Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States.
Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States.
Front Public Health. 2024 Jan 4;11:1321331. doi: 10.3389/fpubh.2023.1321331. eCollection 2023.
We examined over a million California birth records for 2010 through 2021 to investigate whether disparities in preterm birth (PTB) by nativity and race support the widely held but hitherto unsubstantiated belief that genetic differences explain the persistent Black-White disparity in PTB.
We examined PTB rates and risk ratios among African-, Caribbean-, and U.S.-born Black women compared to U.S.-born White women. Multivariate analyses adjusted for maternal age, education, number of live births, delivery payer, trimester of prenatal care initiation, pre-pregnancy BMI, smoking, and prevalence of poverty in a woman's residence census tract; and for paternal education.
In adjusted analyses, African-born Black women's PTB rates were no different from those of U.S.-born White women.
The results add to prior evidence making a genetic etiology for the racial disparity in PTB unlikely. If genetic differences tied to "race" explained the Black-White disparity in PTB among U.S.-born women, the African immigrants in this study would have had higher rates of PTB, not the lower rates observed. Multiple explanations for the observed patterns and their implications are discussed. Failure to distinguish causes of PTB from causes of the racial disparity in PTB have likely contributed to erroneous attribution of the racial disparity to genetic differences. Based on the literature, unmeasured experiences of racism, including racism-related stress and adverse environmental exposures, are plausible explanations for the PTB disparity between Black and White U.S.-born women. The favorable birth outcomes of African-born Black immigrants may reflect less exposure to racism during sensitive life periods, e.g., childhood, when they were in African countries, where Black people are in the racial majority.
我们研究了 2010 年至 2021 年期间超过 100 万份加利福尼亚州的出生记录，以调查先天因素和种族导致的早产（PTB）差异是否支持广泛存在但尚未得到证实的观点，即遗传差异解释了 PTB 方面持续存在的黑人和白人之间的差异。
我们比较了非裔、加勒比裔和美国出生的黑人女性与美国出生的白人女性之间的 PTB 率和风险比。多变量分析调整了母亲的年龄、教育程度、活产数、分娩支付者、产前护理开始的孕期、孕前 BMI、吸烟以及女性居住地普查区的贫困率；以及父亲的教育程度。
在调整后的分析中，非裔出生的黑人女性的 PTB 率与美国出生的白人女性没有差异。
结果增加了先前的证据，表明遗传病因不太可能是 PTB 种族差异的原因。如果与“种族”相关的遗传差异解释了美国出生女性中 PTB 的黑人和白人之间的差异，那么这项研究中的非洲移民应该有更高的 PTB 率，而不是观察到的较低率。讨论了观察到的模式及其影响的多种解释。未能将 PTB 的原因与 PTB 种族差异的原因区分开来，可能导致将种族差异错误归因于遗传差异。基于文献，无法衡量的种族主义经历，包括与种族主义相关的压力和不利的环境暴露，是解释黑人和美国出生的白人女性之间 PTB 差异的合理原因。非洲出生的黑人移民的良好生育结果可能反映了在敏感生命时期（例如童年时期）接触到较少的种族主义，当时他们在非洲国家，那里的黑人占多数。
