Historically, the overall risk of infant mortality in the United States has declined. However, the rate of decline has slowed over the last 20 years and racial and ethnic disparities have increased. Consequently, infant mortality remains a serious public health problem. Moreover, the cause of the racial and ethnic differentials has remained elusive. The objective of this proposal is to develop the methodological tools necessary to better understand the factors, biological, environmental, economic and social that influence infant mortality and racial and ethnic disparities in infant mortality. It is our view that effective theoretical tools, such as the proximate determinants model of infant and childhood mortality, are available, but that the statistical tools to fully operationalize these models are not available. Ideally, these statistical tools should be able to accommodate direct and indirect (through the proximate determinants) effects, allow for non-linear effects, appropriately parameterize the proximate determinants (the most important of which are birthweight and gestational age), and accommodate unobservable heterogeneity in the birth cohort. Our preliminary work indicates that a combination of mixture models and logistic regression can achieve all of these ends. To date we have developed and tested mixture models of birthweight and gestational age (with and without covariate structures), and modeled the relationship of both birthweight and gestational age with mortality. We will extend these results here to test alternative parameterizations of the mixture model and develop multivariate mixture models that combine birthweight and gestational age with mortality. We plan to conduct a power analysis to determine the optimum sample sizes necessary for operationalizing the proximate determinants model of infant mortality. The result will be a well-documented statistical method that fully operationalizes the proximate determinants model of infant and childhood mortality. This will be invaluable for testing theories concerning the causes of the decelerating decline of infant mortality, as well as, the increases in racial and ethnic differentials in infant mortality. Finally, we will conduct an illustrative analysis using this model to evaluate the effects of maternal age and parity on infant mortality including the direct and the indirect effects of maternal age and parity through the proximate determinants of birthweight and gestational age.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
1R01HD037405-01A1
Application #
6095890
Study Section
Special Emphasis Panel (ZRG1-SNEM-3 (01))
Program Officer
Evans, V Jeffery
Project Start
2000-04-01
Project End
2003-03-31
Budget Start
2000-04-01
Budget End
2001-03-31
Support Year
1
Fiscal Year
2000
Total Cost
$94,693
Indirect Cost
Name
State University of New York at Albany
Department
Social Sciences
Type
Schools of Arts and Sciences
DUNS #
City
Albany
State
NY
Country
United States
Zip Code
12222
Gage, Timothy B; Lee, Furrina F; O'Neill, Erin K et al. (2016) Heterogeneity identified at birth and blood pressure in adulthood. Am J Hum Biol 28:545-54
Gage, Timothy B; Fang, Fu; O'Neill, Erin et al. (2013) Maternal education, birth weight, and infant mortality in the United States. Demography 50:615-35
Gage, Timothy B; Fang, Fu; O'Neill, Erin K et al. (2010) Racial disparities in infant mortality: what has birth weight got to do with it and how large is it? BMC Pregnancy Childbirth 10:86
Gage, Timothy B; DeWitte, Sharon (2009) What do we know about the agricultural demographic transition? Curr Anthropol 50:649-55
Gage, Timothy B; Fang, Fu; O'Neill, Erin et al. (2009) Maternal age and infant mortality: a test of the Wilcox-Russell hypothesis. Am J Epidemiol 169:294-303
Gage, Timothy B; Fang, Fu; Stratton, Howard (2008) Modeling the pediatric paradox: birth weight by gestational age. Biodemography Soc Biol 54:95-112
Fang, Fu; Stratton, Howard; Gage, Timothy B (2007) Multiple mortality optima due to heterogeneity in the birth cohort: a continuous model of birth weight by gestational age-specific infant mortality. Am J Hum Biol 19:475-86
Gage, Timothy B; Bauer, Michael J; Heffner, Nathan et al. (2004) Pediatric paradox: heterogeneity in the birth cohort. Hum Biol 76:327-42
Gage, T B (2003) Classification of births by birth weight and gestational age: an application of multivariate mixture models. Ann Hum Biol 30:589-604
Gage, Timothy B (2003) The evolution of human phenotypic plasticity: age and nutritional status at maturity. Hum Biol 75:521-37

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