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 Article Swipe
Laurens Holmes
,
Leah M. O'Neill
,
Hikma Elmi
,
Chinacherem Chinaka
,
Camillia Comeaux
,
Lavisha Pelaez
,
Kirk Dabney
,
Olumuyiwa Akinola
,
Michael Enwere
·
YOU?
·
· 2020
· Open Access
·
· DOI: https://doi.org/10.3390/ijerph17093146
YOU?
·
· 2020
· Open Access
·
· DOI: https://doi.org/10.3390/ijerph17093146
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.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.3390/ijerph17093146
- https://www.mdpi.com/1660-4601/17/9/3146/pdf?version=1588682153
- OA Status
- gold
- Cited By
- 13
- References
- 38
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W3023772224
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- OpenAlex ID
-
https://openalex.org/W3023772224Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.3390/ijerph17093146Digital Object Identifier
- 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, 2007–2016Work title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2020Year of publication
- Publication date
-
2020-04-30Full publication date if available
- Authors
-
Laurens Holmes, Leah M. O'Neill, Hikma Elmi, Chinacherem Chinaka, Camillia Comeaux, Lavisha Pelaez, Kirk Dabney, Olumuyiwa Akinola, Michael EnwereList of authors in order
- Landing page
-
https://doi.org/10.3390/ijerph17093146Publisher landing page
- PDF URL
-
https://www.mdpi.com/1660-4601/17/9/3146/pdf?version=1588682153Direct link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
goldOpen access status per OpenAlex
- OA URL
-
https://www.mdpi.com/1660-4601/17/9/3146/pdf?version=1588682153Direct OA link when available
- Concepts
-
Demography, Medicine, Confidence interval, Pacific islanders, Infant mortality, Socioeconomic status, Obstetrics, Rate ratio, Vaginal delivery, Incidence (geometry), Live birth, Pregnancy, Relative risk, Population, Environmental health, Biology, Physics, Optics, Genetics, Sociology, Internal medicineTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
13Total citation count in OpenAlex
- Citations by year (recent)
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2025: 2, 2024: 1, 2023: 4, 2022: 4, 2021: 2Per-year citation counts (last 5 years)
- References (count)
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38Number of works referenced by this work
- Related works (count)
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.38% | 270 |
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| abstract_inverted_index.(IM) | 5 |
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| abstract_inverted_index.(4.24 | 181 |
| abstract_inverted_index.(5.19 | 172 |
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| abstract_inverted_index.0.69, | 224 |
| abstract_inverted_index.0.94, | 259 |
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| abstract_inverted_index.Islanders | 180 |
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| corresponding_author_ids | https://openalex.org/A5004959201 |
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| institutions_distinct_count | 9 |
| corresponding_institution_ids | https://openalex.org/I4210108049, https://openalex.org/I86501945 |
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