Published online December 1, 2006
PEDIATRICS Vol. 118 No. 6 December 2006, pp. 2488-2497 (doi:10.1542/peds.2006-1824)
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ARTICLE

The Changing Risk of Infant Mortality by Gestation, Plurality, and Race: 1989–1991 Versus 1999–2001

Barbara Luke, ScD, MPH, RN, RDa,b and Morton B. Brown, PhDc

a School of Nursing and Health Studies, University of Miami, Coral Gables, Florida
b Departments of Obstetrics and Gynecology and Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida
c Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan

OBJECTIVE. Our aim was to quantify contemporary infant mortality risks and to evaluate the change by plurality, gestation, and race during the most recent decade.

PATIENTS AND METHODS. The study population included live births of 20 to 43 weeks' gestation from the 1989–1991 and 1999–2001 US Birth Cohort Linked Birth/Infant Death Data Sets, including 11317895 and 11181095 live births and 89823 and 67129 infant deaths, respectively. Adjusted odds ratios and 95% confidence intervals were calculated to evaluate the change in risk by plurality and gestation and to compare the change with that for singletons.

RESULTS. Overall, the infant mortality risk decreased significantly for singletons, twins, and triplets but nonsignificantly for quadruplets and quintuplets. Compared with singletons, significantly greater reductions were experienced by twins overall and at <37 weeks and triplets at <29 weeks. The largest reduction was for triplets at 20 to 24 weeks and for quadruplets and quintuplets at 25 to 28 weeks. For white infants, significant reductions were achieved overall for singletons, twins, and triplets and at every gestation. For black infants, significant reductions occurred for singletons overall and at every gestation, for twins at <37 weeks, and for triplets at 25 to 28 weeks. Compared with white infants, black infants had significantly lower risks before and higher risks after 33 weeks, although between 1989–1991 and 1999–2001 this survival advantage at earlier ages diminished, and the risk at later gestations increased.

CONCLUSIONS. The improvements in survival were greater for multiples versus singletons and for white versus black infants. Within each plurality, at each gestation the racial disparity in mortality has widened.

Key Words: infant mortality • birth weight • gestation • plurality • racial disparities

Abbreviations: RDS—respiratory distress syndrome • SIDS—sudden infant death syndrome • NCHS—National Center for Health Statistics • AOR—adjusted odds ratio • CI—confidence interval • ART—assisted reproductive technology

Accepted Aug 7, 2006.