Malcoe L H, Shaw G M, Lammer E J, Herman A A
California Birth Defects Monitoring Program, Emeryville, USA.
Am J Public Health. 1999 Jun;89(6):887-92. doi: 10.2105/ajph.89.6.887.
This population-based study examined the effect of all major congenital anomalies on the mortality of White and Black infants by infant sex, birthweight, gestational age, and lethality of the anomaly. The study also determined the total contribution of anomalies to infant mortality.
California Birth Defects Monitoring Program data were merged with linked birth-death files for 278,646 singleton non-Hispanic White and Black infants born in 1983 through 1986. Malformed infants were compared with nonmalformed infants to determine the effect of anomalies on mortality.
The presence of any congenital anomaly increased mortality 9.0-fold (95% CI = 7.3, 11.1) for Black infants and 17.8-fold (95% CI = 16.2, 19.6) for White infants. Even "non-lethal" anomalies increased mortality up to 8.9-fold. Overall, anomalies contributed to 33% of White infant deaths, to 19% of Black infant deaths, and to over 60% of deaths among Black and White neonates weighing over 1499 g.
The contribution of congenital anomalies to mortality of both low- (< 2500 g) and normal-birth-weight infants is substantially higher than previously estimated, representing a large public health problem for both Black and White infants.
这项基于人群的研究考察了所有主要先天性异常对白人及黑人婴儿死亡率的影响，分析了婴儿性别、出生体重、胎龄以及异常的致死性与死亡率之间的关系。该研究还确定了异常对婴儿死亡率的总体影响。
将加利福尼亚出生缺陷监测项目的数据与1983年至1986年出生的278,646名单胎非西班牙裔白人和黑人婴儿的出生-死亡关联档案进行合并。将畸形婴儿与非畸形婴儿进行比较，以确定异常对死亡率的影响。
任何先天性异常的存在使黑人婴儿死亡率增加9.0倍（95%置信区间=7.3, 11.1），白人婴儿死亡率增加17.8倍（95%置信区间=16.2, 19.6）。即使是“非致死性”异常也会使死亡率增加高达8.9倍。总体而言，异常导致白人婴儿死亡的比例为33%，黑人婴儿死亡的比例为19%，在体重超过1499克的黑人和白人新生儿死亡中，异常导致的死亡比例超过60%。
先天性异常对低体重（<2500克）和正常出生体重婴儿死亡率的影响大大高于先前的估计，这对黑人和白人婴儿来说都是一个重大的公共卫生问题。
