Maternal Race and Ethnicity and Mortality Differences Among Infants with Birth Defects: A Statewide Cohort Analysis in Texas.

Abstract

To understand better the differences in post-neonatal mortality (PNM) among infants with isolated birth defects by Hispanic and non-Hispanic (NH) Black vs NH White maternal race and ethnicity in Texas. We analyzed cases with isolated birth defects in the Texas Birth Defects Registry born during 1999-2017. The association between maternal race and ethnicity and PNM (death during day 28-364) was assessed using Cox regression. Analyses were stratified across education levels and repeated among other subgroups (eg, those age ≥25). To understand if associations persisted after accounting for gestational age and sixteen other covariates, we also adjusted for these variables. A total of 1.4% of infants with isolated birth defects born to NH Black women died vs 0.7% born to NH White women (hazard ratio: 1.94, 95% CI: 1.69-2.23). Adjustment for gestational age, birth weight, and 15 other maternal/infant covariates attenuated but did not completely nullify the association. The magnitude of this association was similar across education levels and was particularly high among the subgroup of full-term, singleton infants with normal birthweight born to women age ≥25, with > high school education, and with private insurance (hazard ratio: 3.37, 95% CI: 1.83-6.19). Few significant differences in PNM between those born to Hispanic vs NH White women were observed. NH-Black-White differences in PNM among infants with birth defects likely result from socioeconomic, contextual, psychosocial, health, and other disadvantages. A better understanding of the complex underlying basis for these differences could help inform interventions to reduce them.