American journal of preventive medicine
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Comparative Study
Confronting racial disparities in infant mortality: reconciling science and politics.
The public debate surrounding disparities in infant mortality has resulted from a profound failure to seek a common wisdom. Because of its essential social roots, infant mortality will always remain the province of fundamental ideological and political conflict. However, without a more integrated analytic approach, progress in reducing disparate infant mortality will remain limited by internecine struggles for disciplinary purview and false claims of societal relevance. For in the end, the struggle to address disparate infant mortality will be advanced best by integrated technical and political strategies that recognize that the pursuits of efficacy and justice are inextricably linked.
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We suggest an explanation for a pediatric paradox: the low-birthweight-specific (LBW) neonatal mortality rate (NMR) for black infants is less than the NMR for white infants, even though the overall NMR for black infants is about twice the overall NMR for white infants. Analyzing the Delivery Interview Program data set--a large matrix of information collected at the Boston Hospital for Women (now the Brigham and Women's Hospital)--we found that, overall, black infants' gestations are about four days shorter than white infants'. However, after stratifying by birthweight, we found a reversal in our data, namely, LBW (< 2,500 g) black infants' gestations are seven days longer than the gestations of LBW white infants. We believe that this increased chronological maturity may account for some of the survival advantage of the LBW black infant compared with the LBW white infant of the same weight.