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Examining the Epidemiologic Paradox

Elena Fuentes-Afflick, MD, MPH; Peter Lurie, MD, MPH

Arch Pediatr Adolesc Med. 1997;151(7):665-674.

Abstract
Objective
To assess the relation between Latino ethnicity, Latino subgroup, and low birth weight (LBW).

Data Sources
From the MEDLINE computer database, we used the key words birth weight; infant, LBW; Latinos; Hispanic Americans; Cuban Americans; Mexican Americans; and Puerto Ricans to identify studies that analyzed LBW in Latinos.

Study Selection
Thirty-two studies, published from 1982 to 1996, that analyzed US Latinos and whites or multiple Latino subgroups, that used the revised definition of LBW (<2500 g), and had a large sample size (> 10 000) were selected.

Data Extraction
Two reviewers extracted LBW rates and data on the relation between Institute of Medicine risk factors and LBW by maternal ethnicity and Latino subgroup.

Data Synthesis
Low-birth-weight rates were similar for Latino (median, 6.2%) and white infants (median, 5.8%). By Latino subgroup, LBW rates were similar for Central/South American, Cuban, Mexican, and white infants. Puerto Rican infants had consistently higher LBW rates (median, 9.1%). Two risk factors—maternal birth-place and gestational weight gain—were identified as confounders of the relation between Latino ethnicity, Latino subgroup, and LBW.

Conclusions
Low-birth-weight rates of Latinos and whites are similar, consistent with the "epidemiologic paradox" of unexpectedly favorable perinatal outcomes for Latinos. However, this paradoxical relation for all Latinos masks the notably elevated LBW risk among Puerto Ricans. Further study of LBW among Latinos, including cultural factors, is needed.

Arch Pediatr Adolesc Med. 1997;151:665-674

Author Affiliations
From the Department of Pediatrics (Dr Fuentes-Afflick), Medical Effectiveness Research Center for Diverse Populations (Dr Fuentes-Afflick), the Department of Epidemiology and Biostatistics (Drs Fuentes-Afflick and Lurie), Institute for Health Policy Studies (Drs Fuentes-Afflick and Lurie), and the Department of Family and Community Medicine (Dr Lurie), School of Medicine, University of California, San Francisco.

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