title: Racial, ethnic, and socioeconomic disparities in the prevalence of cerebral palsy.
abstract: OBJECTIVE
  Racial and ethnic disparities in cerebral palsy have been documented, but the underlying mechanism is poorly understood. We determined whether low birth weight accounts for ethnic disparities in the prevalence of cerebral palsy and whether socioeconomic factors impact cerebral palsy within racial and ethnic groups.
  
  
  METHODS
  In a retrospective cohort of 6.2 million births in California between 1991 and 2001, we compared maternal and infant characteristics among 8397 infants with cerebral palsy who qualified for services from the California Department of Health Services and unaffected infants.
  
  
  RESULTS
  Overall, black infants were 29% more likely to have cerebral palsy than white infants (relative risk: 1.29 [95% confidence interval: 1.19-1.39]). However, black infants who were very low or moderately low birth weight were 21% to 29% less likely to have cerebral palsy than white infants of comparable birth weight. After we adjusted for birth weight, there was no difference in the risk of cerebral palsy between black and white infants. In multivariate analyses, women of all ethnicities who did not receive any prenatal care were twice as likely to have infants with cerebral palsy relative to women with an early onset of prenatal care. Maternal education was associated with cerebral palsy in a dose-response fashion among white and Hispanic women. Hispanic adolescent mothers (aged <18 years) had increased risk of having a child with cerebral palsy.
  
  
  CONCLUSIONS
  The increased risk of cerebral palsy among black infants is primarily related to their higher risk of low birth weight. Understanding how educational attainment and use of prenatal care impact the risk of cerebral palsy may inform new prevention strategies.
authors.affiliation: Department of Neurology, University of California San Francisco, San Francisco, California 94143-0137, USA. wuy@neuropeds.ucsf.edu
authors.forename: Yvonne W
authors.initials: YW
authors.lastname: Wu
authors.forename: Guibo
authors.initials: G
authors.lastname: Xing
authors.forename: Elena
authors.initials: E
authors.lastname: Fuentes-Afflick
authors.forename: Beate
authors.initials: B
authors.lastname: Danielson
authors.forename: Lloyd H
authors.initials: LH
authors.lastname: Smith
authors.forename: William M
authors.initials: WM
authors.lastname: Gilbert
mesh_terms: D000293:Adolescent; D000328:Adult; D002140:California / Q000453:epidemiology; D002547:Cerebral Palsy / Q000208:ethnology*; D005006:Ethnicity; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D015995:Prevalence; D044469:Racial Groups; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult