WHAT'S KNOWN ON THIS SUBJECT: Black infants have an increased risk of cerebral palsy when compared with white infants. The reason for this racial disparity is unclear. Lower socioeconomic status may be associated with an increased risk of cerebral palsy. WHAT THIS STUDY ADDS: The increase in cerebral palsy among blacks is due to higher rates of low birth weight. Among low birth weight infants, blacks are less likely to have cerebral palsy than whites. Prenatal care and maternal education also

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... pact cerebral palsy risk. abstract OBJECTIVE: Racial and ethnic disparities in cerebral palsy have been documented, but the underlying mechanism is poorly understood. We determined whether low birth weight accounts for ethnic disparities in the prevalence of cerebral palsy and whether socioeconomic factors impact cerebral palsy within racial and ethnic groups. METHODS: In a retrospective cohort of 6.2 million births in California between 1991 and 2001, we compared maternal and infant characteristics among 8397 infants with cerebral palsy who qualified for services from the California Department of Health Services and unaffected infants. RESULTS: Overall, black infants were 29% more likely to have cerebral palsy than white infants (relative risk: 1.29 [95% confidence interval: 1.19 -1.39]). However, black infants who were very low or moderately low birth weight were 21% to 29% less likely to have cerebral palsy than white infants of comparable birth weight. After we adjusted for birth weight, there was no difference in the risk of cerebral palsy between black and white infants. In multivariate analyses, women of all ethnicities who did not receive any prenatal care were twice as likely to have infants with cerebral palsy relative to women with an early onset of prenatal care. Maternal education was associated with cerebral palsy in a dose-response fashion among white and Hispanic women. Hispanic adolescent mothers (aged Ͻ18 years) had increased risk of having a child with cerebral palsy. CONCLUSIONS: The increased risk of cerebral palsy among black infants is primarily related to their higher risk of low birth weight. Understanding how educational attainment and use of prenatal care impact the risk of cerebral palsy may inform new prevention strategies. KEY WORDS cerebral palsy, racial disparity, epidemiology, sociodemographic ABBREVIATIONS DDS-California Department of Developmental Services RR-relative risk CI-confidence interval OR-odds ratio www.pediatrics.org/cgi/doi/10.1542/peds.