WHO, USEPA, Newark, DE, USA.
DuPont Haskell, Newark, DE, USA.
J Racial Ethn Health Disparities. 2019 Feb;6(1):86-93. doi: 10.1007/s40615-018-0502-1. Epub 2018 Jun 11.
Black/African American (AA) infants have been persistently observed with survival disadvantage compared to White infants in the USA, implying excess mortality. While reliable epidemiologic data continue to illustrate these disparities, data are yet to provide a substantial explanation to the observed rates and risk differences over the past six decades. We aimed in this study to examine the infant mortality risk differences by temporal trends and to provide an ecologic and non-concurrent explanation for the persisted variability.
A retrospective design with aggregate data from the Center for Disease Control and Prevention (CDC) was used to access the risk difference in cause-specific mortality, while stratification analysis was utilized for the risk ratio estimation. We also estimated the percent change for mortality trends.
The cumulative infant mortality (IM) incidence was two times as likely for Black/AA relative to White, risk ratio (RR), 2.05. There were temporal trends in IM between 1968 and 2015 with excess IM among Black/AA children. Specifically, between 1968 and 2015, the percent change (% change) for digestive system disorders (58.43%); genito-urinary tract system disorders (58.20%); muscle, skeleton, and connective tissue disorders (66.60%); congenital anomalies (23.79%); and certain perinatal causes (38.65%) indicated upward trends in infant mortality Black/AA and White risk ratio. Except for neoplasm, and the initial study period (1968-1978) for congenital anomalies, Black/AA infants indicated survival disadvantage, implying excess mortality ratio relative to their White counterparts.
Disease-specific infant mortality is higher among black/AA except for neoplasm, and increasing percent changes are observed in digestive; genito-urinary; and muscle, skeleton, and connective tissue disorders. These findings are suggestive of the pressing needs to examine the cause of these disparities namely social determinants of health and social inequity for specific risk-adapted intervention in achieving health equity in US infant mortality.
与美国的白人婴儿相比，黑种人/非裔美国婴儿的存活率一直存在劣势，这意味着死亡率过高。尽管可靠的流行病学数据继续表明存在这些差异，但数据仍未能对过去六十年观察到的比率和风险差异提供实质性解释。我们旨在本研究中通过时间趋势检查婴儿死亡率差异，并为过去六十年持续存在的变异性提供生态和非同期解释。
使用来自疾病控制与预防中心（CDC）的汇总数据的回顾性设计来评估特定原因死亡率的风险差异，同时利用分层分析来估计风险比估计值。我们还估计了死亡率趋势的百分比变化。
黑种人/非裔美国人的累积婴儿死亡率（IM）发生率是白人的两倍，风险比（RR）为 2.05。1968 年至 2015 年间存在 IM 时间趋势，黑人/非裔美国人儿童的 IM 过多。具体而言，1968 年至 2015 年间，消化系统疾病（58.43％）；生殖泌尿系统疾病（58.20％）；肌肉、骨骼和结缔组织疾病（66.60％）；先天性异常（23.79％）；和某些围产期原因（38.65％）的百分比变化表明黑人/非裔美国人婴儿的死亡率呈上升趋势，而白人婴儿的风险比则呈上升趋势。除了肿瘤和先天性异常的初始研究期（1968-1978 年）外，黑人/非裔美国人婴儿的生存率较差，这意味着与白人相比，他们的死亡率过高。
除了肿瘤外，黑种人/非裔美国人的特定婴儿死亡率更高，并且在消化系统；生殖泌尿系统；肌肉、骨骼和结缔组织疾病中观察到的百分比变化更大。这些发现表明迫切需要检查这些差异的原因，即健康的社会决定因素和社会不平等，以便为美国婴儿死亡率的健康公平制定特定的风险适应干预措施。
