National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland.
Institute for Global Health Sciences, Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
Pediatrics. 2023 May 1;151(5). doi: 10.1542/peds.2022-060512.
Although mortality rates are highest for infants of teens aged 15 to 19, no studies have examined the long-term trends by race and ethnicity, urbanicity, or maternal age. The objectives of this study were to examine trends and differences in mortality for infants of teens by race and ethnicity and urbanicity from 1996 to 2019 and estimate the contribution of changes in the maternal age distribution and maternal age-specific (infant) mortality rates (ASMRs) to differences in infant deaths in 1996 and 2019.
We used 1996 to 2019 period-linked birth and infant death data from the United States to assess biennial mortality rates per 1000 live births. Pairwise comparisons of rates were conducted using z test statistics and Joinpoint Regression was used to examine trends. Kitagawa decomposition analysis was used to estimate the proportion of change in infant deaths because of changes in the maternal age distribution and ASMRs.
From 1996 to 2019, the mortality rate for infants of teens declined 16.7%, from 10.30 deaths per 1000 live births to 8.58. The decline was significant across racial and ethnic and urbanization subgroups; however, within rural counties, mortality rates did not change significantly for infants of Black or Hispanic teens. Changes in ASMRs accounted for 93.3% of the difference between 1996 and 2019 infant mortality rates, whereas changes in the maternal age distribution accounted for 6.7%.
Additional research into the contextual factors in rural counties that are driving the lack of progress for infants of Black and Hispanic teens may help inform efforts to advance health equity.
尽管 15 至 19 岁青少年所生婴儿的死亡率最高，但尚无研究按种族和民族、城市人口和产妇年龄来考察长期趋势。本研究的目的是检查 1996 年至 2019 年期间，青少年所生婴儿的死亡率的种族和民族以及城市人口差异的趋势和变化，并估计产妇年龄分布和特定产妇年龄（婴儿）死亡率（ASMR）变化对 1996 年和 2019 年婴儿死亡差异的影响。
我们使用美国 1996 年至 2019 年期间的时期关联出生和婴儿死亡数据，评估每千例活产婴儿的两年期死亡率。使用 z 检验统计量进行率的两两比较，并使用 Joinpoint 回归检查趋势。使用 Kitagawa 分解分析来估计由于产妇年龄分布和 ASMR 变化而导致婴儿死亡变化的比例。
从 1996 年至 2019 年，青少年所生婴儿的死亡率下降了 16.7%，从每千例活产婴儿 10.30 例降至 8.58 例。在种族和民族以及城市化亚组中，这一下降是显著的；然而，在农村县，黑人和西班牙裔青少年所生婴儿的死亡率没有显著变化。ASMR 变化解释了 1996 年至 2019 年婴儿死亡率差异的 93.3%，而产妇年龄分布的变化则占 6.7%。
对导致黑人和西班牙裔青少年所生婴儿缺乏进展的农村县的背景因素进行进一步研究，可能有助于为促进健康公平提供信息。
