Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Medical Education, Tufts University School of Medicine, Boston, MA; Department of Medical Education, Maine Medical Center, Portland, ME.
Division of Neonatology, Children's Hospital of Pennsylvania, Philadelphia.
Ann Epidemiol. 2023 Jul;83:54-59.e1. doi: 10.1016/j.annepidem.2023.04.010. Epub 2023 Apr 22.
In the US, preterm birth (PTB) is 55% more common among Black compared to White individuals and psychosocial stressors may contribute. Resilience is associated with improved health outcomes; whether it modifies PTB inequity is unknown. We hypothesized high resilience would reduce inequities in PTB risk.
This study analyzes data from 535 pregnancies among Black (n = 101, 19%) and White (n = 434, 81%) participants from a prospective cohort. Participants completed the Connor-Davidson Resilience Scale. We calculated risk ratios (RR) stratified by resilience tertiles to test for effect measure modification.
Among those in the lowest resilience tertile, there were six (20.7%) PTBs among Black and seven (4.9%) among White participants (RR: 4.26; 95% confidence interval (CI): 1.53, 11.81). Among those in the highest resilience tertile, there were 8 (18.2%) PTBs among Black and 14 (9.5%) among White participants (RR: 1.92; 95% CI: 0.87, 4.24. The adjusted Black:White RR was 2.00 (95% CI 0.47, 8.64) in the lowest and 3.49 (95% CI 1.52, 8.01) in the highest tertile.
Black-White PTB inequity did not differ among resilience strata and remained significant in the highest tertile. Our findings suggest that high resilience is inadequate to overcome Black:White racial inequity in PTB.
在美国，黑人的早产（PTB）发生率比白人高 55%，而心理社会压力因素可能导致了这一差异。韧性与改善健康结果有关；但它是否能改变 PTB 的不平等情况尚不清楚。我们假设高韧性会降低 PTB 风险的不平等。
本研究分析了来自一个前瞻性队列的 535 例妊娠的黑人（n=101，19%）和白人（n=434，81%）参与者的数据。参与者完成了 Connor-Davidson 韧性量表。我们根据韧性三分位值计算了风险比（RR），以检验效应修正。
在最低韧性三分位的人群中，黑人有 6 例（20.7%）PTB，而白人有 7 例（4.9%）（RR：4.26；95%置信区间（CI）：1.53，11.81）。在最高韧性三分位的人群中，黑人有 8 例（18.2%）PTB，而白人有 14 例（9.5%）（RR：1.92；95%CI：0.87，4.24）。调整后的黑人与白人 RR 在最低三分位为 2.00（95%CI 0.47，8.64），在最高三分位为 3.49（95%CI 1.52，8.01）。
在韧性分层中，黑人和白人之间的 PTB 不平等没有差异，在最高三分位仍然显著。我们的研究结果表明，高韧性不足以克服 PTB 中黑人和白人之间的种族不平等。
