title: Impact of fetal death reporting requirements on early neonatal and fetal mortality rates and racial disparities.
abstract: OBJECTIVE
  Racial disparities in infant and neonatal mortality vary substantially across the U.S. with some states experiencing wider disparities than others. Many factors are thought to contribute to these disparities, but state differences in fetal death reporting have received little attention. We examined whether such reporting requirements may explain national variation in neonatal and fetal mortality rates and racial disparities.
  
  
  METHODS
  We used data on non-Hispanic white and non-Hispanic black infants from the U.S. 2000-2002 linked birth/infant death and fetal death records to determine the degree to which state fetal death reporting requirements explain national variation in neonatal and fetal mortality rates and racial disparities. States were grouped depending upon whether they based the lower limit for fetal death reporting on birthweight alone, gestational age alone, both birthweight and gestational age, or required reporting of all fetal deaths. Traditional methods and the fetuses-at-risk approach were used to calculate mortality rates, 95% confidence intervals, and relative and absolute racial disparity measures in these four groups.
  
  
  RESULTS
  States with birthweight-alone fetal death thresholds substantially underreported fetal deaths at lower gestations and slightly overreported neonatal deaths at older gestations. This finding was reflected by these states having the highest neonatal mortality rates and disparities, but the lowest fetal mortality rates and disparities.
  
  
  CONCLUSIONS
  Using birthweight alone as a reporting threshold may promote some shift of fetal deaths to newborn deaths, contributing to racial disparities in neonatal mortality. The adoption of a uniform national threshold for reporting fetal deaths could reduce systematic differences in live birth and fetal death reporting.
authors.affiliation: Michigan State University, Department of Epidemiology, East Lansing, MI, USA. ctyler@cdc.gov
authors.forename: Crystal P
authors.initials: CP
authors.lastname: Tyler
authors.forename: Sue C
authors.initials: SC
authors.lastname: Grady
authors.forename: Violanda
authors.initials: V
authors.lastname: Grigorescu
authors.forename: Barbara
authors.initials: B
authors.lastname: Luke
authors.forename: David
authors.initials: D
authors.lastname: Todem
authors.forename: Nigel
authors.initials: N
authors.lastname: Paneth
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003625:Data Collection; D005313:Fetal Death / Q000208:ethnology*; D046689:Fetal Mortality / Q000639:trends*; D054624:Health Status Disparities; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D019221:Mandatory Reporting; D012042:Registries; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*