Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
JAMA Pediatr. 2019 Dec 1;173(12):e193319. doi: 10.1001/jamapediatrics.2019.3319. Epub 2019 Dec 2.
Large racial/ethnic disparities in breastfeeding are associated with adverse health outcomes.
To examine breastfeeding trends by race/ethnicity from 2009 to 2015 and changes in breastfeeding gaps comparing racial/ethnic subgroups with white infants from 2009-2010 to 2014-2015.
DESIGN, SETTING, AND PARTICIPANTS: This study used data from 167 842 infants from the National Immunization Survey-Child (NIS-Child), a random-digit-dialed telephone survey among a complex, stratified, multistage probability sample of US households with children aged 19 to 35 months at the time of the survey. This study analyzed data collected from January 1, 2011, through December 31, 2017, for children born between 2009 and 2015.
Child's race/ethnicity categorized as Hispanic or non-Hispanic white, black, Asian, or American Indian or Alaskan Native.
Breastfeeding rates, including ever breastfeeding, exclusive breastfeeding through 6 months, and continuation of breastfeeding at 12 months.
This study included 167 842 infants (mean [SD] age, 2.33 [0.45] years; 86 321 [51.4%] male and 81 521 [48.6%] female). Overall unadjusted breastfeeding rates increased from 2009 to 2015 by 7.1 percentage points for initiation, 9.2 percentage points for exclusivity, and 11.3 percentage points for duration, with considerable variation by race/ethnicity. Most racial/ethnic groups had significant increases in breastfeeding rates. From 2009-2010 to 2014-2015, disparities in adjusted breastfeeding rates became larger between black and white infants. For example, the difference for exclusive breastfeeding through 6 months between black and white infants widened from 0.5 to 4.5 percentage points with a 4.0% difference in difference (P < .001) from 2009-2010 to 2014-2015. In contrast, the breastfeeding differences between Hispanic, Asian, and American Indian or Alaskan Native infants and white infants became smaller or stayed the same except for continued breastfeeding at 12 months among Asians. For example, the difference in continued breastfeeding at 12 months between Hispanic and white infants decreased from 7.8 to 3.8 percentage points between 2 periods, yielding a -4.0% difference in difference (P < .001). Because of positive trends among all race/ethnicities, these reduced differences were likely associated with greater increases among white infants throughout the study years.
Despite breastfeeding improvements among each race/ethnicity group, breastfeeding disparities between black and white infants became larger when breastfeeding improvements decreased even further among black infants in 2014-2015. The reduced breastfeeding gaps among all other nonwhite groups may be associated with greater increases among white infants. More efforts appear to be needed to improve breastfeeding rates among black infants.
母乳喂养方面存在的大规模种族/民族差异与不良健康结果有关。
检查 2009 年至 2015 年按种族/民族划分的母乳喂养趋势，以及 2009-2010 年至 2014-2015 年期间，与白种婴儿相比，各种族/民族亚组的母乳喂养差距变化情况。
设计、地点和参与者：这项研究使用了来自 167842 名婴儿的数据，这些婴儿来自全国免疫调查-儿童（NIS-Child），这是一项针对美国家庭的随机数字拨号电话调查，这些家庭的孩子年龄在 19 至 35 个月之间。这项研究分析了 2011 年 1 月 1 日至 2017 年 12 月 31 日期间出生的 2009 年至 2015 年期间出生的儿童的数据。
儿童的种族/民族分为西班牙裔或非西班牙裔白人、黑种人、亚洲人或美洲印第安人或阿拉斯加原住民。
母乳喂养率，包括母乳喂养、6 个月内纯母乳喂养和 12 个月时持续母乳喂养。
本研究纳入了 167842 名婴儿（平均[标准差]年龄为 2.33[0.45]岁；86321 名[51.4%]男性和 81521 名[48.6%]女性）。总体而言，未调整的母乳喂养率从 2009 年到 2015 年增加了 7.1 个百分点，从 2009 年到 2015 年增加了 9.2 个百分点，从 2009 年到 2015 年增加了 11.3 个百分点，种族/民族差异较大。大多数种族/民族群体的母乳喂养率都有显著提高。从 2009-2010 年到 2014-2015 年，黑种婴儿和白种婴儿之间的调整后母乳喂养率差距进一步扩大。例如，在 6 个月时纯母乳喂养的比例从 2009-2010 年的 0.5%增加到 2014-2015 年的 4.5%，差异为 4.0%（P<0.001）。相比之下，西班牙裔、亚洲裔和美洲印第安人或阿拉斯加原住民婴儿与白种婴儿之间的母乳喂养差异要么缩小，要么保持不变，除了亚洲人在 12 个月时持续母乳喂养。例如，西班牙裔婴儿和白种婴儿在 12 个月时持续母乳喂养的差异从两个时期的 7.8%降至 3.8%，差异为-4.0%（P<0.001）。由于所有种族/民族群体的趋势都呈积极态势，因此这些减少的差异可能与白人婴儿在整个研究期间的更大增幅有关。
尽管每个种族/民族群体的母乳喂养情况都有所改善，但在 2014-2015 年期间，黑人婴儿的母乳喂养率进一步下降，黑人和白人婴儿之间的母乳喂养差距进一步扩大。所有其他非白人群体的母乳喂养差距缩小可能与白人婴儿的增幅更大有关。似乎需要进一步努力来提高黑人婴儿的母乳喂养率。
