Yanpeng Wu1, Jianhong Pan1, Dong Han2, Lixin Li1, Yanfei Wu3, Rui Liao4, Zijie Liu5, Dingyun You6, Pingyan Chen7, Ying Wu8. 1. State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China. 2. The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510515, China. 3. The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China. 4. School of Public Health, Kunming Medical University, NHC Key Laboratory of Periconception Health Birth in Western China, Kunming, 650500, China. 5. The First Affiliated Hospital of Kunming Medical University, Kunming, 650500, China. 6. School of Public Health, Kunming Medical University, NHC Key Laboratory of Periconception Health Birth in Western China, Kunming, 650500, China. youdingyun@kmmu.edu.cn. 7. State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China. chenpy99@126.com. 8. State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China. wuying19890321@gmail.com.
Abstract
BACKGROUND: Racial and ethnic disparities in stillbirth risk had been documented in most western countries, but it remains unknown in China. This study was to determine whether exist ethnic disparities in stillbirth risk in mainland China. METHODS: Pregnancy outcomes and ethnicity data were obtained from the National Free Preconception Health Examination Project (NEPHEP), a nationwide prospective population-based cohort study conducted in Yunnan China from 2010-2018. The Han majority and other four main minorities including Yi, Dai, Miao, Hani were investigated in the analysis. The stillbirth hazards were estimated by life-table analysis. The excess stillbirth risk (ESR) was computed for Chinese minorities using multivariable logistic regression. RESULTS: Compared with other four minorities, women in Han majority were more likely to more educated, less multiparous, and less occupied in agriculture. The pattern of stillbirth hazard of Dai women across different gestation intervals were found to be different from other ethnic groups, especially in 20-23 weeks with 3.2 times higher than Han women. The ESR of the Dai, Hani, Miao, and Yi were 45.05, 18.70, -4.17 and 12.28%, respectively. Adjusted for maternal age, education, birth order and other general risk factors, the ethnic disparity still persisted between Dai women and Han women. Adjusted for preterm birth further (gestation age <37 weeks) can reduce 16.91% ESR of Dai women and made the disparity insignificant. Maternal diseases and congenital anomalies explained little for ethnic disparities. CONCLUSIONS: We identified the ethnic disparity in stillbirth risk between Dai women and Han women. General risk factors including sociodemographic factors and maternal diseases explained little. Considerable ethnic disparities can be attributed to preterm birth.
BACKGROUND: Racial and ethnic disparities in stillbirth risk had been documented in most western countries, but it remains unknown in China. This study was to determine whether exist ethnic disparities in stillbirth risk in mainland China. METHODS: Pregnancy outcomes and ethnicity data were obtained from the National Free Preconception Health Examination Project (NEPHEP), a nationwide prospective population-based cohort study conducted in Yunnan China from 2010-2018. The Han majority and other four main minorities including Yi, Dai, Miao, Hani were investigated in the analysis. The stillbirth hazards were estimated by life-table analysis. The excess stillbirth risk (ESR) was computed for Chinese minorities using multivariable logistic regression. RESULTS: Compared with other four minorities, women in Han majority were more likely to more educated, less multiparous, and less occupied in agriculture. The pattern of stillbirth hazard of Daiwomen across different gestation intervals were found to be different from other ethnic groups, especially in 20-23 weeks with 3.2 times higher than Han women. The ESR of the Dai, Hani, Miao, and Yi were 45.05, 18.70, -4.17 and 12.28%, respectively. Adjusted for maternal age, education, birth order and other general risk factors, the ethnic disparity still persisted between Daiwomen and Han women. Adjusted for preterm birth further (gestation age <37 weeks) can reduce 16.91% ESR of Daiwomen and made the disparity insignificant. Maternal diseases and congenital anomalies explained little for ethnic disparities. CONCLUSIONS: We identified the ethnic disparity in stillbirth risk between Daiwomen and Han women. General risk factors including sociodemographic factors and maternal diseases explained little. Considerable ethnic disparities can be attributed to preterm birth.
Authors: Joy E Lawn; Hannah Blencowe; Robert Pattinson; Simon Cousens; Rajesh Kumar; Ibinabo Ibiebele; Jason Gardosi; Louise T Day; Cynthia Stanton Journal: Lancet Date: 2011-04-13 Impact factor: 79.321
Authors: Elizabeth M McClure; Sarah Saleem; Shivaprasad S Goudar; Janet L Moore; Ana Garces; Fabian Esamai; Archana Patel; Elwyn Chomba; Fernando Althabe; Omrana Pasha; Bhalachandra S Kodkany; Carl L Bose; Mabel Berreuta; Edward A Liechty; K Hambidge; Nancy F Krebs; Richard J Derman; Patricia L Hibberd; Pierre Buekens; Albert Manasyan; Waldemar A Carlo; Dennis D Wallace; Marion Koso-Thomas; Robert L Goldenberg Journal: Reprod Health Date: 2015-06-08 Impact factor: 3.223