title: Mortality among infants with birth defects: Joint effects of size at birth, gestational age, and maternal race/ethnicity.
abstract: BACKGROUND
  We examined the separate and joint effects of gestational age, size at birth and maternal race/ethnicity on early childhood survival among 48,391 singleton infants with major birth defects.
  
  
  METHODS
  Texas Birth Defects Registry data were linked to death records and the National Death Index to ascertain deaths. Gestational age categories were preterm or term birth; size at birth included small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA). Kaplan-Meier survival estimates were calculated, and Cox-proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) to determine risk of death after adjusting for covariates.
  
  
  RESULTS
  Overall, relative to non-Hispanic (NH) -whites, NH-blacks, and Hispanics had a 51 and 10% greater risk of death during early childhood, respectively. Compared to NH-whites born term and AGA (survival = 97%), Hispanic children born SGA and preterm had the greatest risk of death (HR(a) = 6.1; 95% CI, 5.2, 7.2) and the lowest early childhood survival (76%), followed by SGA preterm NH-blacks (HR(a) = 4.8; 95% CI, 3.6, 6.5; survival = 81%) and SGA preterm NH-whites (HR(a) = 4.5; 95% CI, 3.7, 5.6; survival = 83%). Children born LGA at term had no increased risk of mortality regardless of maternal race/ethnicity.
  
  
  CONCLUSIONS
  The joint effect of gestational age and size at birth had greatest impact on childhood mortality. Additional population based studies are needed to better understand causes of racial/ethnic disparities in mortality among children with birth defects.
authors.affiliation: Department of Epidemiology & Biostatistics, College of Public Health, University of South Florida, Tampa, Florida 33612-3805, USA. wnembha@health.usf.edu
authors.forename: Wendy N
authors.initials: WN
authors.lastname: Nembhard
authors.forename: Jason L
authors.initials: JL
authors.lastname: Salemi
authors.forename: Mary K
authors.initials: MK
authors.lastname: Ethen
authors.forename: David E
authors.initials: DE
authors.lastname: Fixler
authors.forename: Mark A
authors.initials: MA
authors.lastname: Canfield
mesh_terms: D001724:Birth Weight; D044383:Black People / Q000706:statistics & numerical data*; D046688:Child Mortality; D002675:Child, Preschool; D015331:Cohort Studies; D000013:Congenital Abnormalities; D005865:Gestational Age; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D019102:Infant, Very Low Birth Weight; D053208:Kaplan-Meier Estimate; D012042:Registries; D013781:Texas / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American