Tsoi Stephanie M, Karvonen Kayla L, Steurer Martina A, Keller Roberta L
Division of Critical Care Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.
Division of Neonatology, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA.
Pediatr Pulmonol. 2025 Sep;60(9):e71294. doi: 10.1002/ppul.71294.
To evaluate disparities in 1-year mortality in infants with congenital diaphragmatic hernia (CDH) by maternal race/ethnicity in a US population-based dataset, and to quantify mediation effects of socioeconomic status (SES) and maternal and neonatal medical factors.
We identified infants with CDH from the US Natality Database (2014-2019) that links birth and death certificates to 1-year of age. Primary outcome was 1-year mortality. Primary predictor was maternal race/ethnicity. Candidate mediators (SES [defined by maternal education level and public insurance status] and neonatal and maternal factors) were assessed using structural equation modeling.
Among 2589 infants with CDH, 1-year mortality was 28.4% (n = 734). Infant mortality differed by maternal race/ethnicity: Non-Hispanic White 25.5%, Black 39.1%, Hispanic 31.2%. Mortality differences persisted in multivariate analysis. Mediation analyses showed that SES accounted for 54.1% (20.4-68.6%) of the disparity between infants of Non-Hispanic White and Hispanic mothers. In contrast, SES accounted for only 17.1% (3.6-37.4%) of the disparity between infants of Non-Hispanic White and Black mothers, while the unmeasured remaining effect of race/ethnicity contributed 75.9% (49.5-91.1%).
In CDH, SES accounts for a large proportion of the mortality disparity for infants of Hispanic mothers while the remaining effect of race, aside from SES and neonatal factors, accounts for a large proportion of the mortality disparity for infants of Black mothers. The remaining effect of maternal race may be due to unmeasured aspects of SES, such as social determinants of health, and structural and systemic racism and bias.
在美国基于人群的数据集里，评估先天性膈疝（CDH）婴儿1岁死亡率在母亲种族/族裔方面的差异，并量化社会经济地位（SES）以及母亲和新生儿医疗因素的中介作用。
我们从美国出生数据库（2014 - 2019年）中识别出患有CDH的婴儿，该数据库将出生证明和死亡证明关联至1岁。主要结局是1岁死亡率。主要预测因素是母亲的种族/族裔。使用结构方程模型评估候选中介因素（SES[由母亲教育水平和公共保险状况定义]以及新生儿和母亲因素）。
在2589例患有CDH的婴儿中，1岁死亡率为28.4%（n = 734）。婴儿死亡率因母亲种族/族裔而异：非西班牙裔白人25.5%，黑人39.1%，西班牙裔31.2%。多变量分析中死亡率差异依然存在。中介分析表明，SES占非西班牙裔白人和西班牙裔母亲所生婴儿死亡率差异的54.1%（20.4 - 68.6%）。相比之下，SES仅占非西班牙裔白人和黑人母亲所生婴儿死亡率差异的17.1%（3.6 - 37.4%），而种族/族裔未测量的剩余影响因素占75.9%（49.5 - 91.1%）。
在CDH中，SES在西班牙裔母亲所生婴儿死亡率差异中占很大比例，而除SES和新生儿因素外，种族的剩余影响因素在黑人母亲所生婴儿死亡率差异中占很大比例。母亲种族的剩余影响可能归因于SES未测量的方面，如健康的社会决定因素以及结构性和系统性的种族主义和偏见。
