Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes.

Autor:	Braveman P; School of Medicine, University of California, San Francisco, San Francisco, CA, United States., Dominguez TP; USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States., Burke W; University of Washington School of Medicine, Seattle, WA, United States., Dolan SM; Albert Einstein College of Medicine, New York, NY, United States., Stevenson DK; Stanford University School of Medicine, Stanford, CA, United States., Jackson FM; Majaica LLC, Atlanta, GA, United States., Collins JW Jr; Northwestern University School of Medicine, Chicago, IL, United States., Driscoll DA; University of Pennsylvania School of Medicine, Philadelphia, PA, United States., Haley T; School of Medicine, University of California, San Francisco, San Francisco, CA, United States., Acker J; School of Medicine, University of California, San Francisco, San Francisco, CA, United States., Shaw GM; Stanford University School of Medicine, Stanford, CA, United States., McCabe ERB; David Geffen School of Medicine at University of California, Los Angeles, CA, United States., Hay WW Jr; University of Colorado, Denver, CO, United States., Thornburg K; School of Medicine, Oregon State University, Portland, OR, United States., Acevedo-Garcia D; Brandeis University School for Social Policy and Management, Waltham, MA, United States., Cordero JF; University of Georgia College of Public Health, Athens, GA, United States., Wise PH; Stanford University School of Medicine, Stanford, CA, United States., Legaz G; March of Dimes, White Plains, NY, United States., Rashied-Henry K; March of Dimes, White Plains, NY, United States., Frost J; March of Dimes, White Plains, NY, United States., Verbiest S; University of North Carolina at Chapel Hill, Chapel Hill, NC, United States., Waddell L; March of Dimes, White Plains, NY, United States.
Jazyk:	angličtina
Zdroj:	Frontiers in reproductive health [Front Reprod Health] 2021 Sep 02; Vol. 3, pp. 684207. Date of Electronic Publication: 2021 Sep 02 (Print Publication: 2021).
DOI:	10.3389/frph.2021.684207
Abstrakt:	In 2017-2019, the March of Dimes convened a workgroup with biomedical, clinical, and epidemiologic expertise to review knowledge of the causes of the persistent Black-White disparity in preterm birth (PTB). Multiple databases were searched to identify hypothesized causes examined in peer-reviewed literature, 33 hypothesized causes were reviewed for whether they plausibly affect PTB and either occur more/less frequently and/or have a larger/smaller effect size among Black women vs. White women. While definitive proof is lacking for most potential causes, most are biologically plausible. No single downstream or midstream factor explains the disparity or its social patterning, however, many likely play limited roles, e.g., while genetic factors likely contribute to PTB, they explain at most a small fraction of the disparity. Research links most hypothesized midstream causes, including socioeconomic factors and stress, with the disparity through their influence on the hypothesized downstream factors. Socioeconomic factors alone cannot explain the disparity's social patterning. Chronic stress could affect PTB through neuroendocrine and immune mechanisms leading to inflammation and immune dysfunction, stress could alter a woman's microbiota, immune response to infection, chronic disease risks, and behaviors, and trigger epigenetic changes influencing PTB risk. As an upstream factor, racism in multiple forms has repeatedly been linked with the plausible midstream/downstream factors, including socioeconomic disadvantage, stress, and toxic exposures. Racism is the only factor identified that directly or indirectly could explain the racial disparities in the plausible midstream/downstream causes and the observed social patterning. Historical and contemporary systemic racism can explain the racial disparities in socioeconomic opportunities that differentially expose African Americans to lifelong financial stress and associated health-harming conditions. Segregation places Black women in stressful surroundings and exposes them to environmental hazards. Race-based discriminatory treatment is a pervasive stressor for Black women of all socioeconomic levels, considering both incidents and the constant vigilance needed to prepare oneself for potential incidents. Racism is a highly plausible, major upstream contributor to the Black-White disparity in PTB through multiple pathways and biological mechanisms. While much is unknown, existing knowledge and core values (equity, justice) support addressing racism in efforts to eliminate the racial disparity in PTB. Competing Interests: FJ is President of Majaica, LLC. CDC funds supported March of Dime's (MOD's) Prematurity Campaign, which included convening a scientific workgroup. CDC funds were not used to directly support development of this manuscript. MOD funded a small stipend for TD to conduct a comprehensive scientific edit of the initial consensus statement to prepare it as a manuscript of publishable length. MOD funded a small stipend for TH for additional assistance with references. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2021 Braveman, Dominguez, Burke, Dolan, Stevenson, Jackson, Collins, Driscoll, Haley, Acker, Shaw, McCabe, Hay, Thornburg, Acevedo-Garcia, Cordero, Wise, Legaz, Rashied-Henry, Frost, Verbiest and Waddell.)
Databáze:	MEDLINE
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