Racial disparities in preterm births and fetal losses

早产和胎儿丢失的种族差异

基本信息

批准号：
10297784
负责人：
Tim Allen Bruckner
金额：
$ 58.7万
依托单位：
UNIVERSITY OF CALIFORNIA-IRVINE
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-15 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10297784
关键词：
37 weeks gestation Affect Area Birth Birth Rate Childhood Clinical Conceptions County Data Death Rate Death Records Developmental Delay Disorders Ethnic Origin Fetal Death Fetus Gestational Age Health Healthcare High-Risk Pregnancy Hospitalization Imprisonment Inequality Infant Infant Health Infant Mortality Intervention Knowledge Link Live Birth Measures Medical Methods Morbidity - disease rate Mothers National Institute of Child Health and Human Development Neonatal Not Hispanic or Latino Outcome Pattern Perinatal Pregnancy Premature Birth Premature Infant Public Health Race Records Research Research Priority Resource Allocation Resources Risk Sampling Steroids Stress Structural Racism Structure Survivors Technology Testing Time Variant Work antenatal base black/white disparity clinical practice cohort developmental disease disparity reduction ethnic difference fetal fetal loss fetus at risk health care availability health care disparity health disparity high risk population improved in utero infant death infant morbidity innovation knowledge base neglect neonatal care perinatal health perinatal outcomes racial and ethnic racial difference racial disparity response segregation trend

项目摘要

Project Summary (30 lines) Preterm birth (<37 weeks of gestation) increases the risk infant death, hospitalization, developmental disorders, and low educational attainment. Although non-Hispanic (NH) Black mothers show an increased risk (vs. NH whites) of delivering preterm, NH Black infants historically show―at each gestational age before term―improved health and survival relative to NH white infants. The main explanation for this counterintuitive finding assumes greater selection against frail NH Black fetuses. According to the selection argument, excess fetal loss among frail NH Black gestations results in a hardier cohort of survivors to birth but who are delivered preterm. Prior work describing this racial survival advantage has three important limitations. First, it continues to infer the survival advantage from data now nearly two decades old. Second, it includes no test of the fetal selection argument. Third, it fails to utilize a structural racism framework to understand the potential causes of, and changes over time and place in, racial differences in fetal loss and infant survival. Rapid changes in neonatal technology suggest that decades-old estimates of the survival advantage may have, since 2000, diminished―or even transformed into a disparity. We will use the universe of live births, infant deaths, and fetal deaths among NH Blacks and NH whites in the US (~65 million records, 1995 to 2018) to rigorously examine race-specific trends in preterm birth and infant mortality rates. We will link these records longitudinally by conception cohort to achieve several research objectives. First, we will determine whether NH Blacks (vs. NH whites) born preterm show a survival advantage—or a disparity—in infant mortality in the US. Second, we will investigate how the NH Black / NH white difference in preterm birth rates and infant mortality rates has changed over time, in response to fluctuations in fetal death rates and exogenous changes in neonatal technology (e.g., use of antenatal steroids). Third, we will use a structural racism theoretical framework to examine the extent to which dynamic race-based spatial indicators of inequality (e.g., segregation, incarceration rates) affect patterns across place and time in NH Black (vs. NH white) fetal loss, selection in utero, and infant mortality among preterm births. Our work is significant because we focus on the entire spectrum of perinatal outcomes, including the often neglected but quite large racial disparity in fetal death. Results are expected to advance the knowledge base on NICHD's high-priority research area to better understand racial/ethnic differences in infant health. Our approach will also inform our understanding of the extent to which structural racism may have maintained―or exacerbated―perinatal health disparities. Lastly, our place-based analysis will identify regions with potentially large disparities in fetal loss and perinatal survival that may benefit from targeted healthcare and non-healthcare resources.

项目摘要（30行）早产（妊娠37周）增加了婴儿死亡，住院，发育疾病和低教育程度。虽然非西班牙裔（NH）黑人母亲表现出增加提供早产的风险（与NH白人相对于NH白人），NH黑人婴儿历史上显示了每个胎龄任期前 - 相对于NH白人婴儿的健康和生存。对此的主要解释违反直觉的发现假设对虚弱的NH黑胎儿进行了更大的选择。根据选择争论，超过胎儿损失NH NH黑色妊娠导致生存较高的群体到出生但是谁是早产。描述这种种族生存优势的先前工作具有三个重要的局限性。首先，它继续从现在将近二十年的数据中推断出数据的生存优势。其次，它不包括胎儿的测试选择参数。第三，它无法利用结构性种族主义框架来了解潜在的原因胎儿丧失和婴儿存活的种族差异，以及随着时间和地点的变化。快速变化新生儿技术表明，自2000年以来，数十年来生存优势的估计值可能具有减少甚至变成了差异。我们将使用活产，婴儿死亡和美国NH黑人和NH白人的胎儿死亡（约6500万唱片，1995年至2018年）严格检查早产和婴儿死亡率的特定种族趋势。我们将链接这些记录通过概念队列纵向实现几个研究目标。首先，我们将确定NH黑人（与NH白人）出生的早产是否具有生存优势，或者差异 - 在美国的婴儿死亡率。其次，我们将研究NH黑色 / NH白色差异在早产率和婴儿死亡率中，随着时间的流逝发生了变化，以应对胎儿的波动新生儿技术的死亡率和外源变化（例如，使用抗类固醇）。第三，我们会的使用结构性种族主义理论框架来检查基于动态种族的空间的程度不平等的指标（例如，隔离，影响率）会影响NH的位置和时间的模式黑色（与NH白色）胎儿丧失，子宫内选择以及早产的婴儿死亡率。我们的工作很重要，因为我们专注于整个围产期结局，包括经常在胎儿死亡中被忽视但种族差异很大。结果有望提高知识库在NICHD的高优先研究领域，可以更好地了解婴儿健康中的种族/种族差异。我们的方法还将告知我们对结构性种族主义可能维持或维持的程度的理解恶化 - 围产期健康分布。最后，我们基于地点的分析将确定与可能受益于靶向医疗保健和非健康资源。