Document Detail

State-specific trends in preterm delivery: are rates really declining among non-Hispanic African Americans across the United States?
MedLine Citation:
PMID:  16362234     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: This study sought to examine state-specific trends in preterm delivery rates among non-Hispanic African Americans and to assess whether these rates are influenced by misclassification of gestational age. METHODS: The sample population consisted of singleton non-Hispanic White and non-Hispanic African-American infants born in 1991 and 2001 to U.S. resident mothers. For both time periods, state-specific and national preterm delivery rates were calculated for all infants, stratified by infant race/ethnicity. Next, birth-weight distributions within strata of gestational age were studied to explore possible misclassifications of gestational age. Lastly, state-specific and national preterm delivery rates among infants who weighed less than 2,500 g were separately computed. RESULTS: National analyses showed that the frequency of preterm delivery increased by 15.8% among non-Hispanic Whites but declined by 10.3% among non-Hispanic African Americans over the same period. For both subgroups, a bimodal distribution of birth weights was apparent among preterm births at 28-31 weeks of gestation. The second peak with its cluster of normal-weight infants was more prominent among non-Hispanic African Americans in 1991 than in 2001. After excluding preterm infants who weighed 2,500 g or more, the national trends persisted. State-specific analyses showed that preterm delivery rates increased for both subgroups in 13 states during this period. Of these 13, 6 states had a number of non-Hispanic African-American births classified as preterm that were apparently term births mistakenly assigned short gestational ages. Such misclassification was more frequent in 1991 than in 2001 and inflated 1991 rates. CONCLUSION: There is heterogeneity in state-specific preterm delivery rates. Such differences are often overlooked when aggregate results are presented.
Anjel Vahratian; Pierre Buekens; Greg R Alexander
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Maternal and child health journal     Volume:  10     ISSN:  1092-7875     ISO Abbreviation:  Matern Child Health J     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2006-03-23     Completed Date:  2006-11-09     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  9715672     Medline TA:  Matern Child Health J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  27-32     Citation Subset:  IM    
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48109, USA.
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MeSH Terms
African Americans / statistics & numerical data*
Bias (Epidemiology)
Birth Certificates
Birth Weight / physiology
Diagnostic Errors
European Continental Ancestry Group / statistics & numerical data*
Gestational Age
Infant, Newborn
Infant, Premature / physiology*
Premature Birth / classification,  diagnosis,  epidemiology,  ethnology*
State Government
United States / epidemiology
Grant Support

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