哺乳率种族差异背后的经济因素


  【24drs.com】根据一篇新研究的结果,有关哺乳率的种族差异,或许可用经济因素而非文化因素来解释。
  
  费城Sidney Kimmel医学院Rachel Horowitz表示,这个结果强调了帮助妇女克服哺乳之实际阻碍的重要性;通常,哺乳的决定是根据妇女从事的工作类型。
  
  Horowitz在美国妇产科学院2015年临床会议中发表研究结果。
  
  在美国,黑人妇女的哺乳率一直低于白人妇女,有些研究者认为,这个差异是因为缺乏示范与家庭支持。
  
  为了探讨与这个差异有关的其它可能因素,Horowitz等人分析了在2013年7至12月、分娩足月单胞胎的523名妇女(342名黑人与181名白人)的医疗纪录。
  
  其中,他们确认了337名妇女(白人与黑人)在一次产后就诊纪录中的哺乳方式。
  
  至少有一部份餵母乳的白人妇女比率高于黑人妇女(64% vs 53%;P< .05),不过,当研究者校正年龄、胎次、婚姻状况时,种族之间的差异就不再显著(胜算比[OR]0.91,95%信赖区间[CI]为0.52- 1.56)。
  
  Horowitz报告指出,唯一显著的因素是保险状态。有私人保险的白人妇女多于黑人妇女(60% vs 33%)。
  
  在另一篇分析中,研究团队探讨保险状态和各种族世代(包括亚裔和西班牙裔妇女)之哺乳情况的关联,研究对象是405名在2013年7至12月于研究者的机构中分娩足月单胞胎的妇女;这些妇女都在8周内完成产后追踪且有记录哺乳方法。
  
  校正年龄、种族、胎次、教育、婚姻状态之后,如果妇女只有Medicaid而无商业保险,就比较不会至少还有一部份时间餵母乳(48% vs 69%;OR,0.53;95% CI,0.29- 0.77)。
  
  保险状态对于白人妇女的影响更大于黑人、西班牙裔、亚裔妇女,事实上,有Medicaid妇女的哺乳率,白人妇女最低、其次依序是黑人妇女、西班牙裔与亚裔妇女。
  
  这篇分析并未指出保险状态如何影响哺乳,但是Horowitz表示她相信这是因为贫困因素的影响。
  
  她解释,低收入工作的妇女可能没有工作空档可以挤乳、工作环境也可能没有冷冻储存母乳的冰箱。
  
  之前的研究显示,哺乳因素方面,目的比人口统计学特征更重要,意谓著医师可以在产前讨论时鼓励妇女哺乳。
  
  Horowitz表示,如果可以事先计画,将可望提升哺乳率。她表示,她与研究伙伴正计画进行这个方法的临床试验。
  
  Albuquerque新墨西哥大学Sharon Phelan表示,这篇研究说明了为什么不能妄下结论与种族有关是很重要的。这个想法跳脱出既有的框架,可以说是对于谈论种族等其它因素时的挑战。
  
  Phelan医师表示她同意工作状况是种族差异背后的实际因素,事实上,她的病患有许多人告诉她,「我在快餐店工作;我没有休息时间可以哺乳。」
  
  资料来源:http://www.24drs.com/
  
  Native link:Economics Behind Racial Differences in Breast-feeding Rates

Economics Behind Racial Differences in Breast-feeding Rates

By Laird Harrison
Medscape Medical News

SAN FRANCISCO — Economic factors, not culture, might explain racial differences in breast-feeding rates, according to the results of a new study.

This highlights the importance of helping women overcome practical obstacles to breast-feeding, said Rachel Horowitz, BS, from the Sidney Kimmel Medical College in Philadelphia.

Often, the decision to breast-feed depends on the type of work women do, she told Medscape Medical News.

Horowitz presented the study findings here at the American Congress of Obstetricians and Gynecologists Annual Clinical Meeting 2015.

In the United States, breast-feeding rates have long been lower in black women than in white women. A lack of role models and family support have been proposed as explanations for this disparity by some researchers.

To see what other factors might be contributing to the difference, Horowitz and her colleagues analyzed the medical records of 523 women (342 black, 181 white) who delivered singleton term infants from July to December 2013 in their institution.

Of these, they identified 337 women (white and black) for whom method of feeding was documented during a postpartum visit.

More white women than black women fed their babies at least partly with breast milk (64% vs 53%; P < .05). However, when the researchers adjusted for age, parity, and marital status, the difference between races was no longer significant (odds ratio [OR], 0.91, 95% confidence interval [CI], 0.52 - 1.56).

"The only factor that was significant was insurance status," Horowitz reported. More white women than black women had private insurance (60% vs 33%).

Insurance Status and Breast-feeding

In a separate analysis, the research team looked at the association between insurance status and breast-feeding in a mixed-race cohort (including Asian and Hispanic women) of 405 women who delivered singleton term infants from July to December 2013 in their institution.

The women all completed postpartum follow-up within 8 weeks and had feeding methods recorded.

Women were less likely to breast-feed at least part of the time if they were covered by Medicaid than by commercial insurance (48% vs 69%; OR, 0.53; 95% CI, 0.29- 0.77), even after adjustment for age, race, parity, education, and marital status.

The effect of insurance status was much stronger on white women than on black, Hispanic, and Asian women. In fact, in women covered by Medicaid, the rate of breast-feeding was lowest in white women, followed by black women, then Hispanic women and Asian women.

This was thinking outside of the box, and could serve as a challenge to some of the other things we say about ethnicity and race.

The analysis did not pinpoint how insurance status affects breast-feeding, but Horowitz said she believes it is a proxy for other aspects of poverty.

Women in low-paying jobs might not get breaks from work to pump milk and might not have access to refrigerators to store breast milk, she explained.

Previous research has shown that intention is a more important factor in breast-feeding than demographic characteristics, which means clinicians could use prenatal discussions with mothers to encourage breast-feeding, she added.

"If you can plan in advance, hopefully that will increase breast-feeding rates," said Horowitz.

She said she and her colleagues are planning to conduct a clinical trial of this approach.

This study illustrates why it is important not to jump to conclusions about race, said Sharon Phelan, MD, from the University of New Mexico in Albuquerque.

"This was thinking outside of the box, and could serve as a challenge to some of the other things we say about ethnicity and race," she told Medscape Medical News.

Dr Phelan said she agrees that working conditions could be the driving factor behind the racial differences. In fact, many of her patients have told her, "I work in fast food; I can't take off time to breast-feed."

Ms Horowitz and Dr Phelan have disclosed no relevant financial relationships.

American Congress of Obstetricians and Gynecologists (ACOG) Annual Clinical Meeting 2015: Abstracts73 and 78. Presented May3, 2015.

    
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