A Birth Weight by Gestational Age View of the Pediatric Paradox

Timothy B. Gage, University at Albany, State University of New York
Fu Fang, University at Albany, State University of New York
Howard Stratton, University at Albany, State University of New York

The pediatric paradox, lower African American infant mortality at low birth weights, is traditionally viewed from the marginal distribution of birth weight. Similar findings have not been reported based on the marginal distribution of gestational age. This paper examines the pediatric paradox in terms of birth weight by gestational age, using covariate density defined mixtures of logistic regressions, fitted to New York State birth cohorts 1985-88. The results indicate that the pediatric paradox is isolated in a subpopulation of births accounting for less then 20% of the total birth cohort. The phenomenon is not limited to low birth weight births as is usually reported. It also occurs at normal birth weights with low gestational ages. Finally, the results are consistent with the hypotheses that higher fetal losses may be responsible for the pediatric paradox and African American/European American infant mortality differentials are underestimated.