528: Prevalence of hepatitis B infection by test for HBsAg and HBV DNA during pregnancy and risk of perinatal vertical transmission: a multicenter, prospective study

OBJECTIVE: 1) To examine trends in black-white disparities in infant deaths due to congenital anomalies in the United States, and 2) To explore whether state funding of pregnancy termination for women on Medicaid is associated with rates of infant death due to anomalies. STUDY DESIGN: We used US vital statistics records from 1983-2004. Data on state funding of pregnancy termination under Medicaid was obtained from the Guttmacher Institute. Poisson regression was used to examine rates of infant death due to congenital anomalies by race and year, adjusting for maternal age. Trends in racial disparities were examined by including an interaction term between year and race, then calculating adjusted risk differences (RD) and rate ratios (IRR) at various years. The association between state Medicaid coverage of pregnancy termination for fetal indications and mortality rates in recent years (2001-2004) was examined using a Poisson model. RESULTS: Infant deaths due to anomalies decreased by 3% per year between 1983 and 2004, from 257 to 136 per 100,000 live births. During this time, the gap between blacks and whites widened steadily (Figure). In 1983, the adjusted RD was 20.5 per 100,000 (95% CI [13.8, 27.2], IRR1⁄41.08 [1.06, 1.11]); by 2004, this had grown to 36.2 per 100,000 ([31.5, 40.9], IRR1⁄41.27 [1.24, 1.31]). Black women were more likely to live in states without Medicaid coverage of pregnancy termination (68 vs 59%) and these states had higher rates of infant death due to anomalies (22.0/100,000 higher [15.4, 28.5], IRR1⁄41.19 [1.16, 1.23]). CONCLUSION: Infant deaths due to anomalies are more common among blacks than whites, and this disparity has increased steadily over time. Rates are higher when pregnancy termination for fetal indications is not covered under Medicaid. There is a need to better understand whether differences in access to, or uptake of, pregnancy termination of anomalous fetuses has contributed to the growing black-white gap in infant deaths due to anomalies.