MORTALITY BY RACE AMONG LOW BIRTH WEIGHT INFANTS

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The primary goal of the proposed study is to examine the relationship between race and infant mortality in the context of a general model of risk factors for infant mortality. Data on births and deaths will be obtained from a 20 county region in North Carolina (Perinatal Care Region Two) for 1984-1987. The model will include demographic characteristics, medical and behavioral factors, and characteristics of the mother and infant previously found to be related to low birth weight and infant mortality. Analyses that focus specifically on low birth weight births also will include a risk factor defined as medical etiology that identifies the proximal processes and events judged directly responsible for a preterm birth, and incorporates them into a more detailed categorization of the traditional dichotomization of term vs. preterm birth. Detailed preliminary analyses will be conducted between race and medical etiology and the manner in which they related to infant mortality. Data on medical etiology will be obtained from records of hospitals in Perinatal Care Region Two, and from a small number of hospitals peripheral to the region where residents may go to give birth. These data will be merged with computerized information from the North Carolina vital statistics birth/fetal death and birth/infant death files, and with data from the prevention of prematurity program currently being conducted in Perinatal Care Region Two. Data from the prevention of prematurity program will provide an expanded set of risk factors generally not available in studies of risk for infant mortality. As the initial step in the development of multivariate models of risk for infant mortality, all risk factors hypothesized to impact on infant mortality will be identified as exogenous and intervening. Intervening variables will be further delineated in terms of their type and temporal proximity to the outcome variable. Multivariate analyses will examine the appropriateness of a single model of risk for infant mortality as opposed to separate models for specific subgroups of women. Analyses will be conducted separately for neonatal and postneonatal deaths.