Reduction in malformation-related early mortality--a possibility for modifying perinatal mortality

From 1980 to 1996 1.8% of all births died as a result of malformations during the first week of life. This rate has been declining significantly after 1992. Congenital malformations of the heart have increased significantly because of improved diagnostic methods. From 1980 to 1996 0.67/1000 of all children died of vitium cordis during the first week of life. From 1992 to 1996 this group of malformations increased the perinatal mortality rate by 0.4/1000. There is a decreased mortality rate of neural tube defects by 0.25/1000 1980 to 1986 and by 0.08/1000 1992 to 1996. Trisomy 21: the early mortality rate decreased from 0.07/1000 to 0.03/1000. The number of non-deceased children with Down's syndrome remains constant, even though 40 per cent of all cases with trisomy 21 were prenatal. 3 per cent of all malformed newborn died during the first week of life as a result of their congenital malformations. The possibility of primary prevention of malformations with folic acid has not been sufficiently utilised.     

Ethnic differences in mammographic densities.

BACKGROUND: Breast cancer incidence is considerably lower among Japanese and Chinese women than among Caucasian and Native Hawaiian even in second and third generation migrants. Mammographic densities, which refer to the radiological appearance of the healthy female breast, are related to breast cancer risk. The purpose of this project was to explore the hypothesis that women from ethnic groups at high breast cancer risk are more likely to have high levels of densities than women from low breast cancer risk groups. METHODS: In a cross-sectional design, 514 pre- and post-menopausal women recruited at mammography screening clinics completed a self-administered questionnaire. We used a computer-assisted method to measure the dense and the total areas of the breast and to compute per cent breast density. Student's t-tests and multiple linear regression were applied to examine ethnic differences and to explore determinants of mammographic densities, respectively. RESULTS: The unadjusted mean dense area was 15% smaller in Chinese and Japanese women than in the Caucasian/Hawaiian group. However, because of their smaller breast size, the per cent of the breast occupied by dense tissue in Chinese and Japanese women was 20% higher than in Caucasian women. Body mass index, age, menopausal status, parity, and oestrogen therapy were associated with mammographic densities, but they did not account for all ethnic differences. CONCLUSIONS: Whereas this study detected some ethnic differences in mammographic densities, the importance of dense areas and per cent densities as indicators of breast cancer risk in ethnically diverse populations remains to be clarified.     

Ethnic differences in midwife-attended US births.

This study examined US ethnic differences in midwifery care from 1982 through 1989. After adjustment for maternal characteristics, Native American mothers were most likely, and White and Asian mothers were least likely, to obtain midwifery care. For these three groups, midwifery use increased rapidly in the period from 1982 through 1989. Compared with White mothers, Black and Hispanic mothers were more likely to be attended by a midwife; however, their use of midwives increased more slowly. Though the local availability of obstetricians and midwives may determine a woman's choice of care provider, these data suggest that cultural factors also play a role.     

Ethnic differences in certified sickness absence.

The certified sickness absence of 4482 employees in one plant of a large manufacturing company in South-east England was studied for 12 months. The absences in the principal ethnic groups, Caucasian, Asian, and West Indian were compared. After standardisation for age and job grade in each department the Asians had twice the spells per man and nearly twice the days lost per man compared with the Caucasians. Compared with the Caucasians there was slightly more absence in West Indians. Various factors affect absence, and one reason for these differences may be that the three ethnic groups appreciate painful or unpleasant stimuli to a different degree.     

Ethnic differences in accident rates at work.

The accidents at work of 4482 employees in a car engine machining and assembly plant in south east England were studied retrospectively over a 12 month period. The study population was composed of Asian (22%), white (66%), and West Indian employees (12%). The crude accident rates differed among the groups, the means being Asians 1.58, white 1.23, and West Indians 1.28. There was, however, no consistent ethnic difference after adjustment for other factors such as age, type of job, and duration of service. Accident rates were higher in those employees who were younger, newly employed, and in production jobs. The findings of this research imply that accident prevention programmes should be directed to those factors known to relate to accidents and not to any specific ethnic group.     

Ethnic differences in preterm and very preterm delivery.

Ethnic differences in preterm (less than 37 weeks) and very preterm (less than 33 weeks) delivery were evaluated in a prospective cohort of 28,330 women. Blacks had the highest rate of preterm and very preterm delivery, followed by Mexican-Americans, Asians, and Whites. Adjustment for maternal age, education, marital status, employment, parity, number of previous spontaneous or induced abortions, smoking and drinking during pregnancy, infant sex, and gestational age at initiation of prenatal care resulted in the following odds ratios for preterm delivery: 1.79 (1.55-2.08) for Blacks, 1.40 (1.19-1.63) for Mexican-Americans, 1.40 (1.16-1.69) for Asians, and 1.00 for Whites. The corresponding odds ratios for very preterm delivery were 2.35 (1.72-3.22) for Blacks, 1.31 (0.88-1.94) for Mexican-Americans, 1.10 (0.67-1.83) for Asians, and 1.00 for Whites. Exclusion of cases of premature rupture of membranes, placenta previa, and abruptio placenta did not explain the large ethnic differences. Although Whites and Mexican-Americans had similar birthweight distributions, Mexican-Americans had an increased risk for preterm delivery. Fifty-five per cent of low birthweight babies in Kaiser were preterm and this fraction did not vary substantially by ethnic group.     

Ethnic differences in past hysterectomy for benign conditions.

BACKGROUND: Hysterectomy for a benign condition is common, particularly in the underserved. The objective was to determine if ethnic differences could be explained by known risk factors. METHODS: A phone survey was conducted at random on 15,160 women, ages 40-55, from seven US cities. Subjects were 49.9% Caucasian, 28.1% African American, 12.3% Hispanic, and 9.8% Asian American. RESULTS: Ethnicity was associated with past hysterectomy (odds ratio [OR]: Caucasian = 1.0, African American = 1.66; confidence interval [CI] = 1.46-1.88, Hispanic = 1.64, CI = 1.29-2.07; Asian American = 0.44, CI = 0.34-0.56), after adjustment for age, education, fibroids, body mass index, marital status, smoking, geographic site, and country of education. CONCLUSION: Because the highest rates occurred in the disadvantaged African American and Hispanic subgroups, and could not be explained by known risk factors, disparity in the form of overuse in these disadvantaged groups may exist.     

Ethnic differences in laboratory results

Over the years the Netherlands has become a country with a population comprising over 20% of immigrants. Immigrants differ from natives in both biological and cultural aspects, amongst others in laboratory results, but also in level of participation in clinical trials, and treatment outcomes. It is important for physicians to keep these differences between ethnic groups in mind. The authors argue that specific reference ranges for subgroups should be established.     

Ethnic differences in pregnancy outcome

The relationship between perinatal mortality and low birthweight was investigated using routinely available birth statistics for the administrative health areas of England and Wales. Perinatal mortality rates tended to be low in areas with a high proportion of births to ethnic minorities, compared to areas with a similar incidence of low birthweight.