Minhas Anum S, Boakye Ellen, Obisesan Olufunmilayo H, Kwapong Yaa A, Zakaria Sammy, Creanga Andreea A, Vaught Arthur J, Mehta Laxmi S, Davis Melinda B, Bello Natalie A, Cainzos-Achirica Miguel, Nasir Khurram, Blaha Michael J, Blumenthal Roger S, Douglas Pamela S, Wang Xiaobin, Sharma Garima
Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
CJC Open. 2021 Nov 5;4(3):289-298. doi: 10.1016/j.cjco.2021.10.009. eCollection 2022 Mar.
Preterm birth (PTB) is associated with future cardiovascular disease (CVD) risk and disproportionally affects non-Hispanic Black (NHB) women. Limited data exist on the influence of length of US residence on nativity-related disparities in PTB. We examined PTB by maternal nativity (US born vs foreign born) and length of US residence among NHB women.
We analyzed data from 2699 NHB women (1607 US born; 1092 foreign born) in the Boston Birth Cohort, originally designed as a case-control study. Using multivariable logistic regression, we investigated the association of PTB with maternal nativity and length of US residence.
In the total sample, 29.1% of women delivered preterm (31.4% and 25.6% among US born and foreign born, respectively). Compared with foreign born, US-born women were younger (25.8 vs 29.5 years), had higher prevalence of obesity (27.6% vs 19.6%), smoking (20.5% vs 4.9%), alcohol use (13.2% vs 7.4%), and moderate to severe stress (73.5% vs 59.4%) (all < 0.001). Compared with US-born women, foreign-born women had lower odds of PTB after adjusting for sociodemographic characteristics, alcohol use, stress, parity, smoking, body mass index, chronic hypertension, and diabetes (adjusted odds ratio [aOR], 0.79; 95% confidence interval [CI], 0.65-0.97. Foreign-born NHB women with < 10 years of US residence had 43% lower odds of PTB compared with US-born (aOR, 0.57; 95% CI, 0.43-0.75), whereas those with ≥ 10 years of US residence did not differ significantly from US-born women in their odds of PTB (aOR, 0.76; 95% CI, 0.54-1.07).
The prevalence of CVD risk factors and proportion of women delivering preterm were lower in foreign-born than US-born NHB women. The "foreign-born advantage" was not observed with ≥ 10 years of US residence. Our study highlights the need to intensify public health efforts in exploring and addressing nativity-related disparities in PTB.
早产（PTB）与未来心血管疾病（CVD）风险相关，并且对非西班牙裔黑人（NHB）女性的影响尤为严重。关于在美国居住时长对与出生地相关的早产差异的影响，现有数据有限。我们研究了NHB女性中按母亲出生地（美国出生与外国出生）及在美国居住时长划分的早产情况。
我们分析了波士顿出生队列中2699名NHB女性（1607名美国出生；1092名外国出生）的数据，该队列最初设计为一项病例对照研究。我们使用多变量逻辑回归分析早产与母亲出生地及在美国居住时长之间的关联。
在总样本中，29.1%的女性早产（美国出生和外国出生的女性中分别为31.4%和25.6%）。与外国出生的女性相比，美国出生的女性更年轻（25.8岁对29.5岁），肥胖（27.6%对19.6%）、吸烟（20.5%对4.9%）、饮酒（13.2%对7.4%）及中度至重度压力（73.5%对59.4%）的患病率更高（均P<0.001）。在调整了社会人口学特征、饮酒、压力、产次、吸烟、体重指数、慢性高血压和糖尿病后，与美国出生的女性相比，外国出生的女性早产几率更低（调整后的优势比[aOR]为0.79；95%置信区间[CI]为0.65 - 0.97）。在美国居住时间不足10年的外国出生NHB女性早产几率比美国出生的女性低43%（aOR为0.57；95%CI为0.43 - 0.75），而在美国居住时间≥10年的外国出生女性早产几率与美国出生的女性相比无显著差异（aOR为0.76；95%CI为0.54 - 1.07）。
外国出生的NHB女性中CVD风险因素的患病率及早产女性比例低于美国出生的NHB女性。在美国居住≥10年未观察到“外国出生优势”。我们的研究强调了加强公共卫生工作以探索和解决与出生地相关的早产差异的必要性。
