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Heterogeneity and the Pediatric Paradox
Comparisons
of birth-weight-specific infant mortality indicate that low-birth-weight
African American infants have lower mortality than low-birth-weight European
American infants despite higher infant mortality overall-the ''pediatric
paradox.'' One explanation is heterogeneity in birth weight. Analyses of African
American and European American births suggest that birth cohorts consist of two
heterogeneous subpopulations. One appears to account for normal births, whereas
the other may consist of compromised births. Estimates of infant mortality
indicate that the compromised subpopulation has higher overall mortality but
lower birth-weight-specific mortality. We attribute lower birth-weight-specific
infant mortality in the compromised subpopulation to higher rates of fetal
loss. Compared to European American birth cohorts, African American birth
cohorts have (1) higher birth-weight-specific mortality in the normal
subpopulation, (2) larger compromised subpopulations, and (3) lower
birth-weight-specific mortality in the compromised subpopulation. Consequently,
the pediatric paradox is attributable to greater rates of compromised
pregnancies and higher fetal losses among African Americans.
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