Arnhold Institute for Global Health at Icahn School of Medicine at Mount Sinai, New York, New York, United States of America.
University of Edinburgh Usher Institute, NINE Edinburgh BioQuarter, Edinburgh, United Kingdom.
PLoS Med. 2022 Jul 12;19(7):e1004040. doi: 10.1371/journal.pmed.1004040. eCollection 2022 Jul.
Apgar scores measure newborn health and are strongly associated with infant outcomes, but their performance has largely been determined in primarily white populations. Given the majority of the global population is not white, we aim to assess whether the association between low Apgar score and mortality in infants varies across racial groups.
Population-based cohort study using 2016 to 2017 United States National Vital Statistics System data. The study included singleton infants born between 37+0 and 44+6 weeks to mothers over 15 years, without congenital abnormalities. We looked at 3 different mortality outcomes: (1) early neonatal mortality; (2) overall neonatal mortality; and (3) infant mortality. We used logistic regression to assess the association between Apgar score (categorized as low, intermediate, and normal) and each mortality outcome, and adjusted for gestational age, sex, maternal BMI, education, age, previous number of live births, and smoking status, and stratified these models by maternal race group (as self-reported on birth certificates). The cohort consisted of 6,809,653 infants (52.8% non-Hispanic white, 23.7% Hispanic, 13.8% non-Hispanic black, 6.6% non-Hispanic Asian, and 3.1% non-Hispanic other). A total of 6,728,829 (98.8%) infants had normal scores, 63,467 (0.9%) had intermediate scores, and 17,357 (0.3%) had low Apgar scores. Compared to infants with normal scores, low-scoring infants had increased odds of infant mortality. There was strong evidence that this association varied by race (p < 0.001) with adjusted odds ratios (AORs) of 54.4 (95% confidence interval [CI] 49.9 to 59.4) in non-Hispanic white, 70.02 (95% CI 60.8 to 80.7) in Hispanic, 23.3 (95% CI 20.3 to 26.8) in non-Hispanic black, 100.4 (95% CI 74.5 to 135.4) in non-Hispanic Asian, and 26.8 (95% CI 19.8 to 36.3) in non-Hispanic other infants. The main limitation was missing data for some variables, due to using routinely collected data.
The association between Apgar scores and mortality varies across racial groups. Low Apgar scores are associated with mortality across racial groups captured by United States (US) records, but are worse at discriminating infants at risk of mortality for black and non-Hispanic non-Asian infants than for white infants. Apgar scores are useful clinical indicators and epidemiological tools; caution is required regarding racial differences in their applicability.
阿普加评分用于衡量新生儿的健康状况，与婴儿的结局密切相关，但该评分主要是在以白人为主的人群中确定的。鉴于全球大多数人口并非白人，我们旨在评估低阿普加评分与婴儿死亡率之间的关联是否因种族群体而异。
这是一项基于人群的队列研究，使用了 2016 年至 2017 年美国国家生命统计系统的数据。研究纳入了母亲年龄在 15 岁以上、胎龄在 37+0 至 44+6 周之间、无先天异常的单胎活产婴儿。我们观察了 3 种不同的死亡结局：（1）早期新生儿死亡；（2）总体新生儿死亡；（3）婴儿死亡。我们使用逻辑回归来评估阿普加评分（分为低、中、正常）与每种死亡结局之间的关联，并根据胎龄、性别、母亲 BMI、教育程度、年龄、既往活产儿数和吸烟状况进行调整，并按母亲的种族群体（出生证明上的自我报告）对这些模型进行分层。该队列包括 6809653 名婴儿（52.8%为非西班牙裔白人，23.7%为西班牙裔，13.8%为非西班牙裔黑人，6.6%为非西班牙裔亚裔，3.1%为其他非西班牙裔）。共有 6728829 名（98.8%）婴儿得分为正常，63467 名（0.9%）得分为中等，17357 名（0.3%）得分为低阿普加评分。与得分正常的婴儿相比，得分较低的婴儿婴儿死亡的风险更高。有强有力的证据表明，这种关联因种族而异（p<0.001），非西班牙裔白人的调整比值比（AOR）为 54.4（95%置信区间 [CI] 49.9 至 59.4），西班牙裔为 70.02（95% CI 60.8 至 80.7），非西班牙裔黑人为 23.3（95% CI 20.3 至 26.8），非西班牙裔亚裔为 100.4（95% CI 74.5 至 135.4），非西班牙裔其他种族为 26.8（95% CI 19.8 至 36.3）。主要限制是由于使用常规收集的数据，一些变量存在缺失数据。
阿普加评分与死亡率之间的关联因种族群体而异。在美国（US）记录中，低阿普加评分与死亡率相关，但对于区分黑人婴儿和非西班牙裔非亚裔婴儿与白人婴儿的死亡风险的区分能力较差。阿普加评分是有用的临床指标和流行病学工具；在应用方面，需要注意种族差异。
