A total of304,466 twins were recorded in the database. Among them, 13,971 were excluded because of other races, 41,115 were excluded because of missing information on race, and 159 were excluded because of missing death data, leaving 249,221 twins for our analysis. Among the 249,221 eligible twins, 213,165 (85.5%) were W-W group, 30667 (12.3%) the B-B group, 3,955 (1.6%) the FB-MW group, and 1,434 (0.6%) the FW-MB group.Table 1 describes the distribution of maternal and infant characteristics among the four study groups. The proportions of teenage, inadequate perinatal care service, FGR, preterm births, and VLBW were higher, and maternal education level were lower in the FB-MW, FW-MB, and B-B groups than in the W-W group (Table 1). The proportion of cigarette smoking during pregnancy was significantly higher in the FB-MW group than other groups (Table 1).

Table 1. The Distribution of Basic Characteristics among the Four Study Groups (%)

W-W

B-B

FW-MB

FB-MW
(n=213,276)

(n=30,70?)

(n=1,435)

(n=3,?60)
Maternal Age
<20 years

4.5

9.8

10.9

12.6
20 years

75.6

78.2

74.3

75.8
35 years

19.9

12.0

14.8

11.6
Paternal Age
<20 years

1.9

4.7

5.1

5.7
20 years

66.3

71.0

71.9

71.5
35 years

31.8

24.3

23.0

22.8
Maternal Education
<12 years

12.9

15.7

14.4

22.0
12 years

28.7

38.4

32.3

40.6
13-15 years

23.4

28.5

31.6

22.8
>16 years

35.0

17.4

21.7

14.6
Maternal Smoking
Yes

10.8

8.0

8.9

20.6
No

89.2

92.0

91.1

79.4
Perinatal Care
Adequate

81.2

68.6

73.4

71.5
Intermediate

16.5

26.1

23.1

24.0
Inadequate

2.4

5.3

3.4

4.5
Fetal Sex
Male

50.3

49.7

49.8

51.4
Female

49.7

50.3

50.2

48.6
1 Score
<10th percentiles

8.8

12.3

11.5

11.1
10th-90th percentiles

80.6

79.0

79.7

79.0
>90th percentiles

10.7

8.7

8.8

9.9
Gestation Weeks
20-27 weeks 4.3

8.7

8.2

6.1
28-31 weeks 6.2

9.0

6.9

6.9
>32 weeks

89.5

82.3

84.9

87.0
Birthweight
<l,500g 8.2

13.8

12.9

10.7
1,500-2,499 9

42.2

47.9

46.9

44.7
>2,500 g

49.5

38.3

40.3

44.6

Figure 1. The Mortality Rate among Four Study Groups

Figure 1. The Mortality Rate among Four Study Groups

Table 2 compares fetal and infant mortality rate among the four study groups. The fetal and infant mortality rates were the highest in the B-B group (21.79%o, 43.68%), FB-MW group (18.69%>, 35.77%o) were the next, FW-MB group (13.94%o, 33.22%o) were the third, and the W-W group (15.98%o, 24.25%o) were the lowest (Table 2 and Figure 1). Exceptions did occur, however. In particular, fetal death rate in the FW-MB group was actually slightly lower than the W-W group, and the late neonatal death rate was the highest in the FW-MB group (Table 2 and Figure 1).
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Table 2. Comparison of Fetal and Infant Mortality among Four Study Groups (%o)

W-W

(n=213,165)

B-B (n=30,667)

FW-MB (n=1,434) FB-MW (n=3,955)
Early fetal deathRate RR

95% CI of RR

8.68 1.00 13.45 1.56 1.40-1.73 6.97 0.80 0.43-1.50 9.34 1.08 0.78-1.49
Late fetal deathRate RR

95% CI of RR

7.37 1.00

8.45 1.15 1.01-1.31

7.02 0.95 0.51-1.78 9.43 1.28 0.92-1.78
Fetal death (subtotal)Rate RR

95% CI of RR

15.98 1.00

21.79 1.37 1.26-1.49

13.94 0.87 0.56-1.36 18.69 1.17 0.93-1.48
Early neonatal (0-6 d)Rate RR

95% CI of RR

17.16 1.00

29.26 1.73 1.60-1.86

19.79 1.16 0.79-1.68 25.48 1.50 1.22-1.83
Late neonatal (7-27 d)Rate RR

95% CI of RR

3.21 1.00

5.49 1.71 1.44-2.03

8.65 2.71 1.53-4.80 3.96 1.23 0.74-2.06
Postneonatal (28-364 d)Rate RR

95% CI of RR

4.01 1.00

9.41 2.36 2.06-2.71

5.09 1.27 0.60-2.68 6.63 1.66 1.11-2.47
Infant Death (subtotal)Rate RR

95% CI of RR

24.25 1.00

43.68 1.84 1.73-1.95

33.22 1.38 1.03-1.85 35.77 1.49 1.26-1.77
Fetal & infant deathRate RR

95% CI of RR

39.85 1.00

64.51 1.66 1.58-1.75

46.69 1.18 0.92-1.51 53.79 1.37 1.19-1.58

Table 3 presents the RR of parental race for fetal and infant mortality by risk-free analysis. After adjustment for parental age, maternal education, cigarette smoking during pregnancy, prenatal care service, and FGR by risk-free analysis, the risks of fetal and infant death in the B-B group and the risk of infant death in the FB-MW group remained significantly higher than that in the W-W group (Table 3). After adjustment for gestational age and birthweight, the risk of fetal death in the B-B group was no longer higher than the W-W group (Table 3).
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Table 3. The Risk Ratio (95% CI) of Parental Race for Fetal and Infant Mortality by Risk-Free* Analysis in Twins in the United States

Variable

W-W

B-B FW-MB FB-MW

Rate (%o)

RR 95% CI RR

95% CI

RR

95% CI

Fetal Death
Overall

16.0

1.36

1.25-1.48

0.87

0.56-1.35

1.17

0.93 – 1.47

Step 1

15.1

1.38

1.26-1.52

0.88

0.53-1.46

1.07

0.80-1.43

Step 2

15.0

1.41

1.28-1.55

0.93

0.56-1.54

0.98

0.71-1.36

Step 3

14.9

1.41

1.28-1.56

0.90

0.53-1.52

0.97

0.69-1.3

Step 4

11.8

1.42

1.26-1.60

1.02

0.57-1.84

1.04

0.70-1.54

Step 5

3.0

1.02

0.75-1.38

0.43

0.06-3.06

1.13

0.51-2.53

Step 6

2.9

1.02

0.75-1.39

0.45

0.06-3.20

1.17

0.52-2.62

Infant Death
Overall

24.3

1.80

1.70-1.91

1.37

1.03-1.82

1.48

1.25-1.75

Step 1

22.4

1.86

1.74-1.99

1.40

1.01-1.94

1.39

1.13-1.72

Step 2

22.1

1.88

1.75-2.02

1.41

1.01-1.98

1.38

1.10-1.73

Step 3

22.0

1.88

1.75-2.02

1.37

0.97-1.94

1.39

1.10-1.75

Step 4

19.7

1.97

1.82-2.13

1.45

0.99-2.12

1.44

1.11-1.86

Step 5

3.5

1.66

1.33-2.08

1.46

0.55-3.90

2.39

1.43-3.99

Step 6

3.4

1.69

1.35-2.12

1.50

0.56-4.00

2.46

1.47-4.11