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The effect of congenital anomalies on mortality risk in white and black infants
L H Malcoe1, G M Shaw, E J Lammer
1California Birth Defects Monitoring Program, Emeryville, USA. lorraine-malcoe@ouhsc.edu
Insights
Congenital anomalies significantly increase infant mortality for White and Black infants, contributing substantially to deaths, especially in normal birth weight neonates. This highlights a major public health issue requiring further attention.
Area of Science:
- Pediatric Health
- Public Health
- Genetics and Genomics
Background:
- Congenital anomalies are a significant concern in infant mortality.
- Previous estimates of anomaly contribution to infant death may be underestimated.
- Understanding racial disparities in anomaly impact is crucial.
Purpose of the Study:
- To investigate the impact of congenital anomalies on infant mortality across different racial groups (White and Black).
- To analyze how infant sex, birth weight, gestational age, and anomaly lethality modify this impact.
- To determine the overall contribution of anomalies to infant mortality.
Main Methods:
- Utilized California Birth Defects Monitoring Program data linked with birth-death records.
- Included 278,646 singleton non-Hispanic White and Black infants born between 1983-1986.
- Compared mortality rates of malformed infants versus non-malformed infants.
Main Results:
- Any congenital anomaly increased mortality 9.0-fold in Black infants and 17.8-fold in White infants.
- Even "non-lethal" anomalies elevated mortality significantly (up to 8.9-fold).
- Anomalies accounted for 33% of White and 19% of Black infant deaths, over 60% in neonates >1499g.
Conclusions:
- Congenital anomalies represent a substantial public health problem for both White and Black infants.
- The impact on mortality is significantly higher than previously estimated, particularly for normal birth weight infants.
- Findings underscore the need for improved interventions and public health strategies.
Objectives:
This population-based study examined the effect of all major congenital anomalies on the mortality of White and Black infants by infant sex, birthweight, gestational age, and lethality of the anomaly. The study also determined the total contribution of anomalies to infant mortality.
Methods:
California Birth Defects Monitoring Program data were merged with linked birth-death files for 278,646 singleton non-Hispanic White and Black infants born in 1983 through 1986. Malformed infants were compared with nonmalformed infants to determine the effect of anomalies on mortality.
Results:
The presence of any congenital anomaly increased mortality 9.0-fold (95% CI = 7.3, 11.1) for Black infants and 17.8-fold (95% CI = 16.2, 19.6) for White infants. Even "non-lethal" anomalies increased mortality up to 8.9-fold. Overall, anomalies contributed to 33% of White infant deaths, to 19% of Black infant deaths, and to over 60% of deaths among Black and White neonates weighing over 1499 g.
Conclusions:
The contribution of congenital anomalies to mortality of both low- (< 2500 g) and normal-birth-weight infants is substantially higher than previously estimated, representing a large public health problem for both Black and White infants.