Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, and Children's Memorial Hermann Hospital, Houston, Texas.
George Washington University Biostatistics Center, Washington, District of Columbia.
Am J Perinatol. 2023 Apr;40(5):557-566. doi: 10.1055/s-0041-1730348. Epub 2021 May 31.
This study aimed to evaluate whether racial and ethnic disparities in adverse perinatal outcomes exist at term.
We performed a secondary analysis of a multicenter observational study of 115,502 pregnant patients and their neonates (2008-2011). Singleton, nonanomalous pregnancies delivered from 37 to 41 weeks were included. Race and ethnicity were abstracted from the medical record and categorized as non-Hispanic White (White; referent), non-Hispanic Black (Black), non-Hispanic Asian (Asian), or Hispanic. The primary outcome was an adverse perinatal composite defined as perinatal death, Apgar score < 4 at 5 minutes, ventilator support, hypoxic-ischemic encephalopathy, subgaleal hemorrhage, skeletal fracture, infant stay greater than maternal stay (by ≥ 3 days), brachial plexus palsy, or facial nerve palsy.
Of the 72,117 patients included, 48% were White, 20% Black, 5% Asian, and 26% Hispanic. The unadjusted risk of the primary outcome was highest for neonates of Black patients (3.1%, unadjusted relative risk [uRR] = 1.16, 95% confidence interval [CI]: 1.04-1.30), lowest for neonates of Hispanic patients (2.1%, uRR = 0.80, 95% CI: 0.71-0.89), and no different for neonates of Asian (2.6%), compared with those of White patients (2.7%). In the adjusted model including age, body mass index (BMI), smoking, obstetric history, and high-risk pregnancy, differences in risk for the primary outcome were no longer observed for neonates of Black (adjusted relative risk [aRR] = 1.06, 95% CI: 0.94-1.19) and Hispanic (aRR = 0.92, 95% CI: 0.81-1.04) patients. Adding insurance to the model lowered the risk for both groups (aRR = 0.85, 95% CI: 0.75-0.96 for Black; aRR = 0.68, 95% CI: 0.59-0.78 for Hispanic).
Although neonates of Black patients have the highest frequency of adverse perinatal outcomes at term, after adjustment for sociodemographic factors, this higher risk is no longer observed, suggesting the importance of developing strategies that address social determinants of health to lessen extant health disparities.
· Term neonates of Black patients have the highest crude frequency of adverse perinatal outcomes.. · After adjustment for confounders, higher risk for neonates of Black patients is no longer observed.. · Disparities in outcomes are strongly related to insurance status..
本研究旨在评估在足月时是否存在种族和民族的不良围产结局差异。
我们对一项包含 115502 名孕妇及其新生儿的多中心观察性研究（2008-2011 年）进行了二次分析。纳入单胎、非畸形、37 至 41 周分娩的孕妇。种族和民族从病历中提取，并分为非西班牙裔白人（白人；参照）、非西班牙裔黑人（黑人）、非西班牙裔亚裔（亚裔）或西班牙裔。主要结局是不良围产复合结局，定义为围产儿死亡、5 分钟时 Apgar 评分<4、呼吸机支持、缺氧缺血性脑病、骨膜下血肿、骨骨折、新生儿住院时间大于母亲（≥3 天）、臂丛神经麻痹或面神经麻痹。
在纳入的 72117 名患者中，48%为白人，20%为黑人，5%为亚裔，26%为西班牙裔。未调整的黑人新生儿不良围产结局风险最高（3.1%，未调整的相对风险[uRR]为 1.16，95%置信区间[CI]：1.04-1.30），西班牙裔新生儿最低（2.1%，uRR 为 0.80，95% CI：0.71-0.89），而与白人新生儿（2.7%）相比，亚裔新生儿（2.6%）无差异。在包括年龄、体重指数（BMI）、吸烟、产科史和高危妊娠的调整模型中，黑人（调整相对风险[aRR]为 1.06，95% CI：0.94-1.19）和西班牙裔（aRR 为 0.92，95% CI：0.81-1.04）新生儿的主要结局风险差异不再显著。在模型中加入保险会降低两组的风险（黑人组的 aRR 为 0.85，95% CI：0.75-0.96；西班牙裔组的 aRR 为 0.68，95% CI：0.59-0.78）。
尽管足月黑人新生儿的不良围产结局发生率最高，但在调整社会人口因素后，这种更高的风险不再存在，这表明需要制定解决健康社会决定因素的策略来减少现有的健康差异。
·黑人足月新生儿不良围产结局发生率最高。
·在调整混杂因素后，黑人新生儿的高风险不再存在。
·结局差异与保险状况密切相关。
