Racial disparities in mortality among infants with Dandy-Walker syndrome.
BACKGROUND
Congenital malformations are the major cause of infant mortality in the United States, but their contribution to overall racial disparity--a major public health concern--is poorly understood. We sought to estimate the contribution of a congenitally acquired central nervous system lesion, Dandy-Walker Syndrome (DWS), to black-white disparity in infant mortality.


METHODS
Data were obtained from the New York State Congenital Malformations Registry, an ongoing population-based validated surveillance system. We compared black to white infants with respect to infant, neonatal, and postneonatal mortality using Cox proportional hazards regression models.


RESULTS
A total of 196 live-born neonates were diagnosed with DWS in the state from 1992 to 2005 inclusive. Of these, 53 were non-Hispanic black and 76 were non-Hispanic white. Neonatal mortality was similar for non-Hispanic blacks and non-Hispanic whites (adjusted hazards ratio [AHR], 1.42; 95% CI, 0.52-3.82), but non-Hispanic blacks had an 8-fold increased risk for postneonatal mortality (AHR, 8.26; 95% CI, 2.08-32.72). Adjustment for fetal growth and other maternal and infant characteristics resulted in a 10-fold increased risk of mortality for non-Hispanic black infants as compared to non-Hispanic whites. By contrast, adjustment for preterm birth attenuated the risk, but non-Hispanic black infants were still more than 6 times as likely to die during the postneonatal period than non-Hispanic whites (AHR, 6.36, 95% CI, 1.52-26.60).


CONCLUSIONS
DWS has one of the largest black-white disparities in postneonatal survival. This underscores the importance of evaluating racial disparities in infant mortality by specific conditions in order to formulate targeted interventions to reduce disparities.
Salihu
Hamisu M
HM
Department of Epidemiology, College of Public Health, University of South Florida, Tampa, FL 33613, USA. hamisu.salihu@gmail.com
Kornosky
Jennifer L
JL
Alio
Amina P
AP
Druschel
Charlotte M
CM
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D003616:Dandy-Walker Syndrome / Q000453:epidemiology / Q000208:ethnology* / Q000401:mortality*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009518:New York / Q000453:epidemiology; D016016:Proportional Hazards Models; D012042:Registries; D012306:Risk; D044465:White People / Q000706:statistics & numerical data*