From Paradox to Disparity: Trends in Neonatal Death in Very Low Birth Weight non-Hispanic Black and White Infants, 1989-2004
Received 11 October 2008; received in revised form 24 March 2009; accepted 17 April 2009. published online 17 July 2009.
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.
aProgram in Public Health, University of California Irvine, Irvine, CA
bSchool of Public Health, University of California Berkeley, Berkeley, CA
cDepartment of Pediatrics, Stanford University, Stanford, CA
Reprint requests: Tim A. Bruckner, Program in Public Health, University of California, Irvine, 101 Theory, Suite 250, Irvine, CA 92697.
Supported by a Ruth L. Kirschstein National Research Service Award (T-32 HS-00086-09) within the Agency for Health Care Research and Quality, and a Title V block grant (under Contract 05-45195) from the California Department of Public Health, Maternal, Child, and Adolescent Health Program. The authors declare no conflicts of interest.
ABSTRACT