摘要：Since 1950, dramatic advances in human genetics have occurred, racial disparities in infant mortality have widened, and the United States’ international ranking in infant mortality has deteriorated. The quest for a “preterm birth gene” to explain racial differences is now under way. Scores of papers linking polymorphisms to preterm birth have appeared in the past few years. Is this strategy likely to reduce racial disparities? We reviewed broad epidemiological patterns that call this approach into question. Overall patterns of racial disparities in mortality and secular changes in rates of prematurity as well as birth-weight patterns in infants of African immigrant populations contradict the genetic theory of race and point toward social mechanisms. We postulate that a causal link to class disparities in health exists. THE AVAILABILITY OF information on molecular genetics has exploded in recent decades. From the description of the double helix by Watson and Crick in 1953 to the sequencing of the human genome in 2003 and the beginnings of genomic medicine, scientific knowledge has accumulated at a breathtaking pace. Over the same decades, the United States, the world leader in newborn intensive care, fell from 6th to 27th in its international standing for infant mortality rate. At the same time, the racial gap for infant mortality in the United States has widened. The rate of death in the first year of life for Black infants increased from 1.6 times to 2.3 times the rate of White infants. 1 , 2 The worsened national statistics for infant mortality are not just the result of including the poor outcomes for Blacks. In 2001 the infant mortality rate for White infants born in the United States was 5.7 per 1000 live births, which would give that subgroup a rank of 23rd in the world, not much better than 27th. The US rate for Whites was more than twice as high as the country with the best record in the world: Singapore, at 2.4 deaths per 1000 live births. 2 Observation of these trends should give pause to those who are tempted to approach public health problems with strictly technological solutions, of which genomic medicine is the latest example. Despite having the world’s most advanced technology, the United States continues to fall farther behind other nations in health outcomes. The widening racial disparity in infant mortality during the era of molecular genetics should also prompt skepticism that genetic research holds the key to understanding and eliminating the disparities, a goal of the Healthy People 2010 objectives. 3 Indeed, it has been argued by anthropologists for years that “race” has little or no meaning as a genetic category but rather derives all its usefulness from its very clear social, political, cultural, and historical meaning. 4 , 5 These social meanings of race have clear public health implications. 1 , 6 – 8 We evaluated the expected utility of 2 approaches to racial disparities: one based on race as a proxy for geographic ancestry and genetics, and the other based on race as a social construct.
