The effect of congenital anomalies on mortality risk in white and black infants.
OBJECTIVE
This population-based study examined the effect of all major congenital anomalies on the mortality of White and Black infants by infant sex, birthweight, gestational age, and lethality of the anomaly. The study also determined the total contribution of anomalies to infant mortality.


METHODS
California Birth Defects Monitoring Program data were merged with linked birth-death files for 278,646 singleton non-Hispanic White and Black infants born in 1983 through 1986. Malformed infants were compared with nonmalformed infants to determine the effect of anomalies on mortality.


RESULTS
The presence of any congenital anomaly increased mortality 9.0-fold (95% CI = 7.3, 11.1) for Black infants and 17.8-fold (95% CI = 16.2, 19.6) for White infants. Even "non-lethal" anomalies increased mortality up to 8.9-fold. Overall, anomalies contributed to 33% of White infant deaths, to 19% of Black infant deaths, and to over 60% of deaths among Black and White neonates weighing over 1499 g.


CONCLUSIONS
The contribution of congenital anomalies to mortality of both low- (< 2500 g) and normal-birth-weight infants is substantially higher than previously estimated, representing a large public health problem for both Black and White infants.
Malcoe
L H
LH
California Birth Defects Monitoring Program, Emeryville, USA. lorraine-malcoe@ouhsc.edu
Shaw
G M
GM
Lammer
E J
EJ
Herman
A A
AA
D017677:Age Distribution; D001719:Birth Certificates; D001724:Birth Weight; D044383:Black People; D002140:California / Q000453:epidemiology; D000013:Congenital Abnormalities / Q000401:mortality*; D003644:Death Certificates; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008498:Medical Record Linkage; D011159:Population Surveillance; D012042:Registries; D017678:Sex Distribution; D044465:White People; D001741:Black or African American