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Risk of low birth weight infants among black and white parents
N A Hessol1, E Fuentes-Afflick, P Bacchetti
1Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, Epidemiology and Biostatistics, University of California San Francisco, 94122, USA. nancyh@itsa.ucsf.edu
Insights
Racial disparities in low birth weight infants are partially explained by demographic, behavioral, medical, and socioeconomic factors. However, a residual risk remains for Black parents, indicating other contributing elements to infant health outcomes.
Area of Science:
- Public Health
- Epidemiology
- Sociology
Background:
- Racial disparities in infant birth weight are a significant public health concern.
- Previous research suggests various demographic, behavioral, medical, and socioeconomic factors contribute to these disparities.
Purpose of the Study:
- To investigate the extent to which demographic, behavioral, medical, and socioeconomic factors explain racial differences in the risk of low birth weight infants between Black and White parents.
- To examine the specific contributions of maternal, paternal, infant, and community characteristics to these disparities.
Main Methods:
- Analysis of 203,815 singleton births from the 1992 California birth certificate data.
- Inclusion of maternal (race, age, education, marital status, parity, obstetric history, tobacco use, medical complications, insurance, prenatal care), paternal (race, age, education), infant (gestational age, gender), and community (median household income) variables.
- Statistical analysis to determine the odds ratios for very low birth weight (500-1499 g) and moderately low birth weight (1500-2499 g) infants.
Main Results:
- Unadjusted analysis showed a risk gradient for low birth weight infants, highest for Black mother/Black father pairs and lowest for White mother/White father pairs.
- After adjusting for covariates, the odds ratio for Black mother/Black father parents decreased but remained elevated for both very low and moderately low birth weight infants.
- Interracial parent groups and White mother/Black father pairs no longer showed an elevated risk for very low birth weight infants compared to White parents.
Conclusions:
- Most of the increased risk of low birth weight infants associated with Black parental race is explained by the examined parental, infant, and community factors.
- A residual, unexplained elevated risk persists for Black mother/Black father parent pairs, suggesting other factors may be involved.
- The findings highlight the complex interplay of factors influencing infant birth weight and racial disparities.
Objective:
To determine whether racial differences in risk of low birth weight infants among black and white parents can be attributed to differences in demographic, behavioral, medical, and socioeconomic factors.
Methods:
We analyzed 203,815 singleton births from the 1992 California birth certificate data set for the risk of very low birth weight (500-1499 g) and moderately low birth weight (1500-2499 g) infants. Additional study variables included maternal (race, age, education, marital status, parity, obstetric history, tobacco use, medical complications, medical insurance, and use of prenatal care), paternal (race, age, and education), infant (gestational age and gender), and community (median household income from the 1990 US Census) characteristics.
Results:
For both very low and moderately low birth weight infants, the unadjusted risk associated with parental race showed a gradient of risk, from highest to lowest, for black mother/black father, black mother/white father, white mother/black father, and white mother/white father parents. After adjusting for other risk factors, the odds ratio associated with black mother/black father parents was reduced from 3.37 to 1.73 for very low birth weight infants and from 2.51 to 1.60 for moderately low birth weight infants, but both remained elevated. Interracial parents no longer had an elevated risk of very low birth weight infants and white mother/black father parents no longer had an elevated risk of moderately low birth weight, compared with white parents.
Conclusion:
After controlling for parental, infant, and community factors, most but not all of the increased risk of low birth weight infants associated with black parental race was explained.