美国妊娠高血压疾病差异中种族主义和歧视的关联：PRAMS 数据分析。
The Association of Racism and Discrimination in Disparities of Hypertensive Disorders of Pregnancy in the United States: An Analysis of PRAMS Data.
机构信息
Center for Biomedical Engineering, School of Engineering, Brown University, Providence, RI, USA.
Department of Behavioral and Social Sciences, International Health Institute, Brown University School of Public Health, Providence, RI, USA.
出版信息
Matern Child Health J. 2024 May;28(5):969-978. doi: 10.1007/s10995-023-03885-0. Epub 2024 Feb 3.
BACKGROUND
Hypertensive disorders of pregnancy are a leading cause of maternal mortality. Racial disparities in maternal outcomes such as maternal mortality in the United States (US) are well-documented, but the relationship of racism and/or discrimination with one's risk of developing a hypertension during pregnancy (HDP) is not well-studied.
METHODS
Data from 17 sites that asked questions regarding experiences with racism and/or discrimination during pregnancy via the Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 (2016-2020) was used. Logistic regression models were used compare the potential of stress induced HDP from perceived experiences of racism and/or discrimination versus the effect of systemic racism and/or discrimination (in healthcare settings and generally) on racial disparities in HDP diagnosis.
RESULTS
Among 9,907 live births, 18% of participants reported they were diagnosed with hypertension during pregnancy, with non-Hispanic Black individuals having the highest rate (21.8%). Regarding experiences of racism and/or discrimination, 76.4% of participants responded "yes", with all races/ethnicities studied here except non-Hispanic White individuals responding "yes" at rates higher than 89%. Perceived experiences of racism and/or discrimination did not statistically significantly affect one's odds of being diagnosed with HDP (OR = 0.94, CI: 0.74, 1.20). The disparity in odds of having hypertension during pregnancy between Non-Hispanic Black individuals and non-Hispanic White individuals was not statistically significant when perceived experiences of racism and/or discrimination were included in the model.
CONCLUSIONS
Experiences of racism and/or discrimination drive racial disparities in hypertensive disorders in pregnancy.
PUBLIC HEALTH IMPLICATIONS
It is vital to eliminate racist and discriminatory practices and behaviors to reduce maternal morbidity and mortality.
背景
妊娠高血压疾病是孕产妇死亡的主要原因。美国（US）等国家的孕产妇结局存在明显的种族差异，如孕产妇死亡率，但种族主义和/或歧视与妊娠期间发生高血压的风险之间的关系尚未得到充分研究。
方法
使用来自 17 个地点的数据，这些数据通过妊娠风险评估监测系统（PRAMS）第 8 阶段（2016-2020 年）询问了与妊娠期间种族主义和/或歧视经历有关的问题。使用逻辑回归模型比较了感知到的种族主义和/或歧视引起的应激性高血压的可能性与系统性种族主义和/或歧视（在医疗保健环境中和一般情况下）对妊娠高血压诊断种族差异的影响。
结果
在 9907 例活产中，18%的参与者报告在妊娠期间被诊断患有高血压，其中非西班牙裔黑人的发病率最高（21.8%）。关于种族主义和/或歧视经历，76.4%的参与者回答“是”，除了非西班牙裔白人外，所有研究种族/族裔的参与者的回答率都高于 89%。感知到的种族主义和/或歧视经历并没有显著影响被诊断为 HDP 的几率（OR=0.94，CI：0.74，1.20）。当将种族主义和/或歧视经历纳入模型时，非西班牙裔黑人和非西班牙裔白人间妊娠期间发生高血压的几率差异在统计学上并不显著。
结论
种族主义和/或歧视经历导致妊娠高血压疾病的种族差异。
公共卫生意义
消除种族主义和歧视性做法和行为对于降低孕产妇发病率和死亡率至关重要。
Zotero 插件