种族差异对美国产妇分娩结果的贝叶斯中介模型。

James Thompson
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引用次数: 0

摘要

背景:在美国,不良孕产妇健康结果的种族差异持续存在,其原因尚不清楚。黑人妇女的差异包括妊娠高血压、高血压子痫、剖宫产和入住重症监护病房的风险增加,以及诱导分娩的风险降低。在没有评估种族差异的情况下,研究确定了这些情况的一个原因是孕前体重指数和妊娠期体重增加之间的相互作用。尚未确定的是体重指数和妊娠期体重增加是如何导致种族差异的。该研究的目的是确定身体质量指数和妊娠期体重增加之间的相互作用是否可以解释五种产妇结局的种族差异。方法:该方法通过对每种原因组合的潜在结果进行贝叶斯估计来进行中介分析。原因包括黑人种族、体重指数和妊娠期体重增加的风险。结果:将体重指数和妊娠期体重增加均提高至最佳水平,妊娠期高血压的种族差异将增加19.2%,对高血压性子痫的种族差异无显著影响,黑人妇女引产的种族优势将减少16.9%,剖宫产和入住重症监护病房的种族劣势将分别减少49.9%和36.9%。结论:预防计划可以对种族差异产生广泛的影响,从减少到增加差距。实施本文所述的中介评估方法将优化临床决策,指导公共卫生政策,并最终减轻种族不信任。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Bayesian mediation modeling of racial disparity for maternal birth outcomes in United States.

Background: In the United States, racial disparities for adverse maternal health outcomes persist, and the causes remain unknown. The disparities for women of Black ethnicity include increased risk of gestational hypertension, hypertension eclampsia, cesarean section, and admission to an Intensive Care Unit, and reduced risk of parturition induction. Without evaluating racial disparity, studies identify one cause of these conditions as the interaction between pre-gestational body mass index and gestational weight gain. What has not been determined is how body mass index and gestational weight gain contribute to racial disparity. The study's objective was to determine if the interaction between body mass index and gestational weight gain can explain the racial disparity in five maternal outcomes.

Methods: The approach involved mediation analysis by performing Bayesian estimation of potential outcomes for each combination of causes. Causes included risk of Black ethnicity, body mass index, and gestational weight gain.

Results: Improving both body mass index and gestational weight gain to what is considered optimal would increase the racial disparity for gestational hypertension by 19.2%, have a non-significant effect on racial disparity for hypertension eclampsia, reduce the racial advantage for Black women receiving induction by 16.9%, and reduce the racial disadvantage for delivery by cesarean and admission to an Intensive Care Unit by 49.9% and 36.9%, respectively.

Conclusion: Preventive programs can have a wide range of effects on racial disparity, from decreasing to increasing the disparity. Implementing the mediation evaluation approach illustrated here would optimize clinical decisions, guide public health policy, and eventually mitigate racial mistrust.

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