Social Policy, McGill University Montreal , Quebec, Canada.
出版信息
Environ Health Perspect. 2017 Oct 4;125(10):107003. doi: 10.1289/EHP490.
BACKGROUND
Racial/ethnic disparities in preterm birth (PTB) are well documented in the epidemiological literature, but little is known about the relative contribution of different social and environmental determinants of such disparities in birth outcome. Furthermore, increased focus has recently turned toward modifiable aspects of the environment, including physical characteristics, such as neighborhood air pollution, to reduce disparities in birth outcomes.
OBJECTIVES
To apply decomposition methods to understand disparities in preterm birth (PTB) prevalence between births of non-Hispanic black individuals and births of non-Hispanic white individuals in California, according to individual demographics, neighborhood socioeconomic environment, and neighborhood air pollution.
METHODS
We used all live singleton births in California spanning 2005 to 2010 and estimated PTBs and other adverse birth outcomes for infants borne by non-Hispanic black mothers and white mothers. To compare individual-level, neighborhood-level, and air pollution [Particulate Matter, 2.5 micrometers or less (PM) and nitrogen dioxide (NO)] predictors, we conducted a nonlinear extension of the Blinder-Oaxaca method to decompose racial/ethnic disparities in PTB.
RESULTS
The predicted differences in probability of PTB between black and white infants was 0.056 (95% CI: 0.054, 0.058). All included predictors explained 37.8% of the black-white disparity. Overall, individual (17.5% for PTB) and neighborhood-level variables (16.1% for PTB) explained a greater proportion of the black-white difference in birth outcomes than air pollution (5.7% for PTB).
CONCLUSIONS
Our results suggest that, although the role of individual and neighborhood factors remains prevailing in explaining black-white differences in birth outcomes, the individual contribution of PM is comparable in magnitude to any single individual- or neighborhood-level factor. https://doi.org/10.1289/EHP490.
背景
早产（PTB）方面的种族/族裔差异在流行病学文献中有充分记载，但对于导致此类出生结局差异的不同社会和环境决定因素的相对贡献却知之甚少。此外，最近人们越来越关注环境中可改变的因素，包括物理特征，如邻里空气污染，以减少出生结局方面的差异。
目的
应用分解方法，根据个体人口统计学、邻里社会经济环境和邻里空气污染情况，了解加利福尼亚州非西班牙裔黑人婴儿出生与非西班牙裔白人婴儿出生之间早产（PTB）患病率的差异。
方法
我们使用了2005年至2010年加利福尼亚州所有单胎活产数据，并估计了非西班牙裔黑人母亲和白人母亲所生婴儿的早产及其他不良出生结局情况。为了比较个体层面、邻里层面和空气污染[细颗粒物，直径2.5微米及以下（PM）和二氧化氮（NO）]预测因素，我们对布林德-奥瓦萨卡方法进行了非线性扩展，以分解早产方面的种族/族裔差异。
结果
黑人和白人婴儿早产概率的预测差异为0.056（95%置信区间：0.054，0.058）。所有纳入的预测因素解释了黑人和白人之间差异的37.8%。总体而言，个体因素（早产方面占17.5%）和邻里层面变量（早产方面占16.1%）在解释出生结局的黑白差异方面所占比例高于空气污染因素（早产方面占5.7%）。
结论
我们的结果表明，虽然个体和邻里因素在解释出生结局的黑白差异方面仍然占主导地位，但PM的个体贡献在量级上与任何单个个体或邻里层面因素相当。https://doi.org/10.1289/EHP490。
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