Rates of preterm delivery among Black women and White women in the United States over two decades: an age-period-cohort analysis

The authors assessed the influence of age, period, and cohort effects on rates of preterm delivery in the United States. Rates of preterm delivery for singleton births (<37 weeks) in seven age groups (15-19, 20-24,., 45-49 years), five periods (1975, 1980, 1985, 1990, 1995), and 11 maternal birth cohorts (1926-1930, 1931-1935,., 1976-1980) were examined. Over the 20-year study interval, preterm delivery increased by 3.6% among Blacks (from 15.5% in 1975 to 16.0% in 1995) and by 22.3% among Whites (from 6.9% to 8.4%). Among Black primigravid women, rates of preterm delivery increased from 1975 to 1990 and began to decline thereafter; among Whites, the rates increased between 1975 and 1995. In Blacks, women aged 25-29 years had the lowest rates for the first and second births, and women aged 30-34 years had the lowest rate for subsequent births. In Whites, the age groups with the lowest preterm delivery rates were 20-24 years for first births and 25-29 years for subsequent births. Cohort-specific rates of preterm delivery remained fairly constant across age strata and periods for Whites, but a small trend was apparent for Blacks aged 30-44 years. The consistency of the observed age effects across periods and cohorts suggests that the age effect is partly due to biologic factors. The presence of period effects might be linked to the increased survival of premature infants or to increased viability among births occurring at lower lengths of gestation.     

Unwanted and mistimed births in the United States: 1968--1973

Unwanted U.S. marital fertility was down to just nine percent by 1973. The largest proportion of unwanted births was reported by poor black women--23 percent--but this group registered the steepest decline in unwanted childbearing of all the poverty-status and racial groups studied.     

Neighbourhood deprivation and small-for-gestational-age term births in the United States

Residential context has received increased attention as a possible contributing factor to race/ethnic and socio-economic disparities in birth outcomes in the United States. Utilising vital statistics birth record data, this study examined the association between neighbourhood deprivation and the risk of a term small-for-gestational-age (SGA) birth among non-Hispanic whites and non-Hispanic blacks in eight geographical areas. An SGA birth was defined as a newborn weighing <10th percentile of the sex- and parity-specific birthweight distribution for a given gestational week. Multi-level random intercept logistic regression models were employed and statistical tests were performed to examine whether the association between neighbourhood deprivation and SGA varied by race/ethnicity and study site.
The risk of term SGA was higher among non-Hispanic blacks (range 10.8–17.5%) than non-Hispanic whites (range 5.1–9.2%) in all areas and it was higher in cities than in suburban locations. In all areas, non-Hispanic blacks lived in more deprived neighbourhoods than non-Hispanic whites. However, the adjusted associations between neighbourhood deprivation and term SGA did not vary significantly by race/ethnicity or study site. The summary fully adjusted pooled odds ratios, indicating the effect of one standard deviation increase in the deprivation score, were 1.15 [95% CI 1.08, 1.22] for non-Hispanic whites and 1.09 [95% CI 1.05, 1.14] for non-Hispanic blacks. Thus, neighbourhood deprivation was weakly associated with term SGA among both non-Hispanic whites and non-Hispanic blacks.     

Adolescent pregnancy in the United States: an interstate analysis

Rates of teenage pregnancy, birth and abortion vary greatly among states. Because states that have high birthrates tend to have low abortion rates, pregnancy levels vary much less than do the birth and abortion measures. The role of unintended pregnancy is highlighted by the fact that in states that have very high pregnancy rates, the adolescent abortion rate is higher than the birthrate and the abortion rate combined in states that have the lowest pregnancy rates. A series of multivariate analyses that controlled for the percentage of the state population that was black, poor and metropolitan showed that social factors tend to be more important determinants of state differences in teenage pregnancy, birth and abortion levels than are policy-related variables, particularly for whites. Nevertheless, some policy measures have important associations for both races, especially for blacks. Social factors. High rates of population growth and residential mobility over the previous decade, a high crime rate, a high teenage suicide rate, extensive circulation of sexually explicit magazines, a large percentage not voting in elections and a high level of stress are all associated with high pregnancy-related rates for teenagers. The percentage of children living in female-headed households correlates positively with abortion and pregnancy levels among white teenagers, but has no significant association with the birthrate. The percentage of a state's population that belongs to fundamentalist religious groups is positively associated with adolescent birthrates. Political liberalism correlates with relatively low pregnancy rates and birthrates but with a somewhat higher likelihood of pregnancies being terminated by abortion. In states where women's status is higher, birthrates are lower, but abortion levels are higher. Policy measures. States that have high proportions of teenagers dropping out of school and of young women not graduating from high school tend to have high pregnancy rates and birthrates and a somewhat lower proportion of pregnancies ending in abortion. Increased spending on education is associated with relatively high abortion rates (and, therefore, pregnancy rates). The higher the teacher-student ratio, the lower the adolescent birthrate and the more likely the pregnant teenager is to have an abortion. Welfare payments to teenage mothers are negatively associated with both black and white teenage birthrates, and higher maximum payments are associated with relatively high abortion levels.(ABSTRACT TRUNCATED AT 400 WORDS)     

Increasing risk of gastroschisis in Norway: an age-period-cohort analysis

The prevalence of gastroschisis in Norway, as reported to the Medical Birth Registry of Norway, increased regularly and sixfold from 0.5 to 2.9 per 10,000 births during 1967-1998. The prevalence was also consistently higher among children of younger mothers. The authors used age-period-cohort analysis to assess effects of both parents' age and year of birth (parental cohorts). Mother's and father's age were included in three different regression models. Apart from a significantly higher risk at a young maternal age, the authors also found higher risk at a young paternal age (1.6-fold per 10 years' reduction in father's age, 95% confidence interval: 1.0, 2.4). The time trend was highly significant regardless of whether it was ascribed to period, mother's year of birth, or father's year of birth. However, when father's year of birth was used to describe the time trend, no apparent additional effect of father's age was found, only for mother's age. The time trend is likely caused by environmental factors. Persistently increasing risks among children of young mothers may hypothetically be related to lifestyle factors. A contribution to risk also from fathers born in more recent years or from young fathers increases the likelihood that a factor related to modern lifestyles of young couples may be related to risk.     

Placental abruption among singleton and twin births in the United States: risk factor profiles

The authors performed a population-based epidemiologic study to evaluate and contrast risk factor profiles for placental abruption among singleton and twin gestations. Data were derived from linked US birth/infant death files for 1995 and 1996, comprising 7,465,858 singleton births and 193,266 twin births. The authors also evaluated effect modification between smoking and hypertension and the effect of a dose-response relation with number of cigarettes smoked daily on abruption risk. Abruption was recorded in 5.9 per 1,000 singleton births and 12.2 per 1,000 twin births. Risk factors for abruption among singleton and twin births, respectively, included preterm premature rupture of membranes (adjusted relative risks (RRs) = 4.89 and 2.01), eclampsia (RRs = 3.58 and 1.67), anemia (RRs = 2.23 and 2.33), hydramnios (RRs = 2.04 and 1.66), renal disorders (RRs = 1.54 and 2.56), and intrapartum fever (>100 degrees F) (RRs = 1.17 and 1.69). Chronic hypertension (RR = 2.38) and pregnancy-induced hypertension (RR = 2.34) were risk factors for abruption in singleton births but not in twin births. Number of cigarettes smoked daily demonstrated a dose-response trend for abruption risk in singletons and twins. Abruption was more likely to occur among smokers with chronic hypertension (RRs = 4.66 and 3.15) and eclampsia (RRs = 6.28 and 5.08). The authors conclude that abruption is twice as likely to occur in twins as in singletons with differing risk factor profiles. This suggests that abruption in twins may result from different pathophysiologic processes.     

Birthweight, preterm births and neonatal mortality in Belgium and the United States

Summary. Belgium is known to have a lesser low birthweight rate and a lower infant mortality rate than the United States. We used previously unpublished data to show that beneath this comparison lies a more complicated picture. Singleton live birth certificates for 1986-67 were analysed. Despite a lower mean birthweight in Belgium (3360 g) than in the United States (3420 g), Belgium had fewer (4.9%) low birthweight infants than the US (5.9%) because of fewer preterm births (4.4 vs. 9.3%). Consistent with the excess of preterm births in the US, the residual distribution of birthweight was smaller in Belgium (2.2% vs. 3.1%). Whereas neonatal mortality was 4.8/1000 in Belgium and 5.6/1000 in the US, birthweight-specific neonatal mortality was higher in Belgium. The challenge for Belgium is to improve the survival of newborns regardless of their birthweight. In the US, the task is to eliminate the excess of small preterm infants.     

Convenience and the occurrence of births: induction of labor in the United States and Canada.

This paper, using data for the United States and Canada on number of births by day of the week, presents indirect evidence for the widespread incidence of the practice of elective induction. For both the United States and Canada, it is found that substantially fewer births occur on Saturdays, Sundays, and holidays than on weekdays. Controlling for such factors as prenatal care, race, education, legitimacy, birth weight, and time trend strongly suggests that the induction of labor is responsible for the patterns found. The paper concludes by discussing the framework within which the practice of elective induction of labor should be evaluated and justified.     

Neonatal mortality: an analysis of the recent improvement in the United States.

To test the hypothesis that the recent substantial decline in the United States neonatal mortality rate (20.0/1000 in 1950 to 11.6/1000 in 1975) is associated with improvements in perinatal medical care, we examined this change in relation to the two primary components which determine neonatal mortality: birthweight distribution and birthweight-specific mortality. No improvement in the weight distribution of U.S. live births has occurred during this 25-year period, indicating that the change in neonatal mortality is attributable to improved survival for one or more birthweight groups. Decline in the mortality rate in the first 15 years was slow; three-fourths of the decline in the entire 25-year period occurred since 1965. With the exception of perinatal medical care, factors known to affect survival at a given birthweight have not changed in prevalence in the 25-year period. It is a plausible hypothesis that improved perinatal medical care is a major factor in declining neonatal mortality in the U.S.     

Long-term care in the United States: an overview

Although long-term care receives far less U.S. policy attention than health care does, long-term care matters to many Americans of all ages and affects spending by public programs. Problems in the current long-term care system abound, ranging from unmet needs and catastrophic burdens among the impaired population to controversies between state and federal governments about who bears responsibility for meeting them. As the population ages, the pressure to improve the system will grow, raising key policy issues that include the balance between institutional and noninstitutional care, assurance of high-quality care, the integration of acute and long-term care, and financing mechanisms to provide affordable protection.     

Contraceptive failure in the United States: an update

This report provides an update of the authors' previous estimates of first-year probabilities of contraceptive failure for all methods of contraception. Estimates are provided of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct use at every act of intercourse). The difference between these two probabilities provides a measure of how forgiving of imperfect use each method is. These revisions are prompted by recent studies that provide the first estimates of failure during perfect use for periodic abstinence and the cervical cap, by more complete evaluations of implants, and by the appearance of the Copper T 380A and disappearance of other IUDs from the US market. Also provided is a more complete explanation of how the previous estimate of the probability of becoming pregnant while relying solely on chance should be interpreted, and this estimate is revised slightly downward.     

Cat scratch disease in the United States: an analysis of three national databases.

OBJECTIVES. Current knowledge of the epidemiology of cat scratch disease is based primarily on information from case series. We used three national databases to obtain more representative data to determine the incidence and demographics of cat scratch disease. METHODS. Records coded with the diagnosis of cat scratch disease from two hospital discharge databases and an ambulatory care database were analyzed. Costs of diagnostic tests and hospitalization were obtained from a sample of providers and published data. RESULTS. The incidence of patients discharged from hospitals with a diagnosis of cat scratch disease was between 0.77 and 0.86 per 100,000 population per year. Fifty-five percent of the case patients were 18 years of age or younger. Males accounted for 60% of cases. Incidence varied by season; approximately 60% of case patients were discharged in the months September through January. The estimated incidence of disease in ambulatory patients was 9.3 per 100,000 population per year. On the basis of these rates, we estimated the annual health care cost of the disease to be more than $12 million. CONCLUSIONS. The rates and seasonality of cat scratch disease found in this study were consistent with previous reports. Adults represented a higher percentage of the total than reported in previous case series, suggesting that the disease may affect more adults than previously recognized.     

Partner notification in the United States: an evidence-based review

INTRODUCTION: To conduct an evidence-based review of the literature on the effectiveness of partner notification strategies for syphilis, gonorrhea, chlamydia, and human immunodeficiency virus (HIV) in the United States. METHODS: Systematic literature searches of available databases yielded 212 English language articles on partner notification, 13 of which met the inclusion criteria. These 13 articles were systematically reviewed, abstracted, and rated for quality of study methods, analysis, and generalizability. RESULTS: Partner notification can newly detect HIV and other sexually transmitted diseases among partners. Of the six high-quality studies, the highest numbers of infections per infected person, 0.23 and 0.24, were detected by provider referral while the lowest number of infections per infected person, 0.03, was detected by self referral. None of the 13 studies examined the consequences of partner notification, such as infections or health consequences averted or changes in behavior and partnerships for infected persons or their partners. CONCLUSIONS: There is good evidence that partner notification is a means of newly detecting infections. In addition, there is fair evidence that provider referral generally ensures that more partners are notified and medically evaluated than does self referral. More research is needed to improve elicitation and notification procedures and tailor them to specific populations, to assess the effect of new testing technologies on partner notification, and to understand the consequences of partner notification for infected persons and their partners.     

Breast cancer mortality in Russia and Ukraine 1963-2002: an age-period-cohort analysis

OBJECTIVE: To determine the reasons for the steady increase in breast cancer mortality in Russia and Ukraine. METHODS: Age-period-cohort analysis, supplemented by analysis of historical fertility trends. RESULTS: Mortality from breast cancer has risen steadily in both countries over the past 40 years, although faster in Russia than in Ukraine. There are strong birth cohort effects, which are consistent with known changes in fertility. Death rates were highest among those born in the first half of the 20th century, declining among those born after the 1950s. There has been a decline in mortality among younger women since the mid 1990s, which may reflect improvements in treatment. CONCLUSION: The increase in breast cancer mortality in Russia and Ukraine can largely be explained by known changes in fertility, while recent changes may reflect changes in treatment. Observed trends suggest that death rates from female breast cancer in the two countries are likely to stabilize or even decline in the future.     

Tuberculosis: an increasing problem among minorities in the United States

Although the number of tuberculosis cases reported annually in the United States has decreased markedly during the past three and a half decades, the decrease among whites has been considerably greater than among nonwhites. As a result of this widening gap, nearly two-thirds of the cases reported in 1987 occurred in minority populations and, for the first time in history, the number of cases among blacks exceeded the number of cases among non-Hispanic whites. From 1985 to 1987, tuberculosis among blacks increased 6.3 percent and among Hispanics, by 12.7 percent, but it decreased 4.8 percent among non-Hispanic whites. Much of the increase appears attributable to tuberculosis occurring among persons infected with the human immunodeficiency virus (HIV). Although there are many obstacles to the elimination of the disease in minority populations, numerous strategies have been developed and are being implemented to address this situation.     

Federal health policies in the United States: an alternative explanation

Since 1980 there has been an unprecedented shift in federal expenditures away from health and social welfare; an "electoral mandate" to reduce government's role is widely cited as justification. Yet, a survey of all major opinion polls of the past decade shows that electoral behavior and popular opinion are not synonymous. In exploring the historical ideological roots of this disjunction, the post- New Deal rise of "interest group" over "class" behavior is noted; "depoliticization" of political issues and "abstentionism" in voting follow. Rather than a realignment, recent elections represent a dealignment from regressive choices.     

Social work education in the United States: a critical analysis

Social work programs accredited by the Council on Social Work Education educate students for practice at the undergraduate and graduate levels. This paper presents a critical analysis of social work education in the United States. The analysis suggests that graduates of social work programs do not appear to master the skills, knowledge and values critical to effective practice and policy intervention. The implications of these findings are offered.