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In particular, we have argued that the generally higher "normal" birth weight specific mortality compared to "compromised" birth weight specific mortality is due to greater fetal loss among "compromised" births, resulting in a highly selected "compromised" sample at live birth [ 9, 10] similar to the hypothesis concerning the "pediatric paradox".
As a result, the race "pediatric paradox" (i.e. African Americans have lower mortality at lower birth weights compared to their European American peers), is due to this beneficial direct effect of being an African American "compromised" birth.
Gage has hypothesized that the lower birth weight specific mortality of African compared to European American "compromised" birth cohorts[ 10] is due to the heavier fetal loss and selection documented among African Americans [ 27, 28].
Each is associated with compromised birth outcomes and challenges in child-rearing.
Identification of the exact mechanisms and whether birth weight plays a "causal" role conditional on "compromised" birth will require additional analysis, i.e. control of potential confounding.
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However, more efficient interventions might be developed by targeting "compromised" births directly.
We also found that maternal age affected the overall birth weight distribution and total infant mortality through its effects on the proportion of "normal" births versus "compromised" births.
In this regard, truncation of the data at 500 grams creates a significant truncation difference in the standardized birth weight distributions between African and European American "compromised" births.
The mixing proportion effect is due to the difference in the proportion of "normal" to "compromised" births between African and European American births of the same sex.
Here, we use CDDmlr to statistically examine the Wilcox-Russell [ 2, 4, 5] and Hernández-Diaz et al. [ 6] hypotheses for both "normal" and "compromised" births.
One subpopulation accounts for most births in the center of the birth weight distribution and appears to identify "normal" births, while the other accounts for most low and macrosomic births, and is hence called "compromised" births [ 9, 10, 12].
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