Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland.
Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland.
Am J Prev Med. 2019 Nov;57(5):675-686. doi: 10.1016/j.amepre.2019.07.007. Epub 2019 Sep 25.
Reducing racial/ethnic disparities in preterm birth is a priority for U.S. public health programs. The study objective was to quantify the relative contribution of geographic, sociodemographic, and health determinants to the black, non-Hispanic and white, non-Hispanic preterm birth disparity.
Cross-sectional 2016 U.S. birth certificate data (analyzed in 2018-2019) were used. Black-white differences in covariate distributions and preterm birth and very preterm birth rates were examined. Decomposition methods for nonlinear outcomes based on logistic regression were used to quantify the extent to which black-white differences in covariates contributed to preterm birth and very preterm birth disparities.
Covariate differences between black and white women were found within each category of geographic, sociodemographic, and health characteristics. However, not all covariates contributed substantially to the disparity. Close to 38% of the preterm birth and 31% of the very preterm birth disparity could be explained by black-white covariate differences. The largest contributors to the disparity included maternal education (preterm birth, 11.3%; very preterm birth, 9.0%), marital status/paternity acknowledgment (preterm birth, 13.8%; very preterm birth, 14.7%), source of payment for delivery (preterm birth, 6.2%; very preterm birth, 3.2%), and hypertension in pregnancy (preterm birth, 9.9%; very preterm birth, 8.3%). Interpregnancy interval contributed a more sizable contribution to the disparity (preterm birth, 6.2%, very preterm birth, 6.0%) in sensitivity analyses restricted to all nonfirstborn births.
These findings demonstrate that the known portion of the disparity in preterm birth is driven by sociodemographic and preconception/prenatal health factors. Public health programs to enhance social support and preconception care, specifically focused on hypertension, may provide an efficient approach for reducing the racial gap in preterm birth.
降低早产的种族/民族差异是美国公共卫生项目的重点。本研究的目的是量化地理、社会人口统计学和健康决定因素对黑人、非西班牙裔和白人、非西班牙裔早产差异的相对贡献。
使用 2016 年美国出生证明横断面数据（在 2018-2019 年进行分析）。检查了协变量分布和早产及极早产率的黑人和白人之间的差异。使用基于逻辑回归的非线性结果分解方法来量化协变量差异对早产和极早产差异的贡献程度。
在地理、社会人口统计学和健康特征的每个类别中，都发现了黑人和白人妇女之间的协变量差异。然而，并非所有协变量都对差异有很大贡献。接近 38%的早产和 31%的极早产差异可以用黑人和白人之间的协变量差异来解释。差异的最大贡献因素包括母亲的教育程度（早产，11.3%；极早产，9.0%）、婚姻状况/父亲身份承认（早产，13.8%；极早产，14.7%）、分娩付款来源（早产，6.2%；极早产，3.2%）和妊娠高血压（早产，9.9%；极早产，8.3%）。在仅限于所有非第一胎出生的敏感性分析中，产次间隔对差异的贡献更大（早产，6.2%，极早产，6.0%）。
这些发现表明，早产差异的已知部分是由社会人口统计学和孕前/产前健康因素驱动的。加强社会支持和孕前保健的公共卫生项目，特别是专门针对高血压的项目，可能是减少早产种族差距的有效方法。
