title: Disparities in Breastfeeding: Impact on Maternal and Child Health Outcomes and Costs.
abstract: To estimate the disease burden and associated costs attributable to suboptimal breastfeeding rates among non-Hispanic blacks (NHBs), Hispanics, and non-Hispanic whites (NHWs).
  
  
  
  Using current literature on associations between breastfeeding and health outcomes for 8 pediatric and 5 maternal diseases, we used Monte Carlo simulations to evaluate 2 hypothetical cohorts of US women followed from age 15 to 70 years and their infants followed from birth to age 20 years. Accounting for differences in parity, maternal age, and birth weights by race/ethnicity, we examined disease outcomes and costs using 2012 breastfeeding rates by race/ethnicity and outcomes that would be expected if 90% of infants were breastfed according to recommendations for exclusive and continued breastfeeding duration.
  
  
  
  Suboptimal breastfeeding is associated with a greater burden of disease among NHB and Hispanic populations. Compared with a NHW population, a NHB population had 1.7 times the number of excess cases of acute otitis media attributable to suboptimal breastfeeding (95% CI 1.7-1.7), 3.3 times the number of excess cases of necrotizing enterocolitis (95% CI 2.9-3.7), and 2.2 times the number of excess child deaths (95% CI 1.6-2.8). Compared with a NHW population, a Hispanic population had 1.4 times the number of excess cases of gastrointestinal infection (95% CI 1.4-1.4) and 1.5 times the number of excess child deaths (95% CI 1.2-1.9).
  
  
  
  Racial/ethnic disparities in breastfeeding have important social, economic, and health implications, assuming a causal relationship between breastfeeding and health outcomes.
authors.affiliation: Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA. Electronic address: melissabartick@gmail.com.
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Bartick
authors.affiliation: Department of Health Services Administration, D'Youville College, Buffalo, NY.
authors.forename: Briana J
authors.initials: BJ
authors.lastname: Jegier
authors.affiliation: Department of Operations Business Analytics and Information Systems, University of Cincinnati, Cincinnati, OH.
authors.forename: Brittany D
authors.initials: BD
authors.lastname: Green
authors.affiliation: Department of Medicine, University of California, Davis, Davis, CA.
authors.forename: Eleanor Bimla
authors.initials: EB
authors.lastname: Schwarz
authors.affiliation: Alliance for the Prudent Use of Antibiotics, Boston, MA.
authors.forename: Arnold G
authors.initials: AG
authors.lastname: Reinhold
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina School of Medicine, Chapel Hill, NC.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Stuebe
mesh_terms: D000293:Adolescent; D000328:Adult; D044383:Black People / Q000706:statistics & numerical data; D001942:Breast Feeding / Q000191:economics* / Q000208:ethnology*; D000067576:Child Health / Q000208:ethnology*; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D008297:Male; D000068097:Maternal Health / Q000208:ethnology*; D018570:Risk Assessment; D012959:Socioeconomic Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult; D001741:Black or African American
keywords: breast feeding; diarrhea, infantile; health status disparities; infant mortality; minority health; otitis media