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From paradox to disparity: trends in neonatal death in very low birth weight non-Hispanic black and white infants, 1989-2004.

CPQCC Publication
TitleFrom paradox to disparity: trends in neonatal death in very low birth weight non-Hispanic black and white infants, 1989-2004.
Publication TypeJournal Article
Year of Publication2009
AuthorsBruckner TA, Saxton KB, Anderson E, Goldman S, Gould JB
JournalJ Pediatr
Date Published2009 Oct
KeywordsAfrican Americans, California, Educational Status, European Continental Ancestry Group, Female, Health Status Disparities, Humans, Infant Mortality, Infant, Newborn, Infant, Very Low Birth Weight, Male, Maternal Age, Prenatal Care, Risk Factors

OBJECTIVES: To examine temporal trends in race-specific neonatal death in California to determine whether the overall decline in mortality attenuated the paradoxical survival advantage of very low birth weight (VLBW; birth weight < 1500 g) non-Hispanic black infants relative to VLBW non-Hispanic white infants.

STUDY DESIGN: The data set comprised the California birth cohort file on non-Hispanic black and non-Hispanic white VLBW neonatal mortality for 1989-2004. Logistic regression methods were used to control for potentially confounding maternal characteristics.

RESULTS: In 1989 and 1990, non-Hispanic black VLBW infants demonstrated a paradox of lower neonatal mortality (adjusted odds ratio [aOR] = 0.84; 95% confidence interval [CI] = 0.75-0.94). This survival advantage disappeared after 1991, however. In 2003 and 2004, the incidence of neonatal mortality increased in non-Hispanic black VLBW infants but decreased in non-Hispanic white VLBW infants, resulting in a racial disparity (aOR = 1.34; 95% CI = 1.14-1.56).

CONCLUSIONS: An initial survival paradox transformed into a disparity. The magnitude of this non-Hispanic black/non-Hispanic white VLBW disparity rose to its highest levels in the last 2 years of the study period. Moreover, the steady mortality increase in VLBW non-Hispanic black VLBW infants since 2001 reversed the secular decline in neonatal mortality in this population. Our findings underscore the need to augment strategies to improve the health trajectory of gestation in non-Hispanic black women.

Alternate JournalJ Pediatr
PubMed ID19615693
Grant List05-45195 / / PHS HHS / United States
T-32 HS-00086-09 / HS / AHRQ HHS / United States