Very low birth weight births in Georgia, 1994-2005: trends and racial disparities.
OBJECTIVE
To investigate the nature of very low birth weight (VLBW) births in Georgia-a major contributor to the overall and the black-white disparity in infant mortality-as a step toward elucidating strategies for reducing VLBW births.


METHODS
This population-based retrospective cohort study utilized maternally linked vital records data from Georgia to examine the status of and contributors to the VLBW rate for non-Hispanic blacks and whites by comparing trends in the proportion represented by singleton versus multiple gestations, first versus recurrent events, and specific subtypes over three, consecutive 4-year periods (1994-1996 through 2003-2005); and logistic regression to model the risk of various subtypes of VLBW as a function of maternal and obstetrical characteristics.


RESULTS
Georgia's VLBW rate remained unchanged from 1994-1996 to 2003-2005, although there was a significant decrease in the rates of twin and first VLBW and a significant increase in recurrent VLBW. For both first and recurrent VLBW, there was a statistically significant increase for blacks and a decrease for whites. The strongest risk factor for a VLBW birth of any subtype for blacks and whites was a prior VLBW, with recurrent VLBW accounting for 4.8-16% of all VLBW depending upon the subtype.


CONCLUSIONS
From 1994-1996 to 2003-2005, the rate of recurrent VLBW increased while the rate of first VLBW decreased in Georgia. For both first and recurrent VLBW, the black-white disparity widened. Because the strongest risk factor for a VLBW birth is a previous one, there is a need to identify strategies to prevent a woman's first VLBW birth and to reduce recurrences.
Dunlop
Anne L
AL
Department of Family & Preventive Medicine, Emory University School of Medicine, 1256 Briarcliff Road NE, Building A, Suite 238, Atlanta, GA, 30322, USA. amlang@emory.edu
Salihu
Hamisu M
HM
Freymann
Gordon R
GR
Smith
Colin K
CK
Brann
Alfred W
AW
D000328:Adult; D001741:Black or African American; D015331:Cohort Studies; D005845:Georgia / Q000453:epidemiology; D054624:Health Status Disparities; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D016015:Logistic Models; D012189:Retrospective Studies; D014798:Vital Statistics; D044465:White People