Cargando…
Implication of Vaginal and Cesarean Section Delivery Method in Black–White Differentials in Infant Mortality in the United States: Linked Birth/Infant Death Records, 2007–2016
Racial/ethnic disparities in infant mortality (IM) continue to persist in the United States, with Black/African Americans (AA) being disproportionally affected with a three-fold increase in mortality compared to Whites. Epidemiological data have identified maternal characteristics in IM risk such as...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246527/ https://www.ncbi.nlm.nih.gov/pubmed/32365975 http://dx.doi.org/10.3390/ijerph17093146 |
_version_ | 1783537967109767168 |
---|---|
author | Holmes Jr., Laurens O’Neill, Leah Elmi, Hikma Chinacherem, Chinaka Comeaux, Camillia Pelaez, Lavisha Dabney, Kirk W. Akinola, Olumuyiwa Enwere, Michael |
author_facet | Holmes Jr., Laurens O’Neill, Leah Elmi, Hikma Chinacherem, Chinaka Comeaux, Camillia Pelaez, Lavisha Dabney, Kirk W. Akinola, Olumuyiwa Enwere, Michael |
author_sort | Holmes Jr., Laurens |
collection | PubMed |
description | Racial/ethnic disparities in infant mortality (IM) continue to persist in the United States, with Black/African Americans (AA) being disproportionally affected with a three-fold increase in mortality compared to Whites. Epidemiological data have identified maternal characteristics in IM risk such as preeclampsia, eclampsia, maternal education, smoking, maternal weight, maternal socioeconomic status (SES), and family structure. Understanding the social gradient in health including implicit bias, as inherent in the method of labor and delivery and the racial heterogeneity, may facilitate intervention mapping in narrowing the Black–White IM risk differences. We aimed to assess the temporal/racial trends and the methods of delivery, mainly vaginal vs. cesarean section (C-section) as an exposure function of IM. The United States linked birth/infant death records (2007–2016) were used with a cross-sectional ecological design. The analysis involved chi squared statistic, incidence rate estimation by binomial regression model, and period percent change. Of the 40,445,070 births between 2007 and 2016, cumulative mortality incidence was 249,135 (1.16 per 1000). The IM rate was highest among Black/AA (11.41 per 1000), intermediate among Whites (5.19 per 1000), and lowest among Asian /Pacific Islanders (4.24 per 1000). The cumulative incidence rate difference, comparing vaginal to cesarean procedure was 1.73 per 1000 infants, implying excess IM with C-section. Compared to C-section, there was a 31% decreased risk of IM among mothers with vaginal delivery, rate ratio (RR) = 0.69, 95% confidence interval (CI): 0.64–0.74. Racial disparities were observed in the method of delivery associated with IM. Black/AA mothers with vaginal delivery had a 6% decreased risk of IM compared to C-section, RR = 0.94, 95% CI: 0.92–0.95, while Whites with vaginal delivery had a 38% decrease risk of IM relative to C-section, RR= 0.68, 95% CI: 0.67–0.69, p < 0.001. Infant mortality varied by race, with Black/AA disproportionally affected, which is explained in part by labor and delivery procedures, suggestive of reliable and equitable intrapartum assessment of Black/AA mothers during labor, as well as implicit bias marginalization in the healthcare system. |
format | Online Article Text |
id | pubmed-7246527 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-72465272020-06-11 Implication of Vaginal and Cesarean Section Delivery Method in Black–White Differentials in Infant Mortality in the United States: Linked Birth/Infant Death Records, 2007–2016 Holmes Jr., Laurens O’Neill, Leah Elmi, Hikma Chinacherem, Chinaka Comeaux, Camillia Pelaez, Lavisha Dabney, Kirk W. Akinola, Olumuyiwa Enwere, Michael Int J Environ Res Public Health Article Racial/ethnic disparities in infant mortality (IM) continue to persist in the United States, with Black/African Americans (AA) being disproportionally affected with a three-fold increase in mortality compared to Whites. Epidemiological data have identified maternal characteristics in IM risk such as preeclampsia, eclampsia, maternal education, smoking, maternal weight, maternal socioeconomic status (SES), and family structure. Understanding the social gradient in health including implicit bias, as inherent in the method of labor and delivery and the racial heterogeneity, may facilitate intervention mapping in narrowing the Black–White IM risk differences. We aimed to assess the temporal/racial trends and the methods of delivery, mainly vaginal vs. cesarean section (C-section) as an exposure function of IM. The United States linked birth/infant death records (2007–2016) were used with a cross-sectional ecological design. The analysis involved chi squared statistic, incidence rate estimation by binomial regression model, and period percent change. Of the 40,445,070 births between 2007 and 2016, cumulative mortality incidence was 249,135 (1.16 per 1000). The IM rate was highest among Black/AA (11.41 per 1000), intermediate among Whites (5.19 per 1000), and lowest among Asian /Pacific Islanders (4.24 per 1000). The cumulative incidence rate difference, comparing vaginal to cesarean procedure was 1.73 per 1000 infants, implying excess IM with C-section. Compared to C-section, there was a 31% decreased risk of IM among mothers with vaginal delivery, rate ratio (RR) = 0.69, 95% confidence interval (CI): 0.64–0.74. Racial disparities were observed in the method of delivery associated with IM. Black/AA mothers with vaginal delivery had a 6% decreased risk of IM compared to C-section, RR = 0.94, 95% CI: 0.92–0.95, while Whites with vaginal delivery had a 38% decrease risk of IM relative to C-section, RR= 0.68, 95% CI: 0.67–0.69, p < 0.001. Infant mortality varied by race, with Black/AA disproportionally affected, which is explained in part by labor and delivery procedures, suggestive of reliable and equitable intrapartum assessment of Black/AA mothers during labor, as well as implicit bias marginalization in the healthcare system. MDPI 2020-04-30 2020-05 /pmc/articles/PMC7246527/ /pubmed/32365975 http://dx.doi.org/10.3390/ijerph17093146 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Holmes Jr., Laurens O’Neill, Leah Elmi, Hikma Chinacherem, Chinaka Comeaux, Camillia Pelaez, Lavisha Dabney, Kirk W. Akinola, Olumuyiwa Enwere, Michael Implication of Vaginal and Cesarean Section Delivery Method in Black–White Differentials in Infant Mortality in the United States: Linked Birth/Infant Death Records, 2007–2016 |
title | Implication of Vaginal and Cesarean Section Delivery Method in Black–White Differentials in Infant Mortality in the United States: Linked Birth/Infant Death Records, 2007–2016 |
title_full | Implication of Vaginal and Cesarean Section Delivery Method in Black–White Differentials in Infant Mortality in the United States: Linked Birth/Infant Death Records, 2007–2016 |
title_fullStr | Implication of Vaginal and Cesarean Section Delivery Method in Black–White Differentials in Infant Mortality in the United States: Linked Birth/Infant Death Records, 2007–2016 |
title_full_unstemmed | Implication of Vaginal and Cesarean Section Delivery Method in Black–White Differentials in Infant Mortality in the United States: Linked Birth/Infant Death Records, 2007–2016 |
title_short | Implication of Vaginal and Cesarean Section Delivery Method in Black–White Differentials in Infant Mortality in the United States: Linked Birth/Infant Death Records, 2007–2016 |
title_sort | implication of vaginal and cesarean section delivery method in black–white differentials in infant mortality in the united states: linked birth/infant death records, 2007–2016 |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246527/ https://www.ncbi.nlm.nih.gov/pubmed/32365975 http://dx.doi.org/10.3390/ijerph17093146 |
work_keys_str_mv | AT holmesjrlaurens implicationofvaginalandcesareansectiondeliverymethodinblackwhitedifferentialsininfantmortalityintheunitedstateslinkedbirthinfantdeathrecords20072016 AT oneillleah implicationofvaginalandcesareansectiondeliverymethodinblackwhitedifferentialsininfantmortalityintheunitedstateslinkedbirthinfantdeathrecords20072016 AT elmihikma implicationofvaginalandcesareansectiondeliverymethodinblackwhitedifferentialsininfantmortalityintheunitedstateslinkedbirthinfantdeathrecords20072016 AT chinacheremchinaka implicationofvaginalandcesareansectiondeliverymethodinblackwhitedifferentialsininfantmortalityintheunitedstateslinkedbirthinfantdeathrecords20072016 AT comeauxcamillia implicationofvaginalandcesareansectiondeliverymethodinblackwhitedifferentialsininfantmortalityintheunitedstateslinkedbirthinfantdeathrecords20072016 AT pelaezlavisha implicationofvaginalandcesareansectiondeliverymethodinblackwhitedifferentialsininfantmortalityintheunitedstateslinkedbirthinfantdeathrecords20072016 AT dabneykirkw implicationofvaginalandcesareansectiondeliverymethodinblackwhitedifferentialsininfantmortalityintheunitedstateslinkedbirthinfantdeathrecords20072016 AT akinolaolumuyiwa implicationofvaginalandcesareansectiondeliverymethodinblackwhitedifferentialsininfantmortalityintheunitedstateslinkedbirthinfantdeathrecords20072016 AT enweremichael implicationofvaginalandcesareansectiondeliverymethodinblackwhitedifferentialsininfantmortalityintheunitedstateslinkedbirthinfantdeathrecords20072016 |