The First-Year Mortality Rates of Singleton Infants Born at Term of US-Born and Foreign-Born Women: The Effect of Paternal Acknowledgment

Objective: To determine the whether a greater percentage of deaths of infants born at term among US-born (vs foreign-born) women is attributable to paternal nonacknowledgement. Study design: Using a cross-sectional population-based design, stratified and multivariable binomial regression analyses were performed on a subset of the 2017 National Center for Health Statistics linked live birth-infant death cohort dataset of singleton infants born at term (37-42 weeks) of US-born (N = 2 127 243) and foreign-born (N = 334 664) women. Results: Infants of US-born women had a prevalence of paternal nonacknowledgement of 11.3% vs 7.5% for foreign-born women, P < .001. The infant mortality rate of term births to US-born women with paternal nonacknowledgment equaled 5.0/1000 vs 2.0/1000 for those with paternal acknowledgment; relative risk (RR) = 2.47 (2.31, 2.86). The infant mortality rate of term births to foreign-born women with paternal nonacknowledgment equaled 2.5/1000 vs 1.6/1000 for those with paternal acknowledgment, RR = 1.61 (1.24, 2.10). The adjusted (controlling for selected covariates) RR of first-year mortality of term births among US-born and foreign-born women with nonacknowledged (vs acknowledged) fathers equaled 1.43 (1.33, 1.54) and 1.38 (1.04, 1.84), respectively. The population-attributable risk percent of deaths in infants born at term for paternal nonacknowledgement among US-born and foreign-born women equaled 4.9% (246 deaths) and 2.8% (15 deaths), respectively. Conclusions: Paternal nonacknowledgement is associated with a 40% greater infant mortality rate among term births to US-born and foreign-born women; however, a greater proportion of first-year deaths among term births to US-born (vs foreign-born) women is attributable to paternal nonacknowledgment. These findings highlight the importance of a father's involvement in the outcomes of infants born at term.