Infant mortality among twins born to teenagers in the United States - Black-white disparity

OBJECTIVE: To determine the magnitude of the disparity in infant mortality between twins born to black and white teenagers in the United States. STUDY DESIGN: Analysis was performed on twins born to adolescents in the United States within the period 1995-1997. The generalized estimating equations framework was used to generate relative risks after capturing the effects of sibling correlations within twin pairs. RESULTS: Infant mortality was 20% higher among black twins as compared to their white counterparts (adjusted OR = 1.20, 95% CI = 1.04-1.39). The black-white disparity in infant mortality occurred exclusively in the neonatal period (adjusted OR = 1.31, 95% CI = 1.11-1.54), with postneonatal estimates comparable (adjusted OR = 0.86, 95% CI = .63-1.17). The higher proportion of low-birth-weight infants-more specifically, those small for gestational age as opposed to preterm among black twins was the most likely explanation for the lower survival probability among twins born to black teenagers. CONCLUSION. Black-white disparity in infant mortality among twins occurred exclusively during the first 28 days of life rather than throughout infancy. Efforts to bridge the gap should be focused on this critical period and should preferentially target those twins who are small for gestational age. (J Reprod Med 2003;48:257267)