Race/Ethnicity, Apgar and Infant Mortality

PLOS Medicine

Background Apgar scores measure newborn health and are strongly associated with infant outcomes, but their performance has largely been determined in primarily white populations. Given the majority of the global population is not white, we aim to assess whether the association between low Apgar score and mortality in infants varies across racial groups. Methods and findings Population-based cohort study using 2016 to 2017 United States National Vital Statistics System data. The study included singleton infants born between 37+0 and 44+6 weeks to mothers over 15 years, without congenital abnormalities. We looked at 3 different mortality outcomes: (1) early neonatal mortality; (2) overall neonatal mortality; and (3) infant mortality. We used logistic regression to assess the association between Apgar score (categorized as low, intermediate, and normal) and each mortality outcome, and adjusted for gestational age, sex, maternal BMI, education, age, previous number of live births, and s...

The Lancet, 2014

Enlighten -Research publications by members of the University of Glasgow Apgar score and the risk of cause specific infant mortality: a population based cohort study of 1,029,207 livebirths

Journal of Perinatology, 2008

Objective: The purpose of this study was to examine ethnic differences among non-Hispanic black and white births in the distribution of maternal risk factors of infant mortality across specific causes of death. Study Design: The data were obtained from the North Carolina linked birth/infant death files (1989 to 1997). Logistic regression models were built to assess the risk distribution of demographic, behavioral and health related variables in relation to causes of infant death, which included congenital anomalies, short gestation/low birth weight (LBW), sudden infant death syndrome, infections and obstetric conditions. Result: Infants born to black women had the highest rates for all causes of mortality compared to those born to white women. Having at least one prior live birth now dead was associated with congenital anomalies, obstetric conditions and short gestation/LBW related deaths in both ethnic groups. Deaths caused by infections were more likely to occur among white young (<20) women. White women enrolled in Medicaid had an increased risk of infant deaths due to short gestation/LBW when compared to those with no Medicaid, while young black mothers (<20 years old) were less likely to experience an infant death due to short gestation/LBW and obstetric conditions. Conclusion: This study provides evidence that maternal sociodemographic risk factors somewhat vary by infant cause of death and ethnicity. This suggests that race-specific approaches may be necessary to reduce infant mortality rates. The differences, however, in the risk distribution of factors across the two ethnic groups were limited indicating that the heterogeneity in the mortality rates may be due to unmeasured factors.

American Journal of Perinatology, 2012

In the United States, racial/ethnic disparities in infant mortality have persisted over the past decades. 1 In 1997, the mortality rate within the first year was 13.7 per 1,000 live births among blacks-an estimate that was more than two times higher than for whites (6.0 per 1,000). 2 Even a decade later, this disparity still persisted (in 2007, the corresponding mortality rates were 13.3 and 5.6, respectively). 3 The disproportionate rate persists not only between non-Hispanic whites and blacks, but also among American Indians, Hispanic, Asians, or Pacific Islanders and interracial couples. 2,3 Even after adjustment for maternal sociodemographic factors (age, education, income, marital status), behavioral factors (maternal smoking, substance use, unintended pregnancy), and social factors (access to and quality of health care, delayed entry or no prenatal care, negative perception of health care providers, racism, stress,), racial/ethnic disparities in infant Keywords ► infant mortality ► racial disparities ► gestational age ► high-risk pregnancy

Population Research and Policy Review, 2010

Recent studies have proposed alternative birth outcome measures as means of assessing infant mortality risk; nevertheless, there hasn't yet been an integrated analysis of these approaches. We review 14 strategies, including various combinations of birth weight, gestational age, fetal growth rate, and Apgar scoresas predictors of early neonatal, late neonatal, and postneonatal mortality, and infant mortality. Using the NCHS linked birth/infant death file for 2001, we construct multivariate logit models and assess the associations between each of the 14 key birth outcome measures and four mortality outcomes. We find that all evaluated birth outcome measures are strong predictors, but Apgar scores are the strongest among all models for all outcomes, independent of birth weight and gestational age. Apgar scores' predictive power is stronger for Mexican-, white-, and female-infants than for black-and male-infants. Second, all birth outcome measures remain significantly associated with mortality, but their predictive power reduces drastically over time. These findings suggest a rule of thumb for predicting infant mortality odds: when available, Apgar scores should always be included along with birth weight (or LBW status) and gestational age. Additionally, these findings argue for the continued study of low birthweight, gestational age, and Apgar scores as independently salient health outcomes.

Journal of Public Health Management and Practice, 2001

In the United States, racial/ethnic disparities in infant mortality have persisted over the past decades. 1 In 1997, the mortality rate within the first year was 13.7 per 1,000 live births among blacks-an estimate that was more than two times higher than for whites (6.0 per 1,000). 2 Even a decade later, this disparity still persisted (in 2007, the corresponding mortality rates were 13.3 and 5.6, respectively). 3 The disproportionate rate persists not only between non-Hispanic whites and blacks, but also among American Indians, Hispanic, Asians, or Pacific Islanders and interracial couples. 2,3 Even after adjustment for maternal sociodemographic factors (age, education, income, marital status), behavioral factors (maternal smoking, substance use, unintended pregnancy), and social factors (access to and quality of health care, delayed entry or no prenatal care, negative perception of health care providers, racism, stress,), racial/ethnic disparities in infant Keywords ► infant mortality ► racial disparities ► gestational age ► high-risk pregnancy

Journal of Paediatrics and Child Health, 2008

In epidemiological studies on children, information in the neonatal period that might affect children&amp;amp;amp;amp;amp;#39;s long-term health could be extracted from the personal child health record (PCHR), because the booklet exists in most countries. We aimed to assess, in individual children, the validity of Apgar scores reported in the PCHR using maternity medical records as the gold standard. In two French hospitals, 435 women who had a child in January 2006 were recruited and 90% filled in a postal questionnaire 6 weeks after delivery, copying neonatal information (including Apgar scores) from the PCHR. This information was compared with data independently recorded at birth by physicians in maternity medical records. We found that the proportion of missing Apgar scores in the PCHR was higher when scores in the medical records were lower. Moreover, Apgar scores reported in the PCHR were overestimated when scores in the medical records were low. Using medical records as the gold standard, specificity for PCHR-reported 1-min Apgar score was 100% and sensitivity 33%. Similar trends were found for the 5-min score. This supports the hypothesis that information considered as &amp;amp;amp;amp;amp;#39;socially sensitive&amp;amp;amp;amp;amp;#39; by physicians may be intentionally altered in PCHRs. Apgar scores reported in PCHRs may not yield reliable information for epidemiological studies. When the PCHR is the only source of information for the neonatal period in an epidemiological study, it would be preferable to use a composite neonatal indicator rather than the Apgar score.

Demography, 1998

Frisbie, Forbes, and Pullum (1996) show that it is meaningful to account for low birth weight, preterm delivery, and intrauterine growth-retardation when analyzing differences in compromised birth outcomes and infant mortality among racial and ethnic groups. I compare their findings for the 1987 U.S. birth cohort with findings for the 1988 U.S. birth cohort, using linked birth and infant death vital statistics from the National Center for Health Statistics. I focus on their calculation of fetal growth curves, which are highly at odds with the curves commonly used in the obstetric and pediatric literature. I compare birth outcome distributions and infant death probabilities using Frisbie et al. &#39;s method and other standards. I conclude that Frisbie et al. &#39;s method is not suited for the study of intrauterine growth-retardation at the population level because of the major flaws in gestational age measurement that exist in the type of data they use. An appropriate alternative i...

Paediatric and Perinatal Epidemiology, 1993

which primarily serves a low-income population. The data were obtained from the obstetric discharge records for 1985-89. In this case-control study, 939 newborns with Apgar scores of less than 7 were compared with 2817 new-borns with Apgar scores of 7 or higher. Low birthweight (< 2500 g) and short gestational age (< 37weeks) weie each significantly associated with low Apgar scores. Race was not a significant risk factor for Iow Apgar scores in this low socioeconomic population. It is also demonstrated that maternal risk factors (pregnancy-induced hypertension, prolonged rupture of membranes), method of delivery (caesarean, repeat caesarean, vaginal birth after caesarean section) and male sex were significantly associated with Apgar scores of less than 7. As a result of the risks that were found to be associated with method of delivery, further study of the risks associated with caesarean delivery and of the relative advantage of a caesarean delivery versus vaginal delivery after a previous caesarean section is advocated.

In the United States, advances in healthcare delivery and technology have significantly reduced the risk of mortality for critically ill newborns. Despite this reduction, infant mortality differentials between African Americans and non-Hispanic whites, particularly with respect to absolute and disparate infant mortality rates still exist. Infant mortality has been described in the literature as a synoptic indicator of the health and social condition of a population. Although specific risk factors may change over time, the fundamental social causes underlying risk remain constant. The relation of causality to intervention is often oversimplified. Public health interventions often involve changing a wide range of “health behaviors” such as urging people to eat right or stop smoking. However, modification of “health behaviors” is a quick fix that does not address the underlying and prevailing root causes at the source of the problem. Intervening risk factors or proximal causes are focused upon as prominent variables in the causal chain while the more distal or social causes are often neglected. Socio-economic status (SES) is typically thought of as a confounder rather than a risk factor, yet an overwhelming body of evidence suggests that this is not the case. Traditional risk factors do not completely explain racial differences in neonatal outcome. This paper examines the influence of the social conditions that persist despite progress in reducing infant mortality and changes in individual-level risk factors that determine infant mortality. Economic, structural, and social variables that can be modified are discussed.