Braveman Paula, Dominguez Tyan Parker, Burke Wylie, Dolan Siobhan M, Stevenson David K, Jackson Fleda Mask, Collins James W, Driscoll Deborah A, Haley Terinney, Acker Julia, Shaw Gary M, McCabe Edward R B, Hay William W, Thornburg Kent, Acevedo-Garcia Dolores, Cordero José F, Wise Paul H, Legaz Gina, Rashied-Henry Kweli, Frost Jordana, Verbiest Sarah, Waddell Lisa
School of Medicine, University of California, San Francisco, San Francisco, CA, United States.
USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States.
Front Reprod Health. 2021 Sep 2;3:684207. doi: 10.3389/frph.2021.684207. eCollection 2021.
In 2017-2019, the March of Dimes convened a workgroup with biomedical, clinical, and epidemiologic expertise to review knowledge of the causes of the persistent Black-White disparity in preterm birth (PTB). Multiple databases were searched to identify hypothesized causes examined in peer-reviewed literature, 33 hypothesized causes were reviewed for whether they plausibly affect PTB and either occur more/less frequently and/or have a larger/smaller effect size among Black women vs. White women. While definitive proof is lacking for most potential causes, most are biologically plausible. No single downstream or midstream factor explains the disparity or its social patterning, however, many likely play limited roles, e.g., while genetic factors likely contribute to PTB, they explain at most a small fraction of the disparity. Research links most hypothesized midstream causes, including socioeconomic factors and stress, with the disparity through their influence on the hypothesized downstream factors. Socioeconomic factors alone cannot explain the disparity's social patterning. Chronic stress could affect PTB through neuroendocrine and immune mechanisms leading to inflammation and immune dysfunction, stress could alter a woman's microbiota, immune response to infection, chronic disease risks, and behaviors, and trigger epigenetic changes influencing PTB risk. As an upstream factor, racism in multiple forms has repeatedly been linked with the plausible midstream/downstream factors, including socioeconomic disadvantage, stress, and toxic exposures. Racism is the only factor identified that directly or indirectly could explain the racial disparities in the plausible midstream/downstream causes and the observed social patterning. Historical and contemporary systemic racism can explain the racial disparities in socioeconomic opportunities that differentially expose African Americans to lifelong financial stress and associated health-harming conditions. Segregation places Black women in stressful surroundings and exposes them to environmental hazards. Race-based discriminatory treatment is a pervasive stressor for Black women of all socioeconomic levels, considering both incidents and the constant vigilance needed to prepare oneself for potential incidents. Racism is a highly plausible, major upstream contributor to the Black-White disparity in PTB through multiple pathways and biological mechanisms. While much is unknown, existing knowledge and core values (equity, justice) support addressing racism in efforts to eliminate the racial disparity in PTB.
2017年至2019年期间，美国疾病防控中心召集了一个由生物医学、临床和流行病学专家组成的工作组，以审查早产（PTB）方面持续存在的黑白差异原因的相关知识。研究人员检索了多个数据库，以确定同行评审文献中研究的假设原因，并对33个假设原因进行了审查，看它们是否可能影响早产，以及在黑人女性与白人女性中是否更频繁/不那么频繁地出现和/或具有更大/更小的效应量。虽然大多数潜在原因缺乏确凿证据，但大多数在生物学上是合理的。没有单一的下游或中游因素能够解释这种差异或其社会模式，不过，许多因素可能只起到有限的作用，例如，虽然遗传因素可能导致早产，但它们最多只能解释差异的一小部分。研究将大多数假设的中游原因，包括社会经济因素和压力，通过它们对假设的下游因素的影响与这种差异联系起来。仅社会经济因素无法解释这种差异的社会模式。慢性压力可能通过神经内分泌和免疫机制影响早产，导致炎症和免疫功能障碍，压力可能改变女性的微生物群、对感染的免疫反应、慢性病风险和行为，并引发影响早产风险的表观遗传变化。作为一个上游因素，多种形式的种族主义一再与合理的中游/下游因素相关联，包括社会经济劣势、压力和有毒物质暴露。种族主义是唯一被确定的因素，它可以直接或间接地解释合理的中游/下游原因中的种族差异以及观察到的社会模式。历史上和当代的系统性种族主义可以解释社会经济机会方面的种族差异，这种差异使非裔美国人面临终身的经济压力和相关的有害健康状况。种族隔离使黑人女性处于压力环境中，并使她们暴露于环境危害之中。基于种族的歧视性待遇是所有社会经济阶层黑人女性普遍面临的压力源，既要考虑到事件本身，也要考虑到为潜在事件做好准备所需的持续警惕。种族主义通过多种途径和生物学机制，是导致早产方面黑白差异的一个非常合理的主要上游因素。虽然仍有许多未知之处，但现有知识和核心价值观（公平、正义）支持在消除早产种族差异的努力中解决种族主义问题。
