Preprint Article Version 1 This version is not peer-reviewed

Maternal Subpopulation Variances in Vaginal and Cesarean Section Delivery Method Predicts Excess Infant Mortality of Black/African Americans in the United States: Linked Birth/Infant Death Records, 2007-2016

Version 1 : Received: 18 March 2020 / Approved: 23 March 2020 / Online: 23 March 2020 (11:21:46 CET)

A peer-reviewed article of this Preprint also exists.

Holmes Jr., L.; O’Neill, L.; Elmi, H.; Chinacherem, C.; Comeaux, C.; Pelaez, L.; Dabney, K.W.; Akinola, O.; Enwere, M. 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. Int. J. Environ. Res. Public Health 2020, 17, 3146. Holmes Jr., L.; O’Neill, L.; Elmi, H.; Chinacherem, C.; Comeaux, C.; Pelaez, L.; Dabney, K.W.; Akinola, O.; Enwere, M. 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. Int. J. Environ. Res. Public Health 2020, 17, 3146.

Journal reference: Int. J. Environ. Res. Public Health 2020, 17, 3146
DOI: 10.3390/ijerph17093146

Abstract

Objective: Racial/ethnic disparities in infant mortality (IM) continue to persist in the United States, with Black/African Americans (AA) being disproportionally affected with threefold increase in mortality compared to Whites. Epidemiologic data have identified maternal characteristics as risk IM such as eclampsia, maternal education, smoking, maternal weight, maternal SES, and family structure. Understanding the cause of causes including 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 versus cesarean section (C-section) as exposure function of IM. Methods: The United States linked Birth/Infant Death records (2007-2016) were used with a cross-sectional ecologic design. The analysis involved chi squared statistic, incidence rate estimation, and period percent change. Results: 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% CI 0.64-0.74. Racial disparities was 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. Conclusion: Infant mortality varied by race, with Black/AA disproportionally affected which is explained in part by labor and delivery procedures, suggesting reliable and equitable intrapartum assessment of Black/AA mothers during labor.

Subject Areas

vaginal; cesarean section; African American women; infant mortality; race/ethnicity

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