Am J Epidemiol 2004; 159:59-63.
Copyright © 2004 by the Johns
Hopkins Bloomberg School of Public Health
ORIGINAL CONTRIBUTIONS |
Preterm Delivery Rates in North Carolina: Are They Really Declining among Non-Hispanic African Americans?
1 Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
2 State Center for Health Statistics, Division of Public Health, North Carolina Division of Health and Human Services, Raleigh, NC.
3 Office of Data and Information Management, Maternal and Child Health Bureau, Rockville, MD.
The preterm delivery rate in North Carolina is consistently higher than the national average. However, recent reports suggest that singleton preterm delivery rates for non-Hispanic Whites are increasing while those for non-Hispanic African Americans are decreasing. To study this pattern further, the authors examined data on singleton non-Hispanic White and non-Hispanic African-American births in 1989 and 1999 by using North Carolina vital statistics data. They found that the frequency of preterm delivery rose 1.1% (8.5% to 9.6%) among non-Hispanic Whites but declined 1.4% (17.9% to 16.5%) among non-Hispanic African Americans over the same time period. For both subgroups, a bimodal distribution of birth weights was apparent among preterm births at 28–31 weeks of gestation. The second peak with its cluster of normal-weight infants was more prominent among non-Hispanic African Americans in 1989 than in 1999. To reduce the potential for bias due to misclassification of infant gestational age, frequencies of preterm delivery of infants who weighed less than 2,500 g were calculated. Unlike the original analysis, this calculation showed that preterm delivery increased for both subgroups. A number of non-Hispanic African-American births classified as preterm were apparently term births mistakenly assigned short gestational ages. Such misclassification was more frequent in 1989 than in 1999, inflating 1989 preterm delivery rates.
bias (epidemiology); birth certificates; blacks; classification; delivery, obstetric; gestational age; infant, premature
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