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Did low birthweight among US blacks really increase?

R J David

    American Journal of Public Health
    |April 1, 1986
    PubMed
    Summary

    The rise in low birthweight (LBW) rates for non-White births from 1950-1967 was largely due to underreporting of LBW out-of-hospital births. Improved hospital delivery rates reduced this reporting bias.

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    Area of Science:

    • Public Health
    • Epidemiology
    • Sociology

    Background:

    • The United States observed a 32% increase in low birthweight (LBW) rates among non-White births between 1950 and 1967.
    • States with significant increases in LBW rates paradoxically showed improvements in risk factors like lower income and better maternal age and birth order.

    Purpose of the Study:

    • To investigate the reasons behind the apparent rise in non-White LBW rates from 1950 to 1967.
    • To determine the role of birth reporting accuracy in LBW rate trends.

    Main Methods:

    • Comparative analysis of states with rising LBW rates versus stable LBW rates.
    • Examination of birth reporting data, focusing on out-of-hospital births and LBW incidence.
    • Correlation analysis between hospital birth rates and LBW rates for non-White deliveries.

    Main Results:

    • Significant underreporting of LBW births occurred in non-White out-of-hospital deliveries in the 1950s (at least 9.7% unreported).
    • LBW underreporting was biased, disproportionately affecting out-of-hospital births that resulted in infant mortality.
    • A strong correlation (r = .98) was found between the increase in non-White hospital births and LBW rates.

    Conclusions:

    • The observed increase in non-White LBW rates was primarily an artifact of improved reporting, not a true rise in incidence.
    • The shift towards universal hospital delivery for non-White births in the late 1950s and 1960s effectively eliminated systematic LBW underreporting.

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