Plurality of Birth and Infant Mortality Due to External Causes in the United States, 2000-2010

Risk of death during the first year of life due to external causes, such as unintentional injury and homicide, may be higher among twins and higher-order multiples than among singletons in the United States. We used national birth cohort linked birth-infant death data (2000-2010) to evaluate the ris...

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Bibliographic Details
Published in:American journal of epidemiology 2017-03, Vol.185 (5), p.335-344
Main Authors: Ahrens, Katherine A, Thoma, Marie E, Rossen, Lauren M, Warner, Margaret, Simon, Alan E
Format: Article
Language:English
Subjects:
Adult
Birth Certificates
Cause of Death
Chi-Square Distribution
Cohort Studies
Death Certificates
Educational Status
Female
Gestational Age
Humans
Infant
Infant Mortality
Infant, Newborn
Male
Marital Status
Maternal Age
Middle Aged
Mothers - statistics & numerical data
Odds Ratio
Pregnancy
Pregnancy, Multiple - statistics & numerical data
Regression Analysis
United States - epidemiology
Young Adult
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Summary:Risk of death during the first year of life due to external causes, such as unintentional injury and homicide, may be higher among twins and higher-order multiples than among singletons in the United States. We used national birth cohort linked birth-infant death data (2000-2010) to evaluate the risk of infant mortality due to external causes in multiples versus singletons in the United States. Risk of death from external causes during the study period was 3.6 per 10,000 live births in singletons and 5.1 per 10,000 live births in multiples. Using log-binomial regression, the corresponding unadjusted risk ratio was 1.40 (95% confidence interval (CI): 1.30, 1.50). After adjustment for maternal age, marital status, race/ethnicity, and education, the risk ratio was 1.68 (95% CI: 1.56, 1.81). Infant deaths due to external causes were most likely to occur between 2 and 7 months of age. Applying inverse probability weighting and assuming a hypothetical intervention where no infants were low birth weight, the adjusted controlled direct effect of plurality on infant mortality due to external causes was 1.64 (95% CI: 1.39, 1.97). Twins and higher-order multiples were at greater risk of infant mortality due to external causes, particularly between 2 and 7 months of age, and this risk appeared to be mediated largely by factors other than low-birth-weight status.
ISSN:0002-9262
1476-6256
DOI:10.1093/aje/kww119