There was strong evidence that this association varied by race ( p < 0.001) with adjusted odds ratios (AORs) of 54.4 (95% confidence interval 49.9 to 59.4) in non-Hispanic white, 70.02 (95% CI 60.8 to 80.7) in Hispanic, 23.3 (95% CI 20.3 to 26.8) in non-Hispanic black, 100.4 (95% CI 74.5 to 135.4) in non-Hispanic Asian, and 26.8 (95% CI 19.8 to 36.3) in non-Hispanic other infants. Compared to infants with normal scores, low-scoring infants had increased odds of infant mortality. The cohort consisted of 6,809,653 infants (52.8% non-Hispanic white, 23.7% Hispanic, 13.8% non-Hispanic black, 6.6% non-Hispanic Asian, and 3.1% non-Hispanic other). We used logistic regression to assess the association between Apgar score (categorized as low, intermediate, and normal) and each mortality outcome, and adjusted for gestational age, sex, maternal BMI, education, age, previous number of live births, and smoking status, and stratified these models by maternal race group (as self-reported on birth certificates). We looked at 3 different mortality outcomes: (1) early neonatal mortality (2) overall neonatal mortality and (3) infant mortality. The study included singleton infants born between 37 +0 and 44 +6 weeks to mothers over 15 years, without congenital abnormalities. Population-based cohort study using 2016 to 2017 United States National Vital Statistics System data.
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