Elective Deliveries and Neonatal Outcomes in Full-Term Pregnancies.

Cesarean and induced delivery rates have risen substantially in recent decades and currently account for over one-third and one-fourth of US births, respectively. Initiatives to encourage delaying deliveries until a gestational age of 39 weeks appear to have slowed the increases but have not led to declines. The rates are at historic highs and the consequences of these interventions when not medically necessary have not been systematically explored at the population level. In this study, we used population-level data on births in New Jersey (1997-2011) to document trends in elective deliveries (induced vaginal delivery, cesarean delivery with no labor trial, and cesarean delivery after induction) and estimate logistic and linear regression models of associations between delivery method and neonatal morbidities and cost-related outcomes in low-risk pregnancies. We found that elective deliveries more than doubled during the observation period and were associated with neonatal morbidities and cost-related outcomes even at gestational ages of 39 and 40 weeks. Findings suggest that delaying beyond 39 weeks and avoiding delivery interventions when not medically necessary would improve infant health and reduce health-care costs.

Racial-ethnic inequality in cardiovascular health in the United States: Does it mirror socioeconomic inequality?

PURPOSE: To document gender-specific racial-ethnic disparities in cardiovascular (CV) conditions and risk factors net of socioeconomic status (SES) across the lifespan. METHODS: Using pooled data from the 1999 to 2016 U.S. National Health and Nutrition Examination Survey, we document gender-specific proportions of non-Hispanic Whites, non-Hispanic Blacks, and Hispanics ages 12-69 years with various socioeconomic characteristics and CV conditions. We then further disaggregate into 10-year age groups and present unadjusted and SES-adjusted prevalence of each CV condition for each gender/racial-ethnic/age group. RESULTS: Racial-ethnic differences in the prevalence of CV conditions are large for some conditions, emerge early in adulthood, and remain relatively constant though age 69. Only small proportions of the differences can be attributed to differences in SES across groups; attenuation after adjusting for income, education, and available measures of wealth ranged from 0 to 2.3 percentage points. Black-White differences in prevalence of CV conditions differ substantially and systematically by gender; White females have larger advantages or smaller disadvantages (depending on indicator) relative to Black females than White males do relative to Black males. CONCLUSIONS: Racial-ethnic disparities in CV conditions are rooted early in the life course, do not mirror socioeconomic disparities, and vary considerably by gender. Explanations likely involve early life experiences such as racial discrimination and entrenched inequality.

Income disparities in cardiovascular health across the lifespan.

Using data from the 1999-2014 National Health and Nutrition Examination Survey (n ~ 46,000), this study documents income disparities in the age patterning of cardiovascular conditions across the lifespan in the U.S. The conditions were assessed from laboratory test results, self-reports of medications used to treat specific conditions, and anthropometric measurements, allowing us to capture whether individuals at given ages had developed the various conditions, regardless of previous diagnosis and treatment. We found evidence of large income disparities in the presence of cardiovascular conditions and risk factors for females, smaller disparities in the same conditions for males, and few disparities that increased with age for either gender. Results were very similar when considering disparities by education instead of income. The findings suggest that the widening socioeconomic gradients in health over the lifespan found in many previous studies-which have generally focused on self-rated health, activity limitations, or diagnosed conditions-reflect, at least to some extent, differences in diagnosis, treatment, and management of health conditions rather than age-related differences in developing them. The findings also suggest that preventive healthcare is not an important source of socioeconomic disparities in cardiovascular health in the U.S., at least for men. The observed patterns of income disparities in cardiovascular conditions over the lifespan are more consistent with theories of early life conditions and the imprinting of health endowments and susceptibilities early in life than with cumulative life exposure or stress hypotheses.