1 Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA.
2 Southwest Institute for Health Disparities Research, College of Health and Social Services, New Mexico State University, Las Cruces, NM, USA.
Public Health Rep. 2018 May/Jun;133(3):318-328. doi: 10.1177/0033354918765444. Epub 2018 Apr 13.
Despite knowledge that the Hispanic population is growing in the United States and that birth outcomes may vary by maternal country of birth, data on birth outcomes by maternal country of birth among Hispanic women are scant. We compared the rates of 3 birth outcomes for infants born in the United States-preterm birth, low birth weight, and small for gestational age-between foreign-born Hispanic women and US-born Hispanic women, and then we examined these birth outcomes by mother's country of birth for foreign-born Hispanic women.
Using the 2013 natality file from the National Vital Statistics System of the National Center for Health Statistics, we examined data on the 3 birth outcomes and maternal characteristics by maternal country of birth. We used log binomial models to calculate unadjusted and adjusted relative risks for preterm birth, low birth weight, and small for gestational age for US-born Hispanic women compared with foreign-born Hispanic women. We also compared the relative risk of each adverse birth outcome for foreign-born Hispanic women by country of birth.
US-born Hispanic women had higher rates of the 3 birth outcomes than did foreign-born Hispanic women (preterm birth: 8.0% vs 7.0%; low birth weight: 6.1% vs 5.2%; small for gestational age: 9.2% vs 7.9%). These higher rates persisted after adjusting for maternal characteristics. The rates for these 3 birth outcomes varied significantly by country of birth for foreign-born Hispanic women, with Puerto Rican women consistently having the poorest birth outcomes.
Our results demonstrated heterogeneity in rates of adverse birth outcomes by country of birth for foreign-born Hispanic women. Presenting rates for foreign-born mothers as a group masks differences by country. To understand possible changes in data on birth outcomes, states should stratify data by maternal country of birth.
尽管人们知道在美国,西班牙裔人口不断增加,而且出生结果可能因产妇的出生国而异,但有关西班牙裔产妇的出生结果的数据却很少。我们比较了出生于美国的西班牙裔婴儿的三种出生结果(早产、低出生体重和小于胎龄儿)在外国出生的西班牙裔女性和美国出生的西班牙裔女性之间的发生率,然后我们检查了外国出生的西班牙裔女性的这些出生结果与母亲的出生国之间的关系。
我们使用国家卫生统计中心国家生命统计系统 2013 年出生档案,检查了按产妇出生国分类的三种出生结果和产妇特征的数据。我们使用对数二项式模型,计算了与外国出生的西班牙裔女性相比,美国出生的西班牙裔女性早产、低出生体重和小于胎龄儿的未调整和调整后的相对风险。我们还比较了外国出生的西班牙裔女性因出生国而异的每种不良出生结果的相对风险。
美国出生的西班牙裔女性的三种出生结果的发生率均高于外国出生的西班牙裔女性(早产:8.0%对 7.0%;低出生体重:6.1%对 5.2%;小于胎龄儿:9.2%对 7.9%)。在调整了产妇特征后,这些较高的比率仍然存在。对于外国出生的西班牙裔女性,这三种出生结果的发生率因出生国而异,波多黎各女性的出生结果始终最差。
我们的研究结果表明,外国出生的西班牙裔女性的不良出生结果的发生率因出生国而异存在异质性。将外国出生的母亲的比率作为一个整体,掩盖了各国之间的差异。为了了解出生结果数据的可能变化,各州应按产妇的出生国对数据进行分层。