BACKGROUND The causes of preterm birth are multi-dimensional, including delayed and inadequate prenatal services as well as other medical and socioeconomic factors. This study aimed to examine the different levels of association between preterm birth and major medical co-morbidities among various racial/ethnic women enrolled in Medicaid. METHODS This is a retrospective analysis of 457,200 women aged between 15 and 44 with a single live birth from the IBM® MarketScan® Multi-State Medicaid Database from 2014 to 2015. Preterm birth, defined by delivery before 37 completed weeks of gestation, was the primary dependent variable. All births were dichotomously categorized as either preterm or full-term birth using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Independent variables included race/ethnicity, categorized as non-Hispanic white, non-Hispanic black, Hispanic, or other. Medical co-morbidities included smoking, drug dependence, alcohol dependence, diabetes, and hypertension. Total healthy prenatal visit count and high-risk prenatal visit encounters identified during 30 weeks prior to the delivery date were included in the analysis. RESULTS A significantly higher preterm birth rate was found in black women after controlled for medical co-morbidities, age, prenatal visit count, and high-risk pregnancy. Different levels of association between preterm birth outcome and major medical co-morbidities were examined among various racial/ethnic women enrolled in Medicaid. Drug dependence was associated with higher odds of preterm birth in black (OR = 2.56, 95% CI [1.92-3.41]) and white women (OR = 2.12, 95% CI [1.91-2.34]), when controlled for other variables. In Hispanic women, diabetes (OR=1.44, 95% CI [1.27, 1.64]) and hypertension (OR=1.98, 95% CI [1.74, 2.26]) were associated with higher odds of preterm birth. White women diagnosed with drug dependence had a 14.0% predicted probability of preterm birth, whereas black women diagnosed with drug dependence had a predicted probability of preterm birth of 21.5%. CONCLUSIONS The associations of medical co-morbidities and preterm births varied across racial and ethnic groups of women enrolled in Medicaid. This report calls for future research on racial/ethnic disparity in preterm birth to apply integrative and qualitative approaches to understand the disparity from a contextual perspective, especially for vulnerable pregnant women like Medicaid enrollees.

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2014-2015年医疗补助计划中种族/族裔妇女的合并症与早产结局之间的关联程度不同：回顾性分析。

背景技术早产的原因是多方面的，包括延迟和不足的产前服务以及其他医学和社会经济因素。这项研究旨在研究参加医疗补助计划的各种种族/族裔妇女中早产与主要医学合并症之间不同的关联水平。方法这是一项回顾性分析，研究对象是2014年至2015年来自IBM®MarketScan®多州医疗补助数据库的457,200名年龄在15至44岁之间的单胎活产妇女。早产是指在妊娠37个完整星期之前分娩的婴儿。主要因变量。使用《国际疾病分类，第九修订版，临床修改》代码将所有出生一分为二，即早产或足月。自变量包括种族/民族，分为非西班牙裔白色，非西班牙裔黑色，西班牙裔或其他。医学上的合并症包括吸烟，药物依赖，酒精依赖，糖尿病和高血压。分析中包括分娩前30周内确定的健康产前就诊总数和高风险产前就诊次数。结果在控制了医学上的合并症，年龄，产前就诊次数和高危妊娠后，黑人妇女的早产率显着提高。在参加Medicaid的各种种族/族裔妇女中，检查了早产结局与主要医学合并症之间的不同关联水平。黑人（OR = 2.56，95％CI [1.92-3.41]）和白人妇女（OR = 2.12，95％CI [1.91-2.34]），药物依赖与早产几率较高相关，当控制其他变量时。在西班牙裔女性中，糖尿病（OR = 1.44，95％CI [1.27，1.64]）和高血压（OR = 1.98，95％CI [1.74，2.26]）与早产几率较高相关。被诊断为有药物依赖的白人妇女的早产预测概率为14.0％，而被诊断为具有药物依赖的黑人妇女的早产预测概率为21.5％。结论医疗补助发病率与早产的关联因参加医疗补助计划的妇女的种族和族裔群体而异。该报告呼吁对早产中种族/族裔差异的未来研究，以综合和定性的方法从上下文的角度来理解差异，特别是对于像Medicaid参加者这样的弱势孕妇而言。1.64]和高血压（OR = 1.98，95％CI [1.74，2.26]）与早产几率较高相关。被诊断为有药物依赖的白人妇女的早产预测概率为14.0％，而被诊断为具有药物依赖的黑人妇女的早产预测概率为21.5％。结论医疗补助发病率与早产的关联因参加医疗补助计划的种族和族裔妇女而异。该报告呼吁对早产中种族/族裔差异的未来研究，以综合和定性的方法从上下文的角度来理解差异，特别是对于像Medicaid参加者这样的弱势孕妇而言。1.64]和高血压（OR = 1.98，95％CI [1.74，2.26]）与早产几率较高相关。被诊断为毒品依赖的白人妇女的早产预测概率为14.0％，而被诊断为毒品依赖的黑人妇女的早产预测概率为21.5％。结论医疗补助发病率与早产的关联因参加医疗补助计划的妇女的种族和族裔群体而异。该报告呼吁对早产中种族/族裔差异的未来研究，以综合和定性的方法从上下文的角度来理解差异，特别是对于像Medicaid参加者这样的弱势孕妇而言。被诊断为有药物依赖的白人妇女的早产预测概率为14.0％，而被诊断为具有药物依赖的黑人妇女的早产预测概率为21.5％。结论医疗补助发病率与早产的关联因参加医疗补助计划的妇女的种族和族裔群体而异。该报告呼吁对早产中种族/族裔差异的未来研究，以综合和定性的方法从上下文的角度理解差异，特别是对于像Medicaid参加者这样的脆弱孕妇而言。被诊断为有药物依赖的白人妇女的早产预测概率为14.0％，而被诊断为具有药物依赖的黑人妇女的早产预测概率为21.5％。结论医疗补助发病率与早产的关联因参加医疗补助计划的种族和族裔妇女而异。该报告呼吁对早产中种族/族裔差异的未来研究，以综合和定性的方法从上下文的角度来理解差异，特别是对于像Medicaid参加者这样的弱势孕妇而言。结论医疗补助发病率与早产的关联因参加医疗补助计划的种族和族裔妇女而异。该报告呼吁对早产中种族/族裔差异的未来研究，以综合和定性的方法从上下文的角度来理解差异，特别是对于像Medicaid参加者这样的弱势孕妇而言。结论医疗补助发病率与早产的关联因参加医疗补助计划的种族和族裔妇女而异。该报告呼吁对早产中种族/族裔差异的未来研究，以综合和定性的方法从上下文的角度来理解差异，特别是对于像Medicaid参加者这样的弱势孕妇而言。