Explaining Racial Disparities in Infant Health in Brazil

Nyarko, Kwame A.; López-Camelo, Jorge S.; Castilla, Eduardo E.; Wehby, George L.

doi:10.2105/ajph.2012.301021r

Cited by 16 publications

(5 citation statements)

References 93 publications

(119 reference statements)

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“…As a limitation of this study, the non-inclusion of the skin color variable, still limited in the information systems, especially in SIM 4 , may have prevented a better understanding of the interrelationships between these sociodemographic factors 2 . However, based on other studies that analyzed the same variables, we believe that, even with adjustment for skin color, age and education would continue to have magnitude and statistical significance 17 .…”

Section: Discussionmentioning

confidence: 90%

Maternal education and age: inequalities in neonatal death

Fonseca¹,

Flores²,

Camargo³

et al. 2017

Rev. saúde pública

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OBJECTIVE Evaluate the interaction between maternal age and education level in neonatal mortality, as well as investigate the temporal evolution of neonatal mortality in each stratum formed by the combination of these two risk factors.METHODS A nonconcurrent cohort study, resulting from a probabilistic relationship between the Mortality Information System and the Live Birth Information System. To investigate the risk of neonatal death we performed a logistic regression, with an odds ratio estimate for the combined variable of maternal education and age, as well as the evaluation of additive and multiplicative interaction. The neonatal mortality rate time series, according to maternal education and age, was estimated by the Joinpoint Regression program.RESULTS The neonatal mortality rate in the period was 8.09‰ and it was higher in newborns of mothers with low education levels: 12.7‰ (adolescent mothers) and 12.4‰ (mother 35 years old or older). Low level of education, without the age effect, increased the chance of neonatal death by 25% (OR = 1.25, 95%CI 1.14–1.36). The isolated effect of age on neonatal death was higher for adolescent mothers (OR = 1.39, 95%CI 1.33–1.46) than for mothers aged ≥ 35 years (OR = 1.16, 95%CI 1.09–1.23). In the time-trend analysis, no age group of women with low education levels presented a reduction in the neonatal mortality rate for the period, as opposed to women with intermediate or high levels of education, where the reduction was significant, around 4% annually.CONCLUSIONS Two more vulnerable groups – adolescents with low levels of education and older women with low levels of education – were identified in relation to the risk of neonatal death and inequality in reducing the mortality rate.

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Section: Discussionmentioning

confidence: 90%

Maternal education and age: inequalities in neonatal death

Fonseca¹,

Flores²,

Camargo³

et al. 2017

Rev. saúde pública

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“…However, we would caution against such an over-interpretation of the unexplained variation. For instance, in their decomposition analysis in Brazil where a spectrum of genetic admixtures could be studied, Nyarko, et al ( 2014 ) found individual, household, medical, and geographic factors could explain up to 94% of the disparity. Moreover, the decomposition analysis approach highlights the fact that unexplained variation can be due to factors such as variable parameterization and not only unmeasured confounding.…”

Section: Discussionmentioning

confidence: 99%

Decomposition Analysis of Black–White Disparities in Birth Outcomes: The Relative Contribution of Air Pollution and Social Factors in California

Benmarhnia

Huang

Basu

et al. 2017

Environ Health Perspect

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Background:Racial/ethnic disparities in preterm birth (PTB) are well documented in the epidemiological literature, but little is known about the relative contribution of different social and environmental determinants of such disparities in birth outcome. Furthermore, increased focus has recently turned toward modifiable aspects of the environment, including physical characteristics, such as neighborhood air pollution, to reduce disparities in birth outcomes.Objectives:To apply decomposition methods to understand disparities in preterm birth (PTB) prevalence between births of non-Hispanic black individuals and births of non-Hispanic white individuals in California, according to individual demographics, neighborhood socioeconomic environment, and neighborhood air pollution.Methods:We used all live singleton births in California spanning 2005 to 2010 and estimated PTBs and other adverse birth outcomes for infants borne by non-Hispanic black mothers and white mothers. To compare individual-level, neighborhood-level, and air pollution [Particulate Matter, 2.5 micrometers or less (PM2.5) and nitrogen dioxide (NO2)] predictors, we conducted a nonlinear extension of the Blinder–Oaxaca method to decompose racial/ethnic disparities in PTB.Results:The predicted differences in probability of PTB between black and white infants was 0.056 (95% CI: 0.054, 0.058). All included predictors explained 37.8% of the black–white disparity. Overall, individual (17.5% for PTB) and neighborhood-level variables (16.1% for PTB) explained a greater proportion of the black–white difference in birth outcomes than air pollution (5.7% for PTB).Conclusions:Our results suggest that, although the role of individual and neighborhood factors remains prevailing in explaining black–white differences in birth outcomes, the individual contribution of PM2.5 is comparable in magnitude to any single individual- or neighborhood-level factor. https://doi.org/10.1289/EHP490

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“…The “myth of racial democracy” that Brazil has reduced degrees of racial discrimination is very prevalent. Thus, the role of the racial component in generating and maintaining the very high levels of inequality in Brazilian society may be underestimated ( 2 , 10 ).…”

Section: Introductionmentioning

confidence: 99%