Affiliations: Department of Pediatrics, Section of Neonatology,
Christiana Care Health Services, Newark, DE, USA | Department of Pediatrics, Thomas Jefferson University,
Philadelphia, PA, USA | Department of Pediatrics, duPont Hospital for
Children, Wilmington, DE, USA | Department of Pediatrics, University of Auckland,
Auckland, New Zealand
Note: [] Corresponding author: David A. Paul, MD, Section of Neonatology,
Christiana Hospital, MAP-Suite 217, 4745 Ogletown-Stanton RD, Newark, DE 19713,
USA. Tel.: +1 302 733 2410; Fax: +1 302 733 2602; E-mail:
[email protected]
Abstract: Objective: The aim of the study was to determine if states with high
infant mortality rates (IMR) have more live births of infants < 23 weeks
gestation than states with low IMR, and to determine if there are racial
differences in births < 23 weeks in low and high IMR states. Study Design: Data were assessed using United States linked
birth and death certificate data from 1997–2000. Ten states with the highest
IMR over the 4-year study period were compared to 10 states with the lowest
IMR. Statistical analysis was carried out by logistic regression. Results: After controlling for potential confounders, the odds
of death from a birth < 23 weeks gestation were significantly higher in
the states with the highest overall IMR. IMR was adjusted by removing live
births < 23 weeks. African American infants < 23 weeks in high IMR
states contributed to a greater percentage of IMR (25%) compared to African
American infants in low IMR states (20%), or Caucasian infants in high IMR
(15%), or low IMR (13%) states. Conclusions: States with high IMR are more likely to have live
births of infants < 23 weeks gestation, compared to those states with low
IMR. The contribution to the IMR from births < 23 weeks in high IMR states
is disproportionately from African American infants.
