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Published on: January 12, 2018
Racial/ethnic differences in survival of United States children with birth defects: a population-based study
Ying Wang1, Gang Liu2, Mark A Canfield3
1Division of Data Analysis and Research, Office of Primary Care and Health System Management, New York State Department of Health, Albany, NY.
Insights
Children with major birth defects born to non-Hispanic black and Hispanic mothers face higher mortality risks into childhood. These survival disparities highlight the need for targeted policy and service planning for diverse populations.
Area of Science:
- Pediatric Health
- Public Health
- Genetics and Genomics
Background:
- Birth defects are a significant cause of infant mortality.
- Racial and ethnic disparities in healthcare access and outcomes are well-documented.
- Limited data exists on racial/ethnic-specific survival rates for major birth defects in the United States.
Purpose of the Study:
- To investigate racial/ethnic-specific survival probabilities for children diagnosed with major birth defects in the US.
- To identify specific birth defects and racial/ethnic groups with differential mortality risks.
Main Methods:
- Pooled data from 12 population-based birth defects surveillance programs (1999-2007).
- Included live births with any of 21 major birth defects.
- Utilized Kaplan-Meier survival analysis and Cox proportional hazards models to assess mortality risk.
Main Results:
- Neonatal survival showed minor differences across racial/ethnic groups for most defects.
- Postneonatal infant mortality risk was significantly higher for infants born to non-Hispanic black and Hispanic mothers for numerous defects.
- Childhood mortality risk varied, with increased risk for some defects in infants born to Asian/Pacific Islander and American Indian/Alaska Native mothers, and decreased risk for others.
Conclusions:
- Children with birth defects born to non-Hispanic black and Hispanic mothers experience elevated mortality risks extending into childhood.
- Congenital heart defects, in particular, are associated with increased mortality risk for these groups.
- Understanding these survival differences is crucial for informing policy and improving service planning for equitable care.
Objectives:
To examine racial/ethnic-specific survival of children with major birth defects in the US.
Study Design:
We pooled data on live births delivered during 1999-2007 with any of 21 birth defects from 12 population-based birth defects surveillance programs. We used the Kaplan-Meier method to calculate cumulative survival probabilities and Cox proportional hazards models to estimate mortality risk.
Results:
For most birth defects, there were small-to-moderate differences in neonatal (<28 days) survival among racial/ethnic groups. However, compared with children born to non-Hispanic white mothers, postneonatal infant (28 days to <1 year) mortality risk was significantly greater among children born to non-Hispanic black mothers for 13 of 21 defects (hazard ratios [HRs] 1.3-2.8) and among children born to Hispanic mothers for 10 of 21 defects (HRs 1.3-1.7). Compared with children born to non-Hispanic white mothers, a significantly increased childhood (≤ 8 years) mortality risk was found among children born to Asian/Pacific Islander mothers for encephalocele (HR 2.6), tetralogy of Fallot, and atrioventricular septal defect (HRs 1.6-1.8) and among children born to American Indian/Alaska Native mothers for encephalocele (HR 2.8), whereas a significantly decreased childhood mortality risk was found among children born to Asian/Pacific Islander mothers for cleft lip with or without cleft palate (HR 0.6).
Conclusion:
Children with birth defects born to non-Hispanic black and Hispanic mothers carry a greater risk of mortality well into childhood, especially children with congenital heart defect. Understanding survival differences among racial/ethnic groups provides important information for policy development and service planning.
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