哺乳率種族差異背後的經濟因素


  【24drs.com】根據一篇新研究的結果,有關哺乳率的種族差異,或許可用經濟因素而非文化因素來解釋。
  
  費城Sidney Kimmel醫學院Rachel Horowitz表示,這個結果強調了幫助婦女克服哺乳之實際阻礙的重要性;通常,哺乳的決定是根據婦女從事的工作類型。
  
  Horowitz在美國婦產科學院2015年臨床會議中發表研究結果。
  
  在美國,黑人婦女的哺乳率一直低於白人婦女,有些研究者認為,這個差異是因為缺乏示範與家庭支持。
  
  為了探討與這個差異有關的其他可能因素,Horowitz等人分析了在2013年7至12月、分娩足月單胞胎的523名婦女(342名黑人與181名白人)的醫療紀錄。
  
  其中,他們確認了337名婦女(白人與黑人)在一次產後就診紀錄中的哺乳方式。
  
  至少有一部份餵母乳的白人婦女比率高於黑人婦女(64% vs 53%;P< .05),不過,當研究者校正年齡、胎次、婚姻狀況時,種族之間的差異就不再顯著(勝算比[OR]0.91,95%信賴區間[CI]為0.52- 1.56)。
  
  Horowitz報告指出,唯一顯著的因素是保險狀態。有私人保險的白人婦女多於黑人婦女(60% vs 33%)。
  
  在另一篇分析中,研究團隊探討保險狀態和各種族世代(包括亞裔和西班牙裔婦女)之哺乳情況的關聯,研究對象是405名在2013年7至12月於研究者的機構中分娩足月單胞胎的婦女;這些婦女都在8週內完成產後追蹤且有記錄哺乳方法。
  
  校正年齡、種族、胎次、教育、婚姻狀態之後,如果婦女只有Medicaid而無商業保險,就比較不會至少還有一部份時間餵母乳(48% vs 69%;OR,0.53;95% CI,0.29- 0.77)。
  
  保險狀態對於白人婦女的影響更大於黑人、西班牙裔、亞裔婦女,事實上,有Medicaid婦女的哺乳率,白人婦女最低、其次依序是黑人婦女、西班牙裔與亞裔婦女。
  
  這篇分析並未指出保險狀態如何影響哺乳,但是Horowitz表示她相信這是因為貧困因素的影響。
  
  她解釋,低收入工作的婦女可能沒有工作空檔可以擠乳、工作環境也可能沒有冷凍儲存母乳的冰箱。
  
  之前的研究顯示,哺乳因素方面,目的比人口統計學特徵更重要,意謂著醫師可以在產前討論時鼓勵婦女哺乳。
  
  Horowitz表示,如果可以事先計畫,將可望提升哺乳率。她表示,她與研究夥伴正計畫進行這個方法的臨床試驗。
  
  Albuquerque新墨西哥大學Sharon Phelan表示,這篇研究說明了為什麼不能妄下結論與種族有關是很重要的。這個想法跳脫出既有的框架,可以說是對於談論種族等其他因素時的挑戰。
  
  Phelan醫師表示她同意工作狀況是種族差異背後的實際因素,事實上,她的病患有許多人告訴她,「我在快餐店工作;我沒有休息時間可以哺乳。」
  
  資料來源: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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