ORIGINAL ARTICLE

Left Truncation in the Periviable Period and the Black Survival Advantage

Corresponding Author

Tim A. Bruckner

[email protected]

Department of Health, Society, and Behavior, Joe C. Wen School of Population and Public Health, University of California, Irvine, California, USA

Center for Population, Inequality, and Policy, University of California, Irvine, California, USA

Correspondence:

Tim A. Bruckner ([email protected])

Brenda Bustos ([email protected])

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Allison Stolte,

Allison Stolte

orcid.org/0000-0003-0702-2344

Department of Health, Society, and Behavior, Joe C. Wen School of Population and Public Health, University of California, Irvine, California, USA

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Brenda Bustos,

Corresponding Author

Brenda Bustos

[email protected]

orcid.org/0000-0003-4784-6292

Department of Health, Society, and Behavior, Joe C. Wen School of Population and Public Health, University of California, Irvine, California, USA

Correspondence:

Tim A. Bruckner ([email protected])

Brenda Bustos ([email protected])

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Alison Gemmill,

Alison Gemmill

orcid.org/0000-0001-5879-9730

Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA

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Joan A. Casey,

Joan A. Casey

Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA

Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA

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Hedwig Lee,

Hedwig Lee

Department of Sociology, Duke University, Durham, North Carolina, USA

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Ralph A. Catalano,

Ralph A. Catalano

School of Public Health, University of California, Berkeley, California, USA

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Tim A. Bruckner,

Corresponding Author

Tim A. Bruckner

[email protected]

Department of Health, Society, and Behavior, Joe C. Wen School of Population and Public Health, University of California, Irvine, California, USA

Center for Population, Inequality, and Policy, University of California, Irvine, California, USA

Correspondence:

Tim A. Bruckner ([email protected])

Brenda Bustos ([email protected])

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Allison Stolte,

Allison Stolte

orcid.org/0000-0003-0702-2344

Department of Health, Society, and Behavior, Joe C. Wen School of Population and Public Health, University of California, Irvine, California, USA

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Brenda Bustos,

Corresponding Author

Brenda Bustos

[email protected]

orcid.org/0000-0003-4784-6292

Department of Health, Society, and Behavior, Joe C. Wen School of Population and Public Health, University of California, Irvine, California, USA

Correspondence:

Tim A. Bruckner ([email protected])

Brenda Bustos ([email protected])

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Alison Gemmill,

Alison Gemmill

orcid.org/0000-0001-5879-9730

Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA

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Joan A. Casey,

Joan A. Casey

Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA

Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA

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Hedwig Lee,

Hedwig Lee

Department of Sociology, Duke University, Durham, North Carolina, USA

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Ralph A. Catalano,

Ralph A. Catalano

School of Public Health, University of California, Berkeley, California, USA

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First published: 01 April 2025

https://doi.org/10.1111/ppe.70019

Citations: 1

Funding: This work was supported by National Institute of Child Health and Human Development (5R01HD103736) to Tim A. Bruckner.

Editors note: A commentary based on this article appears on page 428.

[Correction added on 08 May 2025, after first online publication: Figures 4 and 5 have been switched in this version.]

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ABSTRACT

Background

Infants born in the periviable period show an extremely high risk of infant death. At all gestational ages in the periviable period, non-Hispanic (NH) Black infants counterintuitively show relatively lower infant mortality risk than do NH white infants. The literature theorises that cohort variation over time in pregnancy loss (a form of left truncation in utero) could explain a portion of this survival advantage.

Objectives

We test this left truncation hypothesis in the US (Jan 1996 to Jun 2018) by focusing on NH Black singleton periviable males. We use twin sex ratios as a gauge of cohort left truncation against frail males.

Methods

We retrieved US birth and infant death records for all NH Black and NH white singleton infants born in the periviable range for 282 monthly conception cohorts. We used high and low outliers in the monthly sex ratio of extremely preterm twins (M:F), where a higher sex ratio indicates less selection against frail males. We applied augmented time-series methods which control for both autocorrelation and confounding.

Results

NH Black male periviable singleton infants show a stronger survival advantage (relative to NH whites) for cohorts with high outliers in left truncation (4.0 fewer deaths per 100 live births, 95% confidence interval 1.0, 7.2).

Conclusions

Elevated left truncation in utero may contribute to the survival advantage of NH Black male singletons in the periviable period. Observed racial/ethnic differences in infant mortality across conception cohorts vary, at least in part, from left truncation.

Conflicts of Interest

The authors declare no conflicts of interest.

Open Research

Data Availability Statement

We will make all de-identified data publicly available on our GitHub repository.

Supporting Information

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Volume39, Issue5

July 2025

Pages 420-427

Left Truncation in the Periviable Period and the Black Survival Advantage

ABSTRACT

Background

Objectives

Methods

Results

Conclusions

Conflicts of Interest

Open Research

Data Availability Statement

Supporting Information

References

Citing Literature

References

Information

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Left Truncation in the Periviable Period and the Black Survival Advantage

ABSTRACT

Background

Objectives

Methods

Results

Conclusions

Conflicts of Interest

Open Research

Data Availability Statement

Supporting Information

References

Citing Literature

References

Related

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