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Alur P, Holla I, Hussain N. Impact of sex, race, and social determinants of health on neonatal outcomes. Front Pediatr 2024; 12:1377195. [PMID: 38655274 PMCID: PMC11035752 DOI: 10.3389/fped.2024.1377195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
Despite the global improvements in neonatal outcomes, mortality and morbidity rates among preterm infants are still unacceptably high. Therefore, it is crucial to thoroughly analyze the factors that affect these outcomes, including sex, race, and social determinants of health. By comprehending the influence of these factors, we can work towards reducing their impact and enhancing the quality of neonatal care. This review will summarize the available evidence on sex differences, racial differences, and social determinants of health related to neonates. This review will discuss sex differences in neonatal outcomes in part I and racial differences with social determinants of health in part II. Research has shown that sex differences begin to manifest in the early part of the pregnancy. Hence, we will explore this topic under two main categories: (1) Antenatal and (2) Postnatal sex differences. We will also discuss long-term outcome differences wherever the evidence is available. Multiple factors determine health outcomes during pregnancy and the newborn period. Apart from the genetic, biological, and sex-based differences that influence fetal and neonatal outcomes, racial and social factors influence the health and well-being of developing humans. Race categorizes humans based on shared physical or social qualities into groups generally considered distinct within a given society. Social determinants of health (SDOH) are the non-medical factors that influence health outcomes. These factors can include a person's living conditions, access to healthy food, education, employment status, income level, and social support. Understanding these factors is essential in developing strategies to improve overall health outcomes in communities.
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Affiliation(s)
- Pradeep Alur
- Penn State College of Medicine, Hampden Medical Center, Enola, PA, United States
| | - Ira Holla
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, United States
| | - Naveed Hussain
- Department of Pediatrics, Connecticut Children’s, Hartford, CT, United States
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Johnson DL, Carlo WA, Rahman AKMF, Tindal R, Trulove SG, Watt MJ, Travers CP. Health Insurance and Differences in Infant Mortality Rates in the US. JAMA Netw Open 2023; 6:e2337690. [PMID: 37831450 PMCID: PMC10576209 DOI: 10.1001/jamanetworkopen.2023.37690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/01/2023] [Indexed: 10/14/2023] Open
Abstract
Importance Health insurance status is associated with differences in access to health care and health outcomes. Therefore, maternal health insurance type may be associated with differences in infant outcomes in the US. Objective To determine whether, among infants born in the US, maternal private insurance compared with public Medicaid insurance is associated with a lower infant mortality rate (IMR). Design, Setting, and Participants This cohort study used data from the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research expanded linked birth and infant death records database from 2017 to 2020. Hospital-born infants from 20 to 42 weeks of gestational age were included if the mother had either private or Medicaid insurance. Infants with congenital anomalies, those without a recorded method of payment, and those without either private insurance or Medicaid were excluded. Data analysis was performed from June 2022 to August 2023. Exposures Private vs Medicaid insurance. Main Outcomes and Measures The primary outcome was the IMR. Negative-binomial regression adjusted for race, sex, multiple birth, any maternal pregnancy risk factors (as defined by the CDC), education level, and tobacco use was used to determine the difference in IMR between private and Medicaid insurance. The χ2 or Fisher exact test was used to compare differences in categorical variables between groups. Results Of the 13 562 625 infants included (6 631 735 girls [48.9%]), 7 327 339 mothers (54.0%) had private insurance and 6 235 286 (46.0%) were insured by Medicaid. Infants born to mothers with private insurance had a lower IMR compared with infants born to those with Medicaid (2.75 vs 5.30 deaths per 1000 live births; adjusted relative risk [aRR], 0.81; 95% CI, 0.69-0.95; P = .009). Those with private insurance had a significantly lower risk of postneonatal mortality (0.81 vs 2.41 deaths per 1000 births; aRR, 0.57; 95% CI, 0.47-0.68; P < .001), low birth weight (aRR, 0.90; 95% CI, 0.85-0.94; P < .001), vaginal breech delivery (aRR, 0.80; 95% CI, 0.67-0.96; P = .02), and preterm birth (aRR, 0.92; 95% CI, 0.88-0.97; P = .002) and a higher probability of first trimester prenatal care (aRR, 1.24; 95% CI, 1.21-1.27; P < .001) compared with those with Medicaid. Conclusions and Relevance In this cohort study, maternal Medicaid insurance was associated with increased risk of infant mortality at the population level in the US. Novel strategies are needed to improve access to care, quality of care, and outcomes among women and infants enrolled in Medicaid.
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Affiliation(s)
- Desalyn L. Johnson
- University of Alabama School of Medicine, University of Alabama at Birmingham, Birmingham
| | - Waldemar A. Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | | | | | - Sarah G. Trulove
- University of Alabama School of Medicine, University of Alabama at Birmingham, Birmingham
| | - Mykaela J. Watt
- University of Alabama School of Medicine, University of Alabama at Birmingham, Birmingham
| | - Colm P. Travers
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham
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Qattea I, Burdjalov M, Quatei A, Agha KT, Kteish R, Aly H. Disparities in Neonatal Mortalities in the United States. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1386. [PMID: 37628385 PMCID: PMC10453382 DOI: 10.3390/children10081386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/06/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVE We aimed to look for the mortality of Black and White Neonates and compare the Black and White neonates' mortalities after stratifying the population by many significant epidemiologic and hospital factors. DESIGN/METHOD We utilized the National Inpatient Sample (NIS) dataset over seven years from 2012 through 2018 for all neonates ≤ 28 days of age in all hospitals in the USA. Neonatal characteristics used in the analysis included ethnicity, sex, household income, and type of healthcare insurance. Hospital characteristics were urban teaching, urban non-teaching, and rural. Hospital location was classified according to the nine U.S. Census Division regions. RESULTS Neonatal mortality continues to be higher in Black populations: 21,975 (0.63%) than in White populations: 35,495 (0.28%). Government-supported health insurance was significantly more among Black populations when compared to White (68.8% vs. 35.3% p < 0.001). Household income differed significantly; almost half (49.8%) of the Black population has income ≤ 25th percentile vs. 22.1% in White. There was a significant variation in mortality in different U.S. LOCATIONS In the Black population, the highest mortality was in the West North Central division (0.72%), and the lower mortality was in the New England division (0.51%), whereas in the White population, the highest mortality was in the East South-Central division (0.36%), and the lowest mortality was in the New England division (0.21%). Trend analysis showed a significant decrease in mortality in Black and White populations over the years, but when stratifying the population by sex, type of insurance, household income, and type of hospital, the mortality was consistently higher in Black groups throughout the study years. CONCLUSIONS Disparities in neonatal mortality continue to be higher in Black populations; there was a significant variation in mortality in different U.S. LOCATIONS In the Black population, the highest mortality was in the West North Central division, and the lower mortality was in the New England division, whereas in the White population, the highest mortality was in the East South Central division, and the lowest mortality was in the New England division. There has been a significant decrease in mortality in Black and White populations over the years, but when stratifying the population by many significant epidemiologic and hospital factors, the mortality was consistently higher in Black groups throughout the study years.
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Affiliation(s)
- Ibrahim Qattea
- Department of Neonatalogy, Cleveland Clinic Children’s, 9500 Euclid Avenue #M31-37, Cleveland, OH 44195, USA; (A.Q.); (H.A.)
- Department of Pediatrics, Nassau University Medical Center, New York, NY 11554, USA;
| | - Maria Burdjalov
- College of Arts and Sciences, The Ohio State University, Columbus, OH 43210, USA;
| | - Amani Quatei
- Department of Neonatalogy, Cleveland Clinic Children’s, 9500 Euclid Avenue #M31-37, Cleveland, OH 44195, USA; (A.Q.); (H.A.)
| | - Khalil Tamr Agha
- Department of Pediatrics, Upstate Golisano Children Hospital, Syracuse, NY 13210, USA;
| | - Rayan Kteish
- Department of Pediatrics, Nassau University Medical Center, New York, NY 11554, USA;
| | - Hany Aly
- Department of Neonatalogy, Cleveland Clinic Children’s, 9500 Euclid Avenue #M31-37, Cleveland, OH 44195, USA; (A.Q.); (H.A.)
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Yearwood L, Bone JN, Wen Q, Muraca GM, Lyons J, Razaz N, Joseph K, Lisonkova S. The association between maternal stature and adverse birth outcomes and the modifying effect of race and ethnicity: a population-based retrospective cohort study. AJOG GLOBAL REPORTS 2023; 3:100184. [PMID: 36941862 PMCID: PMC10024135 DOI: 10.1016/j.xagr.2023.100184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND There are known differences in the risk of perinatal and maternal birth outcomes because of maternal factors, such as body mass index and maternal race. However, the association of maternal height with adverse birth outcomes and the potential differences in this relationship by race and ethnicity have been understudied. OBJECTIVE This study aimed to examine the association between maternal stature and adverse perinatal outcomes and the potential modification of the association by race and ethnicity. STUDY DESIGN This retrospective cohort study was conducted using data on all singleton births in the United States in 2016 and 2017 (N=7,361,713) obtained from the National Center for Health Statistics. Short and tall stature were defined as <10th and >90th percentiles of the maternal height distribution (<154.9 and >172.7 cm, respectively). Race and ethnicity categories included non-Hispanic White, non-Hispanic Black, American Indian or Alaskan Native Asian or Pacific Islander, and Hispanic. The primary outcomes were preterm birth (<37 weeks of gestation), perinatal death, and composite perinatal death or severe neonatal morbidity. Logistic regression was used to obtain adjusted odds ratios and 95% confidence intervals with adjustment for confounding by maternal age, body mass index, and other factors. Multiplicative and additive effect modifications by race and ethnicity were assessed. RESULTS The study population included 7,361,713 women with a singleton stillbirth or live birth. Short women had an increased risk of adverse outcomes, whereas tall women had a decreased risk relative to average-stature women. Short women had an increased risk of perinatal death and composite perinatal death or severe neonatal morbidity (adjusted odds ratios, 1.14 [95% confidence interval, 1.10-1.17] and 1.21 [95% confidence interval, 1.19-1.23], respectively). The association between short stature and perinatal death was attenuated in non-Hispanic Black women compared with non-Hispanic White women (adjusted odds ratio, 1.10 [95% confidence interval, 1.03-1.17] vs 1.26 [95% confidence interval, 1.19-1.33]). Compared with average-stature women, tall non-Hispanic White women had lower rates of preterm birth, perinatal death, and composite perinatal death or severe neonatal morbidity (adjusted odds ratios, 0.82 [95% confidence interval, 0.81-0.83], 0.95 [95% confidence interval, 0.91-1.00], and 0.90 [95% confidence interval, 0.88-0.93], respectively). The association between tall and average stature with perinatal death was reversed in Hispanic women (adjusted odds ratio, 1.27; 95% confidence interval, 1.12-1.44). Compared with average-stature women, all tall women had lower rates of preterm birth, particularly among non-Hispanic Black and Hispanic women. CONCLUSION Relative to average-stature women, short women have an increased risk of adverse perinatal outcomes across all race and ethnicity groups; these associations were attenuated in Hispanic women and for some adverse outcomes in non-Hispanic Black and Asian women. Tall mothers have a lower risk of preterm birth in all racial and ethnic groups, whereas tall non-Hispanic White mothers have a lower risk of perinatal death or severe neonatal morbidity compared with average-stature women.
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Affiliation(s)
- Lauren Yearwood
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (XX Yearwood, XX Bone, Ms Wen, XX Lyons, XX Joseph, and Dr Lisonkova)
| | - Jeffrey N. Bone
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (XX Yearwood, XX Bone, Ms Wen, XX Lyons, XX Joseph, and Dr Lisonkova)
- Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada (XX Bone, XX Joseph, and Dr Lisonkova)
| | - Qi Wen
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (XX Yearwood, XX Bone, Ms Wen, XX Lyons, XX Joseph, and Dr Lisonkova)
| | - Giulia M. Muraca
- Department of Obstetrics and Gynecology and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada (XX Muraca)
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Institutet, Solna, Sweden (XX Muraca and XX Razaz)
| | - Janet Lyons
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (XX Yearwood, XX Bone, Ms Wen, XX Lyons, XX Joseph, and Dr Lisonkova)
| | - Neda Razaz
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Institutet, Solna, Sweden (XX Muraca and XX Razaz)
| | - K.S. Joseph
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (XX Yearwood, XX Bone, Ms Wen, XX Lyons, XX Joseph, and Dr Lisonkova)
- Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada (XX Bone, XX Joseph, and Dr Lisonkova)
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (XX Joseph and Dr Lisonkova)
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (XX Yearwood, XX Bone, Ms Wen, XX Lyons, XX Joseph, and Dr Lisonkova)
- Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada (XX Bone, XX Joseph, and Dr Lisonkova)
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (XX Joseph and Dr Lisonkova)
- Corresponding author: Sarka Lisonkova, MD, PhD.
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Yakubu RA, Scharff DP, Gulley L, BeLue R, Enard KR. Using Collective Impact to Develop a Community-Led Initiative for Improving Black Infant Mortality. Health Promot Pract 2023; 24:282-291. [PMID: 34873946 DOI: 10.1177/15248399211061319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The United States has one of the highest infant mortality rates among developed countries. When stratified by race, disparities are more evident: Black infant mortality rates are 2.5 times higher than non-Hispanic white infants. Structural, systemic racism is a contributing cause for these racial disparities. Multisector collaborations focused on a common agenda, often referred to as collective impact, have been used for infant mortality reduction interventions. In addition, community-based participatory approaches have been applied to incorporate those with lived experience related to adverse pregnancy outcomes. This article critically describes the transition of an infant mortality collective impact initiative from being led by a multisector organizational group to being community led over a 5-year period, 2015-2020. A 34-member community leaders group was developed and determined four priorities and corresponding strategies for the initiative. Findings show that community participatory approaches are a way to address racial equity for public health initiatives.
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Grünebaum A, Bornstein E, Dudenhausen JW, Lenchner E, De Four Jones M, Varrey A, Lewis D, Chervenak FA. Hidden in plain sight in the delivery room - The Apgar score is biased. J Perinat Med 2023:jpm-2022-0550. [PMID: 36706313 DOI: 10.1515/jpm-2022-0550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 12/20/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The objective of this study was to compare the maximum 5-min Apgar score of 10 among different U.S. races and Hispanic ethnicity. METHODS Retrospective population-based cohort study from the National Center for Health Statistics (NCHS), and Division of Vital Statistics natality online database. We included only deliveries where the race and Hispanic ethnicity of the father and mother were listed as either Black, White, Chinese, or Asian Indian and as Hispanic or Latino origin or other. Proportions of 5-Minute Apgar scores of 10 were compared among different races and Hispanic ethnicity for six groups each for mother and father: Non-Hispanic or Latino White, Hispanic or Latino White, Non-Hispanic or Latino Black, Hispanic or Latino Black, Chinese, and Asian Indian. RESULTS The study population consists of 9,710,066 mothers and 8,138,475 fathers from the US natality birth data 2016-2019. Black newborns had a less than 50% chance of having a 5-min Apgar score of 10 when compared to white newborns (OR 0.47 for Black mother and Black father; p<0.001). White babies (non-Hispanic and Hispanic) had the highest proportion of Apgar scores of 10 across all races and ethnicities. CONCLUSIONS The Apgar score introduces a bias by systematically lowering the score in people of color. Embedding skin color scoring into basic data and decisions of health care propagates race-based medicine. By removing the skin color portion of the Apgar score and with it's racial and ethnic bias, we will provide more accuracy and equity when evaluating newborn babies worldwide.
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Affiliation(s)
- Amos Grünebaum
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Eran Bornstein
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | | | | | - Monique De Four Jones
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Aneesha Varrey
- Greater Baltimore Medical Center, Towson, Baltimore, MD, USA
| | - Dawnette Lewis
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Frank A Chervenak
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
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Lombardi BN, Jensen TM, Parisi AB, Jenkins M, Bledsoe SE. The Relationship Between a Lifetime History of Sexual Victimization and Perinatal Depression: A Systematic Review and Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2023; 24:139-155. [PMID: 34132148 PMCID: PMC9660263 DOI: 10.1177/15248380211021611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The association between a lifetime history of sexual victimization and the well-being of women during the perinatal period has received increasing attention. However, research investigating this relationship has yet to be systematically reviewed or quantitatively synthesized. AIM This systematic review and meta-analysis aims to calculate the pooled effect size estimate of the statistical association between a lifetime history of sexual victimization and perinatal depression (PND). METHOD Four bibliographic databases were systematically searched, and reference harvesting was conducted to identify peer-reviewed articles that empirically examined associations between a lifetime history of sexual victimization and PND. A random effects model was used to ascertain an overall pooled effect size estimate in the form of an odds ratio and corresponding 95% confidence intervals (CIs). Subgroup analyses were also conducted to assess whether particular study features and sample characteristic (e.g., race and ethnicity) influenced the magnitude of effect size estimates. RESULTS This review included 36 studies, with 45 effect size estimates available for meta-analysis. Women with a lifetime history of sexual victimization had 51% greater odds of experiencing PND relative to women with no history of sexual victimization (OR = 1.51, 95% CI [1.35, 1.67]). Effect size estimates varied considerably according to the PND instrument used in each study and the racial/ethnic composition of each sample. CONCLUSION Findings provide compelling evidence for an association between a lifetime history of sexual victimization and PND. Future research should focus on screening practices and interventions that identify and support survivors of sexual victimization perinatally.
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Affiliation(s)
- Brooke N. Lombardi
- School of Social Work, University of North Carolina at Chapel Hill,
NC, USA
| | - Todd M. Jensen
- School of Social Work, University of North Carolina at Chapel Hill,
NC, USA
| | - Anna B. Parisi
- School of Social Work, University of North Carolina at Chapel Hill,
NC, USA
| | - Melissa Jenkins
- School of Social Work, University of North Carolina at Chapel Hill,
NC, USA
| | - Sarah E. Bledsoe
- School of Social Work, University of North Carolina at Chapel Hill,
NC, USA
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Corbie G, Brandert K, Noble CC, Henry E, Dave G, Berthiume R, Green M, Fernandez CSP. Advancing Health Equity Through Equity-Centered Leadership Development with Interprofessional Healthcare Teams. J Gen Intern Med 2022; 37:4120-4129. [PMID: 35657467 PMCID: PMC9165542 DOI: 10.1007/s11606-022-07529-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/29/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Events of spring 2020-the COVID19 pandemic and re-birth of a social justice movement-have thrown disparities in disease risk, morbidity, and mortality in sharp relief. In response, healthcare organizations have shifted attentions and resources towards equity, diversity, and inclusion (EDI) issues and initiatives like never before. Focused, proven equity-centered skill and mindset development is needed for healthcare professionals to operationalize these pledges and stated aims. AIM This article highlights program evaluation results for this Clinical Scholars National Leadership Institute (CSNLI) specific to EDI. We will show that CSNLI imparts the valuable and essential skills to health professionals that are needed to realize health equity through organizational and system change. SETTING Initial cohort of 29 participants in CSNLI, engaging in the program over 3 years through in-person and distance-based learning offerings and activities. PROGRAM DESCRIPTION The CSNLI is a 3-year, intensive leadership program that centers EDI skill development across personal, interpersonal, organizational, and systems domains through its design, competencies, and curriculum. PROGRAM EVALUATION A robust evaluation following the Kirkpatrick Model offers analysis of four data collecting activities related to program participants' EDI learning, behavioral change, and results. DISCUSSION Over the course of the program, participants made significant gains in competencies related to equity, diversity, and inclusion. Furthermore, participants demonstrated growth in behavior change and leadership activities in the areas of organizational and system change. Results demonstrate the need to center both leader and leadership development on equity, diversity, and inclusion curriculum to make real change in the US Healthcare System.
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Affiliation(s)
- Giselle Corbie
- Center for Health Equity Research, Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Kathleen Brandert
- Office of Public Health Practice and Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Cheryl C Noble
- Leadership Evaluation Consultant, Scotts Valley, CA, USA
| | - Ellison Henry
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gaurav Dave
- Center for Health Equity Research, Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rachel Berthiume
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melissa Green
- Center for Health Equity Research, Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Claudia S P Fernandez
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Allgood KL, Mack JA, Novak NL, Abdou CM, Fleischer NL, Needham BL. Vicarious structural racism and infant health disparities in Michigan: The Flint Water Crisis. Front Public Health 2022; 10:954896. [PMID: 36148337 PMCID: PMC9486078 DOI: 10.3389/fpubh.2022.954896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/12/2022] [Indexed: 01/24/2023] Open
Abstract
Building on nascent literature examining the health-related effects of vicarious structural racism, we examined indirect exposure to the Flint Water Crisis (FWC) as a predictor of birth outcomes in Michigan communities outside of Flint, where residents were not directly exposed to lead-contaminated water. Using linear regression models, we analyzed records for all singleton live births in Michigan from 2013 to 2016, excluding Flint, to determine whether birth weight (BW), gestational age (GA), and size-for-gestational-age (SzGA) decreased among babies born to Black people, but not among babies born to White people, following the highly publicized January 2016 emergency declaration in Flint. In adjusted regression models, BW and SzGA were lower for babies born to both Black and White people in the 37 weeks following the emergency declaration compared to the same 37-week periods in the previous 3 years. There were no racial differences in the association of exposure to the emergency declaration with BW or SzGA. Among infants born to Black people, GA was 0.05 weeks lower in the 37-week period following the emergency declaration versus the same 37-week periods in the previous 3 years (95% CI: -0.09, -0.01; p = 0.0177), while there was no change in GA for infants born to White people following the emergency declaration (95% CI: -0.01, 0.03; p = 0.6962). The FWC, which was widely attributed to structural racism, appears to have had a greater impact, overall, on outcomes for babies born to Black people. However, given the frequency of highly publicized examples of anti-Black racism over the study period, it is difficult to disentangle the effects of the FWC from the effects of other racialized stressors.
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Affiliation(s)
- Kristi L. Allgood
- 1Department of Epidemiology, Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, MI, United States,*Correspondence: Kristi L. Allgood
| | - Jasmine A. Mack
- 2Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Nicole L. Novak
- 3Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, United States
| | - Cleopatra M. Abdou
- 4Department of Children, Youth, and Families, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Nancy L. Fleischer
- 1Department of Epidemiology, Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Belinda L. Needham
- 1Department of Epidemiology, Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, MI, United States
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10
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Dongarwar D, Maiyegun SO, Yusuf KK, Al Agili DE, Salihu HM. Fetal Maturation and Intrauterine Survival in Asian American Women by Ethnicity. South Med J 2022; 115:658-664. [PMID: 36055652 DOI: 10.14423/smj.0000000000001443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Although there are multiple ethnic subgroups of the Asian race, this population is usually treated as homogenous in public health research and practice. There is a dearth of information on fetal maturation and perinatal outcomes among Asian American women compared with their non-Hispanic (NH) White counterparts. This study aimed to determine whether fetal maturation, as captured by gestational age periods, influences the risk of stillbirth in Asian American fetuses, in general, as well as within different ethnic subgroups: Asian Indian, Korean, Chinese, Vietnamese, Japanese, and Filipino, using NH Whites as referent. METHODS We included singleton births within 37 to 44 gestational weeks occurring in Asian American and NH White mothers from 2014 to 2017. Adjusted logistic regression models were used to quantify the association between mother's race/ethnicity and risk of stillbirth by gestational age phenotypes: early-term, full-term, late-term, and postterm. RESULTS Compared with NH Whites, Asian Americans had 35% (adjusted odds ratio 0.65, 95% confidence interval 0.53-0.76) and 28% (adjusted odds ratio 0.72, 95% confidence interval 0.59-0.85) lower risk of early-term and full-term stillbirths, respectively. CONCLUSIONS Our study suggests the existence of differential maturation of the fetoplacental unit as explanation for the decline in intrauterine survival advantage with advancing gestational age among Asian American subgroups.
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Affiliation(s)
- Deepa Dongarwar
- From the Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas, the Department of Pediatrics, Texas Tech University Health Sciences Center, El Paso, the College of Nursing & Public Health, Adelphi University, Garden City, New York, and the Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah Saudi Arabia
| | - Sitratullah O Maiyegun
- From the Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas, the Department of Pediatrics, Texas Tech University Health Sciences Center, El Paso, the College of Nursing & Public Health, Adelphi University, Garden City, New York, and the Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah Saudi Arabia
| | - Korede K Yusuf
- From the Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas, the Department of Pediatrics, Texas Tech University Health Sciences Center, El Paso, the College of Nursing & Public Health, Adelphi University, Garden City, New York, and the Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah Saudi Arabia
| | - Dania E Al Agili
- From the Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas, the Department of Pediatrics, Texas Tech University Health Sciences Center, El Paso, the College of Nursing & Public Health, Adelphi University, Garden City, New York, and the Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah Saudi Arabia
| | - Hamisu M Salihu
- From the Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas, the Department of Pediatrics, Texas Tech University Health Sciences Center, El Paso, the College of Nursing & Public Health, Adelphi University, Garden City, New York, and the Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah Saudi Arabia
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11
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Echevarria E, Lorch SA. Family Educational Attainment and Racial Disparities in Low Birth Weight. Pediatrics 2022; 150:188346. [PMID: 35757969 DOI: 10.1542/peds.2021-052369] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To evaluate the effect of grandmother and mother educational attainment on low birth weight (LBW) in children and grandchildren. METHODS The National Longitudinal Study of Adolescent to Adult Health is a multigenerational study that collected survey data from 1994 to 2018. Using this database, we constructed a cohort of 2867 non-Hispanic Black (NHB) and non-Hispanic White (NHW) grandmother-mother-grandchild triads to evaluate how education affects the likelihood of having LBW children and grandchildren, while adjusting for socioeconomic and maternal health factors using multivariable logistic regression. RESULTS Similar to previous studies, NHB women were more likely to have LBW descendants compared with NHW women in unadjusted and adjusted analyses. The prevalence of LBW descendants was lower in women with college education, regardless of race. Irrespective of race, mother and grandmother college education was associated with decreased odds of LBW children and grandchildren after adjusting for individual variables. When mother and grandmother education were examined together, and after adjusting for all individual, community, and health variables together, mother college education remained associated with lower odds of LBW (adjusted odds ratio, 0.58; 95% confidence interval, 0.44-0.77). There were no statistically significant differences in these effects between NHW and NHB populations. CONCLUSIONS Educational attainment in mothers is associated with decreased odds of LBW descendants after adjusting for multiple individual, community, and health covariates, regardless of race. Targeting improvements in education may ameliorate adverse pregnancy outcomes that disproportionately affect minority communities and cause significant lifelong consequences.
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Affiliation(s)
- Emily Echevarria
- Department of Pediatrics, New York-Presbyterian Hospital - Weill Cornell Medicine, New York, New York
| | - Scott A Lorch
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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12
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Wallington SF, Noel A. Communicating with Community: Health Disparities and Health Equity Considerations. Med Clin North Am 2022; 106:715-726. [PMID: 35725236 DOI: 10.1016/j.mcna.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This article explores why communicating with communities is important to the health of individuals as well as public health, and best practices of how. We outline the use of relevant theoretic frameworks, understanding the role of technological contextual changes, trust despite misinformation, health and digital literacy skills, and working with the community for effective reciprocal communication. Strategies for developing community communication are also enumerated and applied to addressing health disparities.
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Affiliation(s)
- Sherrie Flynt Wallington
- George Washington University, School of Nursing, 1919 Pennsylvania Avenue, Suite 500, Washington, DC 20048, USA.
| | - Annecie Noel
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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13
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Bogulski CA, Willis DE, Williams CA, Ayers BL, Andersen JA, McElfish PA. Stressful life events and social support among pregnant Marshallese women. Matern Child Health J 2022; 26:1194-1202. [PMID: 35551586 PMCID: PMC9095441 DOI: 10.1007/s10995-022-03404-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 01/12/2022] [Accepted: 03/03/2022] [Indexed: 11/26/2022]
Abstract
Introduction Women from racial and ethnic minority groups in the United States are disproportionately likely to experience adverse perinatal outcomes such as preterm birth, low birthweight infants, and infant mortality. Previous research has demonstrated that exposure to stressful life events and social support may influence perinatal outcomes. Although studies have documented stressful life events and social support for the general United States population and minority groups, less is known about the experiences of Pacific Islander women in the United States, and no prior studies have documented these experiences in Marshallese Pacific Islander women. Methods The present study examined data collected from pregnant Marshallese women (n = 67) in northwest Arkansas participating in a women’s health program using descriptive analyses (means, standard deviations, proportions). Results Results indicated a high prevalence of three stressful life events: experiencing a family member going into the hospital (35.8%), someone close to them dying (29.9%), and being unable to pay bills (53.7%). Food insecurity was higher than previously reported for pregnant women or Pacific Islanders (83.7%). Social support was high among the sample. A majority of women reported receiving help with daily chores (86.6%), help when sick (88.1%), and support on how to deal with personal problems (85.1%). Discussion This study is the first to document the prevalence of stressful life events and social support in a sample of pregnant Marshallese women living in the United States. The findings provide important information to guide efforts to reduce adverse perinatal outcomes in a Pacific Islander population.
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Affiliation(s)
- Cari A. Bogulski
- University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, 72703-1908 Fayetteville, AR United States
| | - Don E. Willis
- University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, 72703-1908 Fayetteville, AR United States
| | - Christina A. Williams
- University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, 72703-1908 Fayetteville, AR United States
| | - Britni L. Ayers
- University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, 72703-1908 Fayetteville, AR United States
| | - Jennifer A. Andersen
- University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, 72703-1908 Fayetteville, AR United States
| | - Pearl A. McElfish
- University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, 72703-1908 Fayetteville, AR United States
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14
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Johnson JD, Louis JM. Does race or ethnicity play a role in the origin, pathophysiology, and outcomes of preeclampsia? An expert review of the literature. Am J Obstet Gynecol 2022; 226:S876-S885. [PMID: 32717255 DOI: 10.1016/j.ajog.2020.07.038] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/17/2020] [Accepted: 07/22/2020] [Indexed: 12/15/2022]
Abstract
The burden of preeclampsia, a substantial contributor to perinatal morbidity and mortality, is not born equally across the population. Although the prevalence of preeclampsia has been reported to be 3% to 5%, racial and ethnic minority groups such as non-Hispanic Black women and American Indian or Alaskan Native women are widely reported to be disproportionately affected by preeclampsia. However, studies that add clarity to the causes of the racial and ethnic differences in preeclampsia are limited. Race is a social construct, is often self-assigned, is variable across settings, and fails to account for subgroups. Studies of the genetic structure of human populations continue to find more variations within racial groups than among them. Efforts to examine the role of race and ethnicity in biomedical research should consider these limitations and not use it as a biological construct. Furthermore, the use of race in decision making in clinical settings may worsen the disparity in health outcomes. Most of the existing data on disparities examine the differences between White and non-Hispanic Black women. Fewer studies have enough sample size to evaluate the outcomes in the Asian, American Indian or Alaskan Native, or mixed-race women. Racial differences are noted in the occurrence, presentation, and short-term and long-term outcomes of preeclampsia. Well-established clinical risk factors for preeclampsia such as obesity, diabetes, and chronic hypertension disproportionately affect non-Hispanic Black, American Indian or Alaskan Native, and Hispanic populations. However, with comparable clinical risk factors for preeclampsia among women of different race or ethnic groups, addressing modifiable risk factors has not been found to have the same protective effect for all women. Abnormalities of placental formation and development, immunologic factors, vascular changes, and inflammation have all been identified as contributing to the pathophysiology of preeclampsia. Few studies have examined race and the pathophysiology of preeclampsia. Despite attempts, a genetic basis for the disease has not been identified. A number of genetic variants, including apolipoprotein L1, have been identified as possible risk modifiers. Few studies have examined race and prevention of preeclampsia. Although low-dose aspirin for the prevention of preeclampsia is recommended by the US Preventive Service Task Force, a population-based study found racial and ethnic differences in preeclampsia recurrence after the implementation of low-dose aspirin supplementation. After implementation, recurrent preeclampsia reduced among Hispanic women (76.4% vs 49.6%; P<.001), but there was no difference in the recurrent preeclampsia in non-Hispanic Black women (13.7 vs 18.1; P=.252). Future research incorporating the National Institute on Minority Health and Health Disparities multilevel framework, specifically examining the role of racism on the burden of the disease, may help in the quest for effective strategies to reduce the disproportionate burden of preeclampsia on a minority population. In this model, a multilevel framework provides a more comprehensive approach and takes into account the influence of behavioral factors, environmental factors, and healthcare systems, not just on the individual.
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Affiliation(s)
- Jasmine D Johnson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC
| | - Judette M Louis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL.
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15
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Eliner Y, Gulersen M, Chervenak FA, Lenchner E, Grunebaum A, Phillips K, Bar-El L, Bornstein E. Maternal education and racial/ethnic disparities in nulliparous, term, singleton, vertex cesarean deliveries in the United States. AJOG GLOBAL REPORTS 2022; 2:100036. [PMID: 36274969 PMCID: PMC9563532 DOI: 10.1016/j.xagr.2021.100036] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 11/30/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Racial and ethnic disparities in obstetrical and neonatal outcomes are prevalent in the United States. Such racial or ethnic disparities have also been documented in the prevalence of cesarean deliveries. OBJECTIVE We aimed to evaluate the impact of maternal education on racial or ethnic disparities in the prevalence of low-risk nulliparous, term, singleton, vertex cesarean deliveries in the United States. STUDY DESIGN This is a retrospective analysis of the Centers for Disease Control and Prevention live births database (2016–2019). Nulliparous, term, singleton, vertex births from the following racial/ethnic groups were included: non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic. Pregnancies complicated by gestational or pregestational diabetes mellitus and hypertensive disorders were excluded. Data were analyzed on the basis of the level of maternal education (less than high school graduate, high school graduate, college graduate, and advanced degree). We compared the prevalence of cesarean deliveries among the different racial or ethnic groups within each education level using Pearson chi-square test with Bonferroni adjustment. Multivariate logistic regression was performed to assess the association between cesarean deliveries and maternal race/ethnicity, maternal education, and the interaction between maternal race or ethnicity and education level, while controlling for potential confounders. To demonstrate the effect of the interaction, separate logistic regression models with similar covariates were performed for each education level and for each race/ethnicity group. Statistical significance was determined as P<.05, and results were displayed as adjusted odds ratios with 95% confidence intervals. RESULTS The overall prevalence of cesarean deliveries during the study period was 23.4% (695,214 of 2,969,207 births). All racial or ethnic minority groups had higher rates of cesarean deliveries than non-Hispanic White women (non-Hispanic Black, 27.4%; non-Hispanic Asian, 25.6%; Hispanic, 23.0%; and non-Hispanic White, 22.4%; [P<.001 for all comparisons]). Similar racial or ethnic differences in cesarean delivery rates were detected among all education levels. Higher levels of education were associated with a lower likelihood of cesarean delivery (adjusted odds ratio, 0.88; [95% confidence interval, 0.87–0.89]) in women with advanced degrees than in women who did not graduate from high school. However, although maternal education was associated with a protective effect in non-Hispanic White and non-Hispanic Asian women (adjusted odds ratio, 0.83 [95% confidence interval, 0.81–0.85] and adjusted odds ratio, 0.81 [95% confidence interval, 0.77–0.86], respectively, for women with advanced degrees), it had a smaller protective effect in non-Hispanic Black women (adjusted odds ratio, 0.93 [95% confidence interval, 0.89–0.97]) and no protective effect in Hispanic women (adjusted odds ratio, 0.98 [95% confidence interval, 0.96–1.01]). CONCLUSION We document a significant racial/ethnic disparity in the prevalence of low-risk nulliparous, term, singleton, vertex cesarean deliveries in the United States. Furthermore, our findings suggest that although a higher level of maternal education is associated with a lower likelihood of cesarean delivery, this protective effect varies among racial or ethnic groups. Further research is needed to investigate the underlying causes for this racial/ethnic disparity.
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16
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Matthews KC, Tangel VE, Abramovitz SE, Riley LE, White RS. Disparities in Obstetric Readmissions: A Multistate Analysis, 2007-2014. Am J Perinatol 2022; 39:125-133. [PMID: 34758500 DOI: 10.1055/s-0041-1739310] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Hospital readmissions are generally higher among racial-ethnic minorities and patients of lower socioeconomic status. However, this has not been widely studied in obstetrics. The aim of the study is to determine 30-day postpartum readmission rates by patient-level social determinants of health: race ethnicity, primary insurance payer, and median income, independently and as effect modifiers. STUDY DESIGN Using state inpatient databases from the health care cost and utilization project from 2007 to 2014, we queried all deliveries. To produce accurate estimates of the effects of parturients' social determinants of health on readmission odds while controlling for confounders, generalized linear mixed models (GLMMs) were used. Additional models were generated with interaction terms to highlight any associations and their effect on the outcome. Adjusted odds ratios (aOR) with 95% confidence intervals are reported. RESULTS There were 5,129,867 deliveries with 79,260 (1.5%) 30-day readmissions. Of these, 947 (1.2%) were missing race ethnicity. Black and Hispanic patients were more likely to be readmitted within 30 days of delivery, as compared with White patients (p < 0.001 and p < 0.05, respectively). Patients with government insurance were more likely to be readmitted than those with private insurance (p < 0.001). Patients living in the second quartile of median income were also more likely to be readmitted than those living in other quartiles (p < 0.05). Using GLMMs, we observed that Black patients with Medicare were significantly more likely to get readmitted as compared with White patients with private insurance (aOR 2.78, 95% CI 2.50-3.09, p < 0.001). Similarly, Black patients living in the fourth (richest) quartile of median income were more likely to get readmitted, even when compared with White patients living in the first (poorest) quartile of median income (aOR 1.48, 95% CI 1.40-1.57, p < 0.001). CONCLUSION Significant racial-ethnic disparities in obstetric readmissions were observed, particularly in Black patients with government insurance and even in Black patients living in the richest quartile of median income. KEY POINTS · Using generalized linear mixed models, we observed significant interactions.. · Government-insured Black patients were 2.78X more likely to be readmitted.. · The wealthiest Black patients were still 1.48X more likely to be readmitted..
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Affiliation(s)
- Kathy C Matthews
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York
| | - Virginia E Tangel
- Department of Anesthesiology, Center for Perioperative Outcomes, Weill Cornell Medicine, New York, New York
| | - Sharon E Abramovitz
- Department of Anesthesiology, Center for Perioperative Outcomes, Weill Cornell Medicine, New York, New York
| | - Laura E Riley
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York
| | - Robert S White
- Department of Anesthesiology, Center for Perioperative Outcomes, Weill Cornell Medicine, New York, New York
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17
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Berhie SH, Cheng YW, Caughey AB, Yee LM. Association between weighted adverse outcome score and race/ethnicity in women and neonates. J Perinatol 2021; 41:2730-2735. [PMID: 34675372 DOI: 10.1038/s41372-021-01237-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 09/08/2021] [Accepted: 10/06/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the association between the Weighted Adverse Outcome Score (WAOS) and race/ethnicity among a large and diverse population-based cohort of women and neonates in the United States. STUDY DESIGN This was a retrospective cohort study of women who delivered in the United States between 2011 and 2013. We identified mother-infant pairs with adverse maternal and/or neonatal outcomes. These outcomes were assigned weighted scores to account for relative severity. The association between race/ethnicity and WAOS was examined using chi-square test and multivariable logistic regression. RESULTS Compared to White women and their neonates, Black women and their neonates were at higher odds of an adverse outcome. CONCLUSION(S) The vast majority of women and neonates had no adverse outcome. However, Black women and their neonates were found to have a higher WAOS. This tool could be used to designate hospitals or regions with higher-than-expected adverse outcomes and target them for intervention.
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Affiliation(s)
- Saba H Berhie
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, US.
| | - Yvonne W Cheng
- Division of Maternal-Fetal Medicine, California Pacific Medical Center, San Francisco, CA, US
| | - Aaron B Caughey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, US
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, US
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18
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"My 9 to 5 Job Is Birth Work": A Case Study of Two Compensation Approaches for Community Doula Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010817. [PMID: 34682558 PMCID: PMC8535486 DOI: 10.3390/ijerph182010817] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/09/2021] [Accepted: 10/10/2021] [Indexed: 01/18/2023]
Abstract
With the increased policy emphasis on promoting doula care to advance birth equity in the United States, there is a vital need to identify sustainable and equitable approaches for compensation of community doulas, who serve clients experiencing the greatest barriers to optimal pregnancy-related outcomes. This case study explores two different approaches for compensating doulas (contractor versus hourly employment with benefits) utilized by SisterWeb San Francisco Community Doula Network in San Francisco, California. We conducted qualitative interviews with SisterWeb doulas in 2020 and 2021 and organizational leaders in 2020. Overall, leaders and doulas reported that the contractor approach, in which doulas were paid a flat fee per client, did not adequately compensate doulas, who regularly attend trainings and provide additional support for their clients (e.g., referrals to promote housing and food security). Additionally, this approach did not provide doulas with healthcare benefits, which was especially concerning during the COVID-19 pandemic. As hourly, benefited employees, doulas experienced a greater sense of financial security and wellbeing from receiving consistent pay, compensation for all time worked, and benefits such as health insurance and sick leave, allowing some to dedicate themselves to birth work. Our study suggests that efforts to promote community doula care must integrate structural solutions to provide appropriate compensation and benefits to doulas, simultaneously advancing birth equity and equitable labor conditions for community doulas.
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19
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Crawford AD, Cleveland L, McGrath JM, Berndt A. Systemic inequities and depressive symptomology in Hispanic mothers: A path analysis model. Public Health Nurs 2021; 39:519-527. [PMID: 34529867 DOI: 10.1111/phn.12968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/20/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hispanic mothers are one of the largest groups to give birth. They also experience high rates of morbidity and mortality; however, there is limited data related to their health inequities. PURPOSE The purpose of this study was to evaluate systemic inequities associated with discrimination using the Reproductive Justice Framework to observe factors that influenced depressive symptomology in Hispanic women. METHODS A path analysis was conducted to evaluate systemic inequities that influenced postpartum depression using the public database, Listening to Mothers III (LMIII). The sub-sample consisted of n = 406 Hispanic mothers. Data was initially collected between the years 2011 and 2013. RESULTS Hispanic mothers were more likely to experience occurrences of perceived discrimination while seeking perinatal healthcare. These occurrences of discrimination led to lower trust in their healthcare providers, lower satisfaction with care, more instances of unwanted medical procedures, the need to feel to hold back comments about their health which ultimately resulted in higher rates of self-reported postpartum depression. The model fit indices supported the model's plausibility (χ2 /df ratio = 3.16, Comparative Fit Index = 0.91, Root Mean Square Error of Approximation = 0.06). CONCLUSIONS This data supported our hypothesis that the pathway of discriminatory barriers Hispanic mothers experience during pregnancy influence postpartum depression.
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Affiliation(s)
- Allison D Crawford
- School of Nursing, The University of Texas Health at San Antonio, San Antonio, Texas, USA.,School of Nursing, The University of Texas at Austin, Austin, Texas, USA
| | - Lisa Cleveland
- School of Nursing, The University of Texas Health at San Antonio, San Antonio, Texas, USA
| | - Jacqueline M McGrath
- School of Nursing, The University of Texas Health at San Antonio, San Antonio, Texas, USA
| | - Andrea Berndt
- School of Nursing, The University of Texas Health at San Antonio, San Antonio, Texas, USA
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20
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Johnson RF, Brown CM, Beams DR, Wang CS, Shah GB, Mitchell RB, Chorney SR. Racial Influences on Pediatric Tracheostomy Outcomes. Laryngoscope 2021; 132:1118-1124. [PMID: 34478158 DOI: 10.1002/lary.29847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/14/2021] [Accepted: 08/22/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the impact of race on outcomes after pediatric tracheostomy. STUDY DESIGN Retrospective case series. METHODS A case series of tracheostomies at an urban, tertiary care children's hospital between 2014 and 2019 was conducted. Children were grouped by race to compare neurocognition, mortality, and decannulation rate. RESULTS A total of 445 children with a median age at tracheostomy of 0.46 (interquartile range [IQR]: 0.97) years were studied. The cohort was 32% Hispanic, 31% White, 30% Black, 2.9% Asian, and 4.3% other race. Black compared to White children had a lower median birth weight (2,022 vs. 2,449 g, P = .005), were more often extremely premature (≤28 weeks gestation: 62% vs. 57%, P = .007), and more frequently had bronchopulmonary dysplasia (BPD) (35% vs. 17%, P = .002). Hispanic compared to Black children had higher median birth weight (2,529 g, P < .001), less extreme prematurity (44%, P < .001), and less BPD (21%, P = .04). The proportion of Black children was higher (30% vs. 19%, P < .001), while the proportion of Hispanic children with a tracheostomy was lower (32% vs. 42%, P = .003) compared to the racial distribution of all pediatric admissions. Racial differences were not seen for rates of severe neurocognitive disability (P = .51), decannulation (P = .17), or death (P = .92) after controlling for age, sex, prematurity, and ventilator dependence. CONCLUSION Black children disproportionately underwent tracheostomy and had a higher comorbidity burden than White or Hispanic children. Hispanic children had proportionally fewer tracheostomies. Neurocognitive ability, decannulation, and mortality were similar for all races implying that health disparities by race may not change long-term outcomes after pediatric tracheostomy. Laryngoscope, 2021.
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Affiliation(s)
- Romaine F Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.,Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, U.S.A
| | - Clarice M Brown
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Dylan R Beams
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Cynthia S Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Gopi B Shah
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.,Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, U.S.A
| | - Ron B Mitchell
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.,Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, U.S.A
| | - Stephen R Chorney
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.,Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, U.S.A
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21
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Ruyak SL, Kivlighan KT. Perinatal Behavioral Health, the COVID-19 Pandemic, and a Social Determinants of Health Framework. J Obstet Gynecol Neonatal Nurs 2021; 50:525-538. [PMID: 34146480 PMCID: PMC8256336 DOI: 10.1016/j.jogn.2021.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 12/01/2022] Open
Abstract
The United States has greater prevalence of mental illness and substance use disorders than other developed countries, and pregnant women are disproportionately affected. The current global COVID-19 pandemic, through the exacerbation of psychological distress, unevenly affects the vulnerable population of pregnant women. Social distancing measures and widespread closures of businesses secondary to COVID-19 are likely to continue for the foreseeable future and to further magnify psychosocial risk factors. We propose the use of a social determinants of health framework to integrate behavioral health considerations into prenatal care and to guide the implementation of universal and comprehensive psychosocial assessment in pregnancy. As the most numerous and well-trusted health care professionals, nurses are ideally positioned to influence program and policy decisions at the community and regional levels and to advocate for the full integration of psychosocial screening and behavioral health into prenatal and postpartum care as core components.
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22
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Glazer KB, Zeitlin J, Egorova NN, Janevic T, Balbierz A, Hebert PL, Howell EA. Hospital Quality of Care and Racial and Ethnic Disparities in Unexpected Newborn Complications. Pediatrics 2021; 148:peds.2020-024091. [PMID: 34429339 PMCID: PMC9708325 DOI: 10.1542/peds.2020-024091] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To investigate racial and ethnic differences in unexpected, term newborn morbidity and the influence of hospital quality on disparities. METHODS We used 2010-2014 birth certificate and discharge abstract data from 40 New York City hospitals in a retrospective cohort study of 483 834 low-risk (term, singleton, birth weight ≥2500 g, without preexisting fetal conditions) neonates. We classified morbidity according to The Joint Commission's unexpected newborn complications metric and used multivariable logistic regression to compare morbidity risk among racial and ethnic groups. We generated risk-standardized complication rates for each hospital using mixed-effects logistic regression to evaluate quality, ranked hospitals on this measure, and assessed differences in the racial and ethnic distribution of births across facilities. RESULTS The unexpected complications rate was 48.0 per 1000 births. Adjusted for patient characteristics, morbidity risk was higher among Black and Hispanic infants compared with white infants (odds ratio: 1.5 [95% confidence interval 1.3-1.9]; odds ratio: 1.2 [95% confidence interval 1.1-1.4], respectively). Among the 40 hospitals, risk-standardized complications ranged from 25.3 to 162.8 per 1000 births. One-third of Black and Hispanic women gave birth in hospitals ranking in the highest-morbidity tertile, compared with 10% of white and Asian American women (P < .001). CONCLUSIONS Black and Hispanic women were more likely to deliver in hospitals with high complication rates than were white or Asian American women. Findings implicate hospital quality in contributing to preventable newborn health disparities among low-risk, term births. Quality improvement targeting routine obstetric and neonatal care is critical for equity in perinatal outcomes.
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Affiliation(s)
- Kimberly B. Glazer
- Departments of Population Health Science and Policy, and Obstetrics, Gynecology and Reproductive Science, and Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jennifer Zeitlin
- Departments of Population Health Science and Policy, and Obstetrics, Gynecology and Reproductive Science, and Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York;,Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center of Research in Epidemiology and Statistics Sorbonne Paris Cité, Université de Paris and Institut National de la Santé et de la Recherche Médicale, Institut National de la Recherche Agronomique, Paris, France
| | - Natalia N. Egorova
- Departments of Population Health Science and Policy, and Obstetrics, Gynecology and Reproductive Science, and Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Teresa Janevic
- Departments of Population Health Science and Policy, and Obstetrics, Gynecology and Reproductive Science, and Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Amy Balbierz
- Departments of Population Health Science and Policy, and Obstetrics, Gynecology and Reproductive Science, and Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York;,Grossman School of Medicine, New York University, New York, New York
| | - Paul L. Hebert
- School of Public Health, University of Washington, Seattle, Washington
| | - Elizabeth A. Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Policy in pediatric nephrology: successes, failures, and the impact on disparities. Pediatr Nephrol 2021; 36:2177-2188. [PMID: 32968856 DOI: 10.1007/s00467-020-04755-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/10/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
Pediatric nephrology has a history rooted in pediatric advocacy and has made numerous contributions to child health policy affecting pediatric kidney diseases. Despite this progress, profound social disparities remain for marginalized and socially vulnerable children with kidney disease. Different risk factors, such as genetic predisposition, environmental factors, social risk factors, or health care access influence the emergence and progression of pediatric kidney disease, as well as access to life-saving interventions, leading to disparate outcomes. This review will summarize the breadth of literature on social determinants of health in children with kidney disease worldwide and highlight policy-based initiatives that mitigate the adverse social factors to generate greater equity in pediatric kidney disease.
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Whipps MDM, Phipps JE, Simmons LA. Perinatal health care access, childbirth concerns, and birthing decision-making among pregnant people in California during COVID-19. BMC Pregnancy Childbirth 2021; 21:477. [PMID: 34215218 PMCID: PMC8250556 DOI: 10.1186/s12884-021-03942-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/01/2021] [Indexed: 12/23/2022] Open
Abstract
Background During public health emergencies, including the COVID-19 pandemic, access to adequate healthcare is crucial for providing for the health and wellbeing of families. Pregnant and postpartum people are a particularly vulnerable subgroup to consider when studying healthcare access. Not only are perinatal people likely at higher risk for illness, mortality, and morbidity from COVID-19 infection, they are also at higher risk for negative outcomes due to delayed or inadequate access to routine care. Methods We surveyed 820 pregnant people in California over two waves of the COVID-19 pandemic: (1) a ‘non-surge’ wave (June 2020, n = 433), and (2) during a ‘surge’ in cases (December 2020, n = 387) to describe current access to perinatal healthcare, as well as concerns and decision-making regarding childbirth, over time. We also examined whether existing structural vulnerabilities – including acute financial insecurity and racial/ethnic minoritization – are associated with access, concerns, and decision-making over these two waves. Results Pregnant Californians generally enjoyed more access to, and fewer concerns about, perinatal healthcare during the winter of 2020–2021, despite surging COVID-19 cases and hospitalizations, as compared to those surveyed during the COVID-19 ‘lull’ in the summer of 2020. However, across ‘surge’ and ‘non-surge’ pandemic circumstances, marginalized pregnant people continued to fare worse – especially those facing acute financial difficulty, and racially minoritized individuals identifying as Black or Indigenous. Conclusions It is important for clinicians, researchers, and policymakers to understand whether and how shifting community transmission and infection rates may impact access to perinatal healthcare. Targeting minoritized and financially insecure communities for increased upstream perinatal healthcare supports are promising avenues to blunt the negative impacts of the COVID-19 pandemic on pregnant people in California. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03942-y.
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Affiliation(s)
- Mackenzie D M Whipps
- Department of Human Ecology, Perinatal Origins of Disparities Center, University of California, Davis, California, USA.
| | - Jennifer E Phipps
- Department of Human Ecology, Perinatal Origins of Disparities Center, University of California, Davis, California, USA
| | - Leigh Ann Simmons
- Department of Human Ecology, Perinatal Origins of Disparities Center, University of California, Davis, California, USA
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Vallejo MC, Shapiro RE, Lilly CL, Nield LS, Ferrari ND. The influence of medical insurance on obstetrical care. J Healthc Risk Manag 2021; 41:16-21. [PMID: 33094546 PMCID: PMC8060349 DOI: 10.1002/jhrm.21451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Maternal and obstetrical outcomes vary widely within the United States. The impact of insurance type on health care disparities and its influence on obstetrical care and maternal outcome is not clear. We report the impact of health care insurance on obstetrical and maternal outcomes in a tertiary care health care system. Our maternal quality care database (n = 4199) was queried comparing commercial insurance to government sponsored insurance from July 1, 2015 through June 30, 2018. Parturients with commercial insurance were older, weighed more, presented with less gravidity and parity, had more advanced gestation, and had a higher neonatal 5-minute Apgar score than government insured parturients. Additionally, government insured parturients were less likely to be admitted for induction with oxytocin, receive labor epidural analgesia, and have a primary caesarean delivery. Similarly, government insured parturients were more likely to be of African American descent, be a current known smoker, have a positive urine drug screen, and receive a general anesthetic. We conclude obstetrical and maternal health care disparities exist based on medical insurance type.
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Affiliation(s)
- Manuel C Vallejo
- Department of Medical Education, West Virginia University School of Medicine, Morgantown, West Virginia
- Department of Anesthesiology, West Virginia University School of Medicine, Morgantown, West Virginia
- Department of Obstetrics & Gynecology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Robert E Shapiro
- Department of Obstetrics & Gynecology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Christa L Lilly
- Department of Biostatistics, West Virginia University School of Public Health, Morgantown, West Virginia
| | - Linda S Nield
- Department of Medical Education, West Virginia University School of Medicine, Morgantown, West Virginia
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Norman D Ferrari
- Department of Medical Education, West Virginia University School of Medicine, Morgantown, West Virginia
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia
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Glazer KB, Zeitlin J, Howell EA. Intertwined disparities: Applying the maternal-infant dyad lens to advance perinatal health equity. Semin Perinatol 2021; 45:151410. [PMID: 33865629 PMCID: PMC8184592 DOI: 10.1016/j.semperi.2021.151410] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Differences in the quality of delivery hospital care contribute to persistent, intertwined racial and ethnic disparities in both maternal and infant health. Despite the shared causal pathways and overlapping burden of maternal and infant health disparities, little research on perinatal quality of care has addressed obstetric and neonatal care jointly to improve outcomes and reduce health inequities for the maternal-infant dyad. In this paper, we review the role of hospital quality in shaping perinatal health outcomes, and investigate how a framework that considers the mother-infant dyad can enhance our understanding of the full burden of obstetric and neonatal disparities on health and society. We conclude with a discussion of how integrating a maternal-infant dyad lens into research and clinical intervention to improve quality of care can move the needle on disparity reduction for both women and infants around the time of birth and throughout the life course.
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Affiliation(s)
- Kimberly B Glazer
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Jennifer Zeitlin
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004 Paris, France
| | - Elizabeth A Howell
- Department of Obstetrics & Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
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Abstract
Advances in neonatal intensive care have improved outcomes for preterm newborns, but significant racial/ethnic disparities persist. Neonatal disparities have their origin in a complex set of factors that include systemic racism and structural disadvantages endured by minority families, but differential quality of care in the neonatal intensive care unit (NICU) remains an important and modifiable source of disparity. NICU care has been shown to be segregated and unequal: Black and Hispanic infants are more likely to be cared for in lower quality NICUs and may receive worse care within a NICU. To eliminate disparities in care and outcomes, it is important to identify and address the mechanisms that lead to lower quality care for minority preterm infants. In this review, we identify improvements in both technical (clinical) and relational (engaging and supporting families) processes of care as critical to better outcomes for minority infants and families.
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Affiliation(s)
- Dhurjati Ravi
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA; California Perinatal Quality Care Collaborative, Palo Alto, CA, USA.
| | - Alexandra Iacob
- Division of Neonatal and Perinatal Medicine, Department of Pediatrics, School of Medicine, University of California Irvine, Irvine, CA, USA
| | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA; California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
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Jones MR, Orhurhu V, O'Gara B, Brovman EY, Rao N, Vanterpool SG, Poree L, Gulati A, Urman RD. Racial and Socioeconomic Disparities in Spinal Cord Stimulation Among the Medicare Population. Neuromodulation 2021; 24:434-440. [PMID: 33723896 DOI: 10.1111/ner.13373] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Spinal cord stimulation (SCS) is used in the treatment of many chronic pain conditions. This study investigates racial and socioeconomic disparities in SCS among Medicare patients with chronic pain. MATERIALS AND METHODS Patients over the age of 18 with a primary diagnosis of postlaminectomy syndrome (ICD-10 M96.1) or chronic pain syndrome (ICD-10 G89.4) were identified in the Center for Medicare and Medicaid Services (CMS) Medicare Claims Limited Data Set. We defined our outcome as SCS therapy by race and socioeconomic status. Multivariable logistic regression was used to determine the variables associated with SCS. RESULTS We identified 1,244,927 patients treated between 2016 and 2019 with a primary diagnosis of postlaminectomy syndrome (PLS) or chronic pain syndrome (CPS). Of these patients, 59,182 (4.8%) received SCS. Multivariable logistic regression analysis revealed that, compared with White patients, Black (OR [95%CI], 0.62 [0.6-0.65], p < 0.001), Asian (0.66 [0.56-0.76], p < 0.001), Hispanic (0.86 [0.8-0.93], p < 0.001), and North American Native (0.62 [0.56-0.69], p < 0.001) patients were significantly less likely to receive SCS. In addition, patients who were dual-eligible for Medicare and Medicaid were significantly less likely to receive SCS than those eligible for Medicare only (OR = 0.38 [95% CI: 0.37-0.39], p < 0.001). CONCLUSIONS This study suggests that racial and socioeconomic disparities exist in SCS among Medicare and Medicaid patients with PLS and CPS. Further work is required to elucidate the complex etiology underlying these findings.
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Affiliation(s)
- Mark R Jones
- Weill Cornell Medical College, Department of Anesthesiology, New York, NY, USA
| | - Vwaire Orhurhu
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian O'Gara
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ethan Y Brovman
- Tufts Medical Center and University School of Medicine, Boston, MA, USA
| | | | | | - Lawrence Poree
- Pain Management Center, UCSF Health, San Francisco, CA, USA
| | - Amitabh Gulati
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard D Urman
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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29
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Shour A, Garacci E, Palatnik A, Dawson AZ, Anguzu R, Walker RJ, Egede L. Association between pregestational diabetes and mortality among appropriate-for-gestational age birthweight infants. J Matern Fetal Neonatal Med 2021; 35:5291-5300. [PMID: 33517824 DOI: 10.1080/14767058.2021.1878142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND/OBJECTIVE Existing studies have shown that pregestational diabetes is a significant risk factor for adverse birth outcomes. However, it is unclear, whether pregestational diabetes and neonatal birthweight that is appropriate for the gestational age (AGA), a proxy for overall adequate glycemic control, is associated with higher infant mortality. To address this controversy, this study investigated the relationship between pregestational diabetes and infant mortality in appropriate-for-gestational age infants in the United States. METHODS Data from the National Vital Statistics System-Linked Birth-Infant Death dataset, including 6,962,028 live births between 2011 and 2013 were analyzed. The study was conducted in the US and data were analyzed in Milwaukee, Wisconsin. The outcome was mortality among AGA newborns, defined as annual deaths per 1000 live births with birthweights between the 10th and 90th percentiles for gestational age delivering at ≥37 weeks. The exposure was pregestational diabetes. Covariates were maternal demographics, behavioral/clinical, and infant factors. Logistic regression was used with p values <.05 considered statistically significant. RESULTS A total of 6,962,028 live births met inclusion criteria. Of these, a total of 11,711 (1.0%) term AGA birthweight infants died before their first birthday. About 35,689 (0.5%) mothers were diagnosed with pregestational diabetes prior to pregnancy with 0.3% of infants whose mothers had diabetes dying in their first year of life. In the unadjusted model, pregestational diabetes had a significant association with increased odds of mortality in term AGA infants (OR: 1.9, 95% CI: 1.6 - 2.3). AGA mortality remained significantly higher for women with pregestational diabetes compared to controls, after adjusting for maternal demographics (OR: 1.9, 95% CI: 1.6-2.3), behavioral/clinical characteristics (OR: 1.6, 95% CI: 1.3-2.0), and infant factors (OR: 1.3, 95% CI: 1.1-1.6). CONCLUSIONS In term pregnancies, pregestational diabetes was significantly associated with 30% higher mortality among AGA birthweight infants. Our study is innovative in its focus on AGA infants that overall is associated with good maternal glycemic control during pregnancy and in theory should confer a risk for infant mortality that is similar to pregnancies not complicated by pregestational diabetes. Despite this, we still found that even term AGA infants have higher risk of mortality in the setting of maternal pregestational diabetes. Implications of our findings underscore the importance of close antepartum surveillance and optimization of glycemic control preconception, identification of treatment targets, and health policies to reduce infant mortality. The results from this study may assist other researchers and clinicians understand how best to target future interventions to reduce term infant mortality and the burden of pregestational diabetes in the United States.
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Affiliation(s)
- Abdul Shour
- Medical College of Wisconsin, Institute for Health and Equity, Milwaukee, WI, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Emma Garacci
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anna Palatnik
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aprill Z Dawson
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ronald Anguzu
- Medical College of Wisconsin, Institute for Health and Equity, Milwaukee, WI, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Gulersen M, Grunebaum A, Lenchner E, Chervenak FA, Bornstein E. Racial disparities in the administration of antenatal corticosteroids in women with preterm birth. Am J Obstet Gynecol 2020; 223:933-934. [PMID: 32679210 DOI: 10.1016/j.ajog.2020.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/10/2020] [Indexed: 11/27/2022]
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The Hispanic/Latinx Perinatal Paradox in the United States: A Scoping Review and Recommendations to Guide Future Research. J Immigr Minor Health 2020; 23:1078-1091. [DOI: 10.1007/s10903-020-01117-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2020] [Indexed: 10/23/2022]
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Pflugeisen BM, Mou J, Drennan KJ, Straub HL. Demographic Discrepancies in Prenatal Urine Drug Screening in Washington State Surrounding Recreational Marijuana Legalization and Accessibility. Matern Child Health J 2020; 24:1505-1514. [PMID: 33009980 DOI: 10.1007/s10995-020-03010-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study evaluated demographic patterns related to prenatal cannabinoid urine drug screening (UDS) over a 5-year period during which recreational marijuana was legalized and became accessible in Washington State. METHODS Using electronic health record data, we performed a retrospective analysis for deliveries occurring over a 5-year period that encapsulated the transitions to marijuana legalization and legal access. For three cohorts of women delivering prior to legalization, between legalization and accessibility, and following accessibility, the UDS completion rate and screening demographic characteristics were assessed using Chi-squared tests and multivariate logistic regression. RESULTS 25,514 deliveries occurred between March 2011 and March 2016. A significantly higher percentage of women underwent UDS post-accessibility (24.5%) compared to pre-legalization (20.0%, p < 0.001). A corresponding increase was not observed in the percentage of marijuana-positive UDS in tested patients (22.7% vs. 23.3%, p = 0.86). African American women had 2.8 times higher odds than Latinas of being tested, 2.1 times higher odds than Asian women, 1.7 times higher odds than White women, and 1.4 times higher odds than women of other races (all p < 0.001). Subsidized insurance status was also strongly associated with increased likelihood of testing (aOR = 3.5, p < 0.001). CONCLUSIONS FOR PRACTICE Prenatal UDS testing patterns changed as recreational marijuana possession and accessibility became legal. Demographic discrepancies in testing reveal biases related to race and insurance status, which may be a proxy for socioeconomic status. As such discrepancies are potential contributors to health outcome disparities, it is important for providers and health care systems to examine their practices and ensure they are being appropriately, equally, and justly applied.
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Affiliation(s)
- Bethann M Pflugeisen
- Institute for Research & Innovation, MultiCare Health System, 314 Martin Luther King Jr. Way, Suite 402, Tacoma, WA, 98405, USA.
| | - Jin Mou
- Institute for Research & Innovation, MultiCare Health System, 314 Martin Luther King Jr. Way, Suite 402, Tacoma, WA, 98405, USA
| | - Kathryn J Drennan
- Division of Maternal-Fetal Medicine, University of Rochester, Rochester, NY, USA
| | - Heather L Straub
- Division of Maternal-Fetal Medicine, University of Colorado, Aurora, CO, USA
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Abstract
Readmission amongst previous neonatal intensive care unit (NICU) graduates, especially for preterm infants, is common and remains a significant risk for these infants beyond the neonatal period. This review explores risk factors for readmissions, common reasons for requiring rehospitalization and explores opportunities for improving the transition from discharge to home with the ultimate goal of reducing readmissions for these high risk infants.
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Affiliation(s)
- Kathleen E Hannan
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Neonatology MS 8402, 13121 E. 17th Ave., Aurora, CO 80045, United States.
| | - Sunah S Hwang
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Neonatology MS 8402, 13121 E. 17th Ave., Aurora, CO 80045, United States
| | - Stephanie L Bourque
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Neonatology MS 8402, 13121 E. 17th Ave., Aurora, CO 80045, United States
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Social disparities negatively impact neonatal follow-up clinic attendance of premature infants discharged from the neonatal intensive care unit. J Perinatol 2020; 40:790-797. [PMID: 32203182 PMCID: PMC9610791 DOI: 10.1038/s41372-020-0659-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/02/2020] [Accepted: 03/11/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Neonatal neurodevelopmental follow-up clinic provides continued surveillance and assessment of high-risk premature infants. We hypothesized that attrition is associated with race and social factors. STUDY DESIGN We performed a retrospective cohort study of neonates born at 26-32 weeks gestation who were admitted to a level IV neonatal intensive care unit. Maternal and neonatal characteristics and follow-up attendance were collected. Statistical analysis was performed with significance set at p value < 0.05. RESULTS In total, 237 neonates met study criteria. There was a 62% loss to follow-up over 2 years. Factors associated with loss to follow-up included older gestational age, African American race, and maternal cigarette smoking. Protective factors included older maternal age, a neonatal diagnosis of bronchopulmonary dysplasia, and longer hospital length of stay. CONCLUSIONS Social disparities negatively impact neonatal follow-up clinic attendance. Efforts to identify and target high-risk populations must be started during initial hospitalization before infants are lost to follow-up.
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Johnson JD, Green CA, Vladutiu CJ, Manuck TA. Racial Disparities in Prematurity Persist among Women of High Socioeconomic Status. Am J Obstet Gynecol MFM 2020; 2:100104. [PMID: 33179010 DOI: 10.1016/j.ajogmf.2020.100104] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives Despite persistent racial disparities in preterm birth (PTB) in the US among non-Hispanic (NH) black women compared to NH white women, it remains controversial whether sociodemographic factors can explain these differences. We sought to evaluate whether disparities in PTB persist among NH black women with high socioeconomic status (SES). Study Design We conducted a population-based cohort study of all live births in the US from 2015-2017 using birth certificate data from the National Vital Statistics System. We included singleton, non-anomalous live births among women who were of high SES (defined as having ≥ 16 years of education, private insurance, and not receiving Women, Infants and Children [WIC] benefits) and who identified as NH white, NH black, or 'mixed' NH black and white race. The primary outcome was PTB <37 weeks; secondary outcomes included PTB <34 and <28 weeks. In addition, analyses were repeated considering birthweight <2500g as a surrogate for preterm birth <37 weeks, birthweight <1500g as a surrogate for preterm birth <34 weeks, and birthweight <750g as a surrogate for preterm birth <28 weeks' gestation. Data were analyzed with chi-square, t-test, and logistic regression. Results 2,170,686 live births met inclusion criteria, with 92.9% NH white, 6.7% NH black, and 0.4% both NH white and black race. Overall, 5.9% delivered <37, 1.3% <34, and 0.3 % <28 weeks. In unadjusted analyses of women with high SES, the PTB rate at each gestational age cutoff was higher for women of 'mixed' NH white and black race, and highest for women who were NH black only compared to women who were NH white only. In regression models we further adjusted for women with insurance and prenatal care their entire pregnancy, maternal race was associated with higher odds of PTB at each GA cutoff, with the highest odds observed at <28 weeks. Finally, in further adjustement analysis including only the 1,934,912 women who received prenatal care in the first trimester, findings were similar. Rates of preterm birth at each gestational age cutoff remained highest for women who identified as non-Hispanic black, intermediate for women identifying as both non-Hispanic black and white race, and lowest for non-Hispanic white women at <37 weeks (9.9% vs. 6.1% vs. 5.5%, respectively; p<0.001), <34 weeks (3.5% vs. 1.5% vs. 1.1%, respectively; p<0.001), and <28 weeks' gestation (1.2% vs. 0.4% vs. 0.2%, respectively, p<0.001). Conclusions Even among college-educated women with private insurance who are not receiving WIC, racial disparities in prematurity persist. These national findings are consistent with prior studies that suggest factors other than socio-demographics are important in the underlying pathogenesis of PTB.
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Affiliation(s)
- Jasmine D Johnson
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC
| | - Celeste A Green
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC
| | - Catherine J Vladutiu
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC
| | - Tracy A Manuck
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC
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Abu-Saad K, Kaufman-Shriqui V, Freedman LS, Belmaker I, Fraser D. Preconceptional diet quality is associated with birth outcomes among low socioeconomic status minority women in a high-income country. Eur J Nutr 2020; 60:65-77. [PMID: 32185478 DOI: 10.1007/s00394-020-02221-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 03/04/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE Studies of the association between maternal nutrition and birth outcomes have investigated differing nutrients, maternal socioeconomic conditions, and timing within the reproductive cycle; and have produced inconsistent results. We evaluated the association of preconceptional maternal dietary intake with birth outcomes among low socioeconomic status ethnic minority women in a high-income country. METHODS In this prospective cohort study, habitual preconceptional dietary intake was assessed among pregnant Bedouin Arab women in Israel (n = 384), using a short culturally specific, targeted food frequency questionnaire. Multiple nutrients (protein, lysine, calcium, iron, zinc, folate, omega-3 fatty acids) were evaluated simultaneously via a diet quality score derived from principal component analysis. Multivariable logistic regression was used to test associations between the diet quality score and a composite adverse birth outcomes variable, including preterm birth, low birth weight and small for gestational age. RESULTS Sixty-nine women (18%) had adverse birth outcomes. Women with low preconceptional diet quality scores had low intakes of nutrient-rich plant foods, bioavailable micronutrients, and complete proteins. In multivariable analysis, a woman at the 10th percentile of the diet quality score had a 2.97 higher odds (95% CI 1.28-6.86) of an adverse birth outcome than a woman at the 90th percentile. CONCLUSION Low diet quality during the preconceptional period was associated with adverse birth outcomes among low socioeconomic status minority women in a high-income country. The results have implications for the development of appropriate intervention strategies to prevent adverse birth outcomes, and the promotion of adequate nutrition throughout the child-bearing years.
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Affiliation(s)
- Kathleen Abu-Saad
- Department of Public Health, Faculty of Health Sciences, The S. Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University of the Negev, 84105, Beer-Sheva, Israel. .,Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 52621, Ramat Gan, Israel.
| | - Vered Kaufman-Shriqui
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, 65 Ramat HaGolan St, Ariel, Israel
| | - Laurence S Freedman
- Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, 52621, Ramat Gan, Israel
| | - Ilana Belmaker
- Division of Community Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, 84105, Beer-Sheva, Israel
| | - Drora Fraser
- Department of Public Health, Faculty of Health Sciences, The S. Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University of the Negev, 84105, Beer-Sheva, Israel
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Beck AF, Edwards EM, Horbar JD, Howell EA, McCormick MC, Pursley DM. The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families. Pediatr Res 2020; 87:227-234. [PMID: 31357209 PMCID: PMC6960093 DOI: 10.1038/s41390-019-0513-6] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/04/2019] [Indexed: 02/06/2023]
Abstract
Racism, segregation, and inequality contribute to health outcomes and drive health disparities across the life course, including for newborn infants and their families. In this review, we address their effects on the health and well-being of newborn infants and their families with a focus on preterm birth. We discuss three causal pathways: increased risk; lower-quality care; and socioeconomic disadvantages that persist into infancy, childhood, and beyond. For each pathway, we propose specific interventions and research priorities that may remedy the adverse effects of racism, segregation, and inequality. Infants and their families will not realize the full benefit of advances in perinatal and neonatal care until we, collectively, accept our responsibility for addressing the range of determinants that shape long-term outcomes.
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Affiliation(s)
- Andrew F Beck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of General & Community Pediatrics and Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Erika M Edwards
- Vermont Oxford Network, Burlington, VT, USA.
- Department of Pediatrics, Robert Larner, MD, College of Medicine, University of Vermont, Burlington, VT, USA.
- Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, University of Vermont, Burlington, VT, USA.
| | - Jeffrey D Horbar
- Vermont Oxford Network, Burlington, VT, USA
- Department of Pediatrics, Robert Larner, MD, College of Medicine, University of Vermont, Burlington, VT, USA
| | - Elizabeth A Howell
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marie C McCormick
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - DeWayne M Pursley
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Cotton QD, Smith P, Ehrenthal DB, Green-Harris G, Kind AJH. A Case Study on A University-Community Partnership to Eliminate Racial Disparities in Infant Mortality: Effective Strategies and Lessons Learned. SOCIAL WORK IN PUBLIC HEALTH 2019; 34:673-685. [PMID: 31578940 PMCID: PMC6910997 DOI: 10.1080/19371918.2019.1671933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This case study discusses the implementation framework, effective strategies, and lessons learned of a university-community partnership addressing racial disparities in infant mortality. The partnership was successful at enhancing coordination within service delivery systems for maternal and child health programs. Results: the elimination of waiting list for services, maximizing federal and state reimbursement, the adoption of culturally-appropriate intervention practices, increasing racial diversity in the workforce, diffusing silos, and facilitating healthier relationships among service providers. Key lessons: activating the collective strengths among a network of diverse community stakeholders with shared interests, prioritizing black voices in the change process, and capacity building opportunities.
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Affiliation(s)
- Quinton D Cotton
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatrics Research Education and Clinical Center (GRECC), William S. Middleton VA Hospital, Madison, WI, USA
| | - Pamela Smith
- Division of Health, Kenosha Department of Human Services, Kenosha, WI, USA
| | - Deborah B Ehrenthal
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Gina Green-Harris
- Center for Community Engagement and Health Partnerships, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, USA
| | - Amy J H Kind
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatrics Research Education and Clinical Center (GRECC), William S. Middleton VA Hospital, Madison, WI, USA
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Lee M, Hall ES, DeFranco E. Contribution of previable births to infant mortality rate racial disparity in the United States. J Perinatol 2019; 39:1190-1195. [PMID: 31089258 DOI: 10.1038/s41372-019-0394-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/11/2019] [Accepted: 04/03/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To quantify racial differences in contribution of previable live births (<20 weeks gestational age (GA)) to United States (US) Infant Mortality Rates (IMR). METHODS Population-based retrospective cohort of US live births (2007-14) using CDC WONDER database stratified by maternal race/ethnicity. We compared the contribution of previable births to IMR and calculated modified IMRs (≥20 weeks GA) excluding previable live births in each group. Contingency tables and chi-square calculations were performed to detect differences between groups. RESULTS Previable deaths represented 4.1%, 7.7%, and 5.0% of total deaths for nonHispanic white, nonHispanic black, and Hispanic, respectively. Previable contribution to total IMR are 0.21, 0.89, and 0.26 per 1000 live births (P < 0.0001). Modified IMRs are 4.98, 10.85, and 4.69 deaths per 1000 live births. CONCLUSION IMR standardization with a minimum GA may obscure the disproportionate contribution of previable births to IMRs among the black population, which has the largest proportion of previable births.
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Affiliation(s)
- MacKenzie Lee
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Eric S Hall
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Emily DeFranco
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA. .,Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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Slaughter-Acey JC, Talley LM, Stevenson HC, Misra DP. Personal Versus Group Experiences of Racism and Risk of Delivering a Small-for-Gestational Age Infant in African American Women: a Life Course Perspective. J Urban Health 2019; 96:181-192. [PMID: 30027428 PMCID: PMC6458205 DOI: 10.1007/s11524-018-0291-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The majority of studies investigating the relationship between racism/racial discrimination and birth outcomes have focused on perceived experiences of racism/racial discrimination directed at oneself (personal racism). However, evidence suggests individuals report with greater frequency racism/racial discrimination directed at friends, family members, or other members of their racial/ethnic group (group racism). We examined how much African American (AA) women report lifetime experiences of perceived racism or racial discrimination, both personal and group, varied by maternal age. We also investigated whether reports of personal and group racism/racial discrimination were associated with the risk of delivering a small-for-gestational age (SGA) infant and how much maternal age in relation to developmental life stages (adolescence [≤ 18 years], emerging adulthood [19-24 years], and adulthood [≥ 25 years]) moderated the relationship. Data stem from the Baltimore Preterm Birth Study, a hybrid prospective/retrospective cohort study that enrolled 872 women between March 2000 and July 2004 (analyzed in 2016-2017). Spline regression analyses demonstrated a statistically significant (p value for overall association < 0.001) and non-linear (p value = 0.044) relationship between maternal age and the overall racism index. Stratified analysis showed experiences of racism overall was associated with a higher odds ratio of delivering an SGA infant among AA women aged ≥ 25 years (OR = 1.45, 95% CI 1.02-2.08). The overall racism index was not associated with the SGA infant odds ratio for emerging adults (OR = 0.86, 95% CI 0.69-1.06) or adolescents (OR = 0.92, 95% CI 0.66-1.28). Multiple aspects of racism and the intersection between racism and other contextual factors need to be considered.
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Affiliation(s)
- Jaime C Slaughter-Acey
- Department of Health Systems and Sciences Research, College of Nursing and Health Profession, Drexel University, 1601 Cherry St, Mail Stop 71044, Philadelphia, PA, 19102, USA. .,Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA.
| | - Lloyd M Talley
- Graduate School of Education, University of Pennsylvania, Philadelphia, PA, 19131, USA
| | - Howard C Stevenson
- Graduate School of Education, University of Pennsylvania, Philadelphia, PA, 19131, USA
| | - Dawn P Misra
- Department of Family Medicine and Public Health Science, School of Medicine, Wayne State University, Detroit, MI, 48201, USA
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Hawks RM, McGinn AP, Bernstein PS, Tobin JN. Exploring Preconception Care: Insurance Status, Race/Ethnicity, and Health in the Pre-pregnancy Period. Matern Child Health J 2019; 22:1103-1110. [PMID: 29464549 DOI: 10.1007/s10995-018-2494-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective To measure the association of preconception health insurance status with preconception health among women in New York City, and examine whether this association is modified by race/ethnicity. Methods Using data from the New York City Pregnancy Risk Assessment Monitoring System 2009-2011 (n = 3929), we created a "Preconception Health Score" (PHS) capturing modifiable behaviors, healthcare services utilization, pregnancy intention, and timely entry into prenatal care. We then built multivariable logistic regression models to measure the association of PHS with health insurance status and race/ethnicity. Results We found PHS to be higher among women with private insurance (7.3 ± 0.07) or public insurance (6.3 ± 0.08) before pregnancy than no insurance (5.9 ± 0.09) (p < .001). However, when stratified by race/ethnicity, the positive association of PHS with insurance was absent in the non-white population. Conclusions for Practice Having health insurance during the pre-pregnancy period is associated with greater health among white women, but not among black or Hispanic women in NYC.
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Affiliation(s)
- Rebecca Mahn Hawks
- Department of Obstetrics & Gynecology, NYU Langone Medical Center, 550 First Ave, New York, NY, 10016, USA.
| | - Aileen P McGinn
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, USA
| | - Peter S Bernstein
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, USA
| | - Jonathan N Tobin
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, USA.,Center for Clinical and Translational Science, The Rockefeller University, New York, USA
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Bohanon FJ, Lopez ON, Adhikari D, Mehta HB, Rojas-Khalil Y, Bowen-Jallow KA, Radhakrishnan RS. Race, Income and Insurance Status Affect Neonatal Sepsis Mortality and Healthcare Resource Utilization. Pediatr Infect Dis J 2018; 37:e178-e184. [PMID: 29189608 PMCID: PMC5953763 DOI: 10.1097/inf.0000000000001846] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Socioeconomic disparities negatively impact neonatal health. The influence of sociodemographic disparities on neonatal sepsis is understudied. We examined the association of insurance payer status, income, race and gender on neonatal sepsis mortality and healthcare resource utilization. METHODS We used the Kid's Inpatient Database, a nationwide population-based survey from 2006, 2009 and 2012. Neonates diagnosed with sepsis were included in the study. Multivariable logistic regression (mortality) and multivariable linear regression (length of stay and total hospital costs) were constructed to determine the association of patient and hospital characteristics. RESULTS Our study cohort included a weighted sample of 160,677 septic neonates. Several sociodemographic disparities significantly increased mortality. Self-pay patients had increased mortality (odds ratio 3.26 [95% confidence interval: 2.60-4.08]), decreased length of stay (-2.49 ± 0.31 days, P < 0.0001) and total cost (-$5015.50 ± 783.15, P < 0.0001) compared with privately insured neonates. Additionally, low household income increased odds of death compared with the most affluent households (odds ratio 1.19 [95% confidence interval: 1.05-1.35]). Moreover, Black neonates had significantly decreased length of stay (-0.86 ± 0.25, P = 0.0005) compared with White neonates. CONCLUSIONS This study identified specific socioeconomic disparities that increased odds of death and increased healthcare resource utilization. Moreover, this study provides specific societal targets to address to reduce neonatal sepsis mortality in the United States.
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Affiliation(s)
- Fredrick J. Bohanon
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, 77555
| | - Omar Nunez Lopez
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, 77555
| | - Deepak Adhikari
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, 77555
- Center for Comparative Effectiveness and Cancer Outcomes, University of Texas Medical Branch, Galveston, Texas, 77555
| | - Hemalkumar B. Mehta
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, 77555
- Center for Comparative Effectiveness and Cancer Outcomes, University of Texas Medical Branch, Galveston, Texas, 77555
| | - Yesenia Rojas-Khalil
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, 77555
| | | | - Ravi S. Radhakrishnan
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, 77555
- Center for Comparative Effectiveness and Cancer Outcomes, University of Texas Medical Branch, Galveston, Texas, 77555
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Paul DA, Goldstein ND, Locke R. Delaware Infant Mortality. Dela J Public Health 2018; 4:24-31. [PMID: 34466974 PMCID: PMC8389118 DOI: 10.32481/djph.2018.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- David A Paul
- Clinical Leader, Women and Children's Service Line; Chair, Pediatrics, Christiana Care Health System; Professor, Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University; Governor Appointed Chair, Delaware Healthy Mother and Infant Consortium
| | - Neal D Goldstein
- Clinical Leader, Women and Children's Service Line; Chair, Pediatrics, Christiana Care Health System; Professor, Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University; Governor Appointed Chair, Delaware Healthy Mother and Infant Consortium
- Infectious Disease Epidemiologist, Christiana Care Health System; Assistant Research Professor, Department of Epidemiology & Biostatistics, Drexel University Dornsife School of Public Health
- Attending Critical Care Neonatologist, Christiana Care Health System; Professor, Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University
| | - Robert Locke
- Attending Critical Care Neonatologist, Christiana Care Health System; Professor, Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University
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The contribution of gestational age, area deprivation and mother's country of birth to ethnic variations in infant mortality in England and Wales: A national cohort study using routinely collected data. PLoS One 2018; 13:e0195146. [PMID: 29649290 PMCID: PMC5896919 DOI: 10.1371/journal.pone.0195146] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/16/2018] [Indexed: 02/03/2023] Open
Abstract
Objectives We aimed to describe ethnic variations in infant mortality and explore the contribution of area deprivation, mother’s country of birth, and prematurity to these variations. Methods We analyzed routine birth and death data on singleton live births (gestational age≥22 weeks) in England and Wales, 2006–2012. Infant mortality by ethnic group was analyzed using logistic regression with adjustment for sociodemographic characteristics and gestational age. Results In the 4,634,932 births analyzed, crude infant mortality rates were higher in Pakistani, Black Caribbean, Black African, and Bangladeshi infants (6.92, 6.00, 5.17 and 4.40 per 1,000 live births, respectively vs. 2.87 in White British infants). Adjustment for maternal sociodemographic characteristics changed the results little. Further adjustment for gestational age strongly attenuated the risk in Black Caribbean (OR 1.02, 95% CI 0.89–1.17) and Black African infants (1.17, 1.06–1.29) but not in Pakistani (2.32, 2.15–2.50), Bangladeshi (1.47, 1.28–1.69), and Indian infants (1.24, 1.11–1.38). Ethnic variations in infant mortality differed significantly between term and preterm infants. At term, South Asian groups had higher risks which cannot be explained by sociodemographic characteristics. In preterm infants, adjustment for degree of prematurity (<28, 28–31, 32–33, 34–36 weeks) fully explained increased risks in Black but not Pakistani and Bangladeshi infants. Sensitivity analyses with further adjustment for small for gestational age, or excluding deaths due to congenital anomalies did not fully explain the excess risk in South Asian groups. Conclusions Higher infant mortality in South Asian and Black infants does not appear to be explained by sociodemographic characteristics. Higher proportions of very premature infants appear to explain increased risks in Black infants but not in South Asian groups. Strategies targeting the prevention and management of preterm birth in Black groups and suboptimal birthweight and modifiable risk factors for congenital anomalies in South Asian groups might help reduce ethnic inequalities in infant mortality.
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Atreya MR, Muglia LJ, Greenberg JM, DeFranco EA. Racial Differences in the Influence of Interpregnancy Interval on Fetal Growth. Matern Child Health J 2018; 21:562-570. [PMID: 27475828 DOI: 10.1007/s10995-016-2140-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives Assess the influence of maternal race on the association between interpregnancy interval (IPI) and risk of small for gestational age (SGA) and large for gestational age (LGA) births. Methods Statewide population-based cohort study of 380,520 singleton births. We calculated risk of SGA and LGA births following IPIs of 0 to <6, 6 to <12, 12 to <24 (referent), 24 to <60 months, and ≥60 months, by maternal race after adjustment for confounding influences. Results The highest risk for SGA among white women followed short IPI of 0 to <6 months [adjRR 1.14 (95 % CI 1.08-1.21)], and long IPI ≥ 60 months [adjRR 1.37 (95 % CI 1.31-1.43)]. Only long IPI ≥ 60 months increased SGA risk in black women [adjRR 1.22 (95 % CI 1.13-1.32)]. LGA risk in white women was lowest with shortest and longest IPIs, 0 to <6 [adjRR 0.80 (95 % CI 0.76-0.84)] and ≥60 months [adjRR 0.68 (95 % CI 0.66-0.70)]. The crude risk of LGA was directly proportional to longer IPIs in black women. However, after adjusting for confounding effects of age, obesity, excessive gestational weight gain, and gestational diabetes, the effect was reversed to reduced risk following long IPI ≥ 60 months [adjRR 0.82 (95 % CI 0.74-0.91)], similar to that of white women. Conclusions In black and white women, an interpregnancy interval of 1-2 years is associated with optimal fetal growth. In addition to birth spacing, addressing modifiable factors such as pre-pregnancy BMI, monitoring gestational weight gain, and control of gestational diabetes in black women may help optimize fetal growth.
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Affiliation(s)
- Mihir R Atreya
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Louis J Muglia
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, MSB-4553B, Cincinnati, OH, 45267-0526, USA.,Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James M Greenberg
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Emily A DeFranco
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, MSB-4553B, Cincinnati, OH, 45267-0526, USA. .,Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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Salow AD, Pool LR, Grobman WA, Kershaw KN. Associations of neighborhood-level racial residential segregation with adverse pregnancy outcomes. Am J Obstet Gynecol 2018; 218:351.e1-351.e7. [PMID: 29421603 DOI: 10.1016/j.ajog.2018.01.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/10/2018] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Previous analyses utilizing birth certificate data have shown environmental factors such as racial residential segregation may contribute to disparities in adverse pregnancy outcomes. However, birth certificate data are ill equipped to reliably differentiate among small for gestational age, spontaneous preterm birth, and medically indicated preterm birth. OBJECTIVE We sought to utilize data from electronic medical records to determine whether residential segregation among Black women is associated with an increased risk of adverse pregnancy outcomes. STUDY DESIGN The study population was composed of 4770 non-Hispanic Black women who delivered during the years 2009 through 2013 at a single urban medical center. Addresses were geocoded at the level of census tract, and this tract was used to determine the degree of residential segregation for an individual's neighborhood. Residential segregation was measured using the Gi* statistic, a z-score that measures the extent to which the neighborhood racial composition deviates from the composition of the larger surrounding area. The Gi* statistic z-scores were categorized as follows: low (z < 0), medium (z = 0-1.96), and high (z > 1.96). Adverse pregnancy outcomes included overall preterm birth, spontaneous preterm birth, medically indicated preterm birth, and small for gestational age. Hierarchical logistic regression models accounting for clustering by census tract and repeated births among mothers were used to estimate odds ratios of adverse pregnancy outcomes associated with segregation. RESULTS In high segregation areas, the prevalence of overall preterm birth was significantly higher than that in low segregation areas (15.5% vs 10.7%, respectively; P < .001). Likewise, the prevalence of spontaneous preterm birth and medically indicated preterm birth were higher in high (9.5% and 6.0%) vs low (6.2% and 4.6%) segregation neighborhoods (P < .001 and P = .046, respectively). The associations of high segregation with overall preterm birth (odds ratio, 1.31; 95% confidence interval, 1.02-1.69) and spontaneous preterm birth (odds ratio, 1.37; 95% confidence interval, 1.02-1.85) remained significant with adjustment for neighborhood poverty, insurance status, parity, and maternal medical conditions. CONCLUSION Among non-Hispanic Black women in an urban area, high levels of segregation were independently associated with the higher odds of spontaneous preterm birth. These findings highlight one aspect of social determinants (ie, segregation) through which adverse pregnancy outcomes may be influenced and points to a potential target for intervention.
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Ncube CN, Enquobahrie DA, Gavin AR. Racial Differences in the Association Between Maternal Antenatal Depression and Preterm Birth Risk: A Prospective Cohort Study. J Womens Health (Larchmt) 2017; 26:1312-1318. [PMID: 28622475 PMCID: PMC5733649 DOI: 10.1089/jwh.2016.6198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In the United States, racial/ethnic disparities in preterm birth (PTB) are well documented, but explanations for why the disparity persists remain to be fully explored. We examined racial/ethnic differences in the association of maternal antenatal depression with PTB (<37 completed weeks of gestation) risk. METHODS In a prospective cohort study, participants (n = 2073) included non-Hispanic (NH) black, NH white, Asian, and Hispanic women who received prenatal care at a university obstetric clinic January 2004-March 2010, and delivered at the university's hospital. We obtained data from self-reported questionnaires and electronic medical records. We assessed antenatal depression using the Patient Health Questionnaire-9 and self-reported antenatal antidepressant medication use. Poisson regression models were used to estimate the association between antenatal depression and PTB risk, within strata of race/ethnicity. RESULTS NH black (risk ratio [RR] = 1.89; 95% confidence interval [CI]: 0.94, 3.80), NH white (RR = 1.58, 95% CI: 1.04, 2.39), and Asian (RR = 2.06; 95% CI: 0.69, 6.13) women with antenatal depression were at increased risk for delivering preterm infants, compared with women without antenatal depression, although the associations were statistically significant only among NH white women. There was no evidence of an association between antenatal depression and risk of PTB among Hispanic women (RR = 0.96; 95% CI: 0.28, 3.25); p-value for interaction = 0.81. CONCLUSION Our findings suggest race-specific associations of antenatal depression with an increased risk of delivering a preterm infant, supporting the importance of considering race/ethnicity when examining risk factors for health outcomes.
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Affiliation(s)
- Collette N. Ncube
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Daniel A. Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Amelia R. Gavin
- School of Social Work, University of Washington, Seattle, Washington
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Abstract
Preterm birth remains the leading cause of morbidity and mortality among nonanomalous neonates, and is a major public health problem. Non-Hispanic black women have a 2-fold greater risk for preterm birth compared with non-Hispanic white race. The reasons for this disparity are poorly understood and cannot be explained solely by sociodemographic factors. Underlying factors including a complex interaction between maternal, paternal, and fetal genetics, epigenetics, the microbiome, and these sociodemographic risk factors likely underlies the differences between racial groups, but these relationships are currently poorly understood. This article reviews the epidemiology of disparities in preterm birth rates and adverse pregnancy outcomes and discuss possible explanations for the racial and ethnic differences, while examining potential solutions to this major public health problem.
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Ayers BL, Hawley NL, Purvis RS, Moore SJ, McElfish PA. Providers' perspectives of barriers experienced in maternal health care among Marshallese women. Women Birth 2017; 31:e294-e301. [PMID: 29126795 DOI: 10.1016/j.wombi.2017.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/26/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
Abstract
PROBLEM Pacific Islanders are disproportionately burdened by poorer maternal health outcomes with higher rates of pre-term births, low birth weight babies, infant mortality, and inadequate or no prenatal care. PURPOSE The purpose of this study was twofold: (1) to explore maternal health care providers' perceptions and experiences of barriers in providing care to Marshallese women, and (2) providers perceived barriers of access to care among Marshallese women. This is the first paper to explore perceived barriers to maternal health care among a Marshallese community from maternal health care providers' perspectives in the United States. METHODS A phenomenological, qualitative design, using a focus group and in-depth interviews with 20 maternal health care providers residing in northwest Arkansas was chosen. FINDINGS Several perceived barriers were noted, including transportation, lack of health insurance, communication and language, and socio-cultural barriers that described an incongruence between traditional and Western medical models of care. There was an overall discord between the collectivist cultural identity of Marshallese families and the individualistic maternal health care system that merits further research. DISCUSSION Solutions to these barriers, such as increased cultural competency training for maternal health care providers and the incorporation of community health workers are discussed.
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Affiliation(s)
- Britni L Ayers
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest Campus, Fayetteville, AR, United States.
| | - Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States.
| | - Rachel S Purvis
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest Campus, Fayetteville, AR, United States.
| | - Sarah J Moore
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest Campus, Fayetteville, AR, United States.
| | - Pearl A McElfish
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest Campus, Fayetteville, AR, United States.
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50
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Abstract
In the United States, African-American infants have significantly higher mortality than white infants. Previous work has identified associations between individual socioeconomic factors and select community-level factors. In this review, the authors look beyond traditional risk factors for infant mortality and examine the social context of race in this country, in an effort to understand African-American women's long-standing birth outcome disadvantage. In the process, recent insights are highlighted concerning neighborhood-level factors such as crime, segregation, built environment, and institutional racism, other likely causes for the poor outcomes of African-American infants in this country compared with infants in most other industrialized nations.
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Affiliation(s)
- Nana Matoba
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - James W Collins
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
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