Parametric modelling of neonatal mortality in relation to size at birth

We use a richly parameterized model to analyse the effects of shortness and thinness at birth on neonatal mortality in Swedish live-born singletons. The model captures the hazard of neonatal mortality according to the function alpha x exp(-gamma x t) + delta, where t represents age. Covariates are allowed to simultaneously influence the initial excess hazard, the rate of decay, and the long-term hazard. Among term newborns, birth length for gestational age had a stronger effect on the long-term hazard and a weaker effect on the initial excess hazard than the Ponderal index. The initial excess hazard associated with a low Ponderal index tended to decay quickly. Among preterm newborns, a higher birth length for gestational age was associated with lower initial and long-term hazards, and with a faster rate of decay of the initial excess hazard. In contrast, the Ponderal index was not associated with the long-term hazard. We discuss the interpretability of the model and its potential use in neonatology and medical demography. We also compare the model to a Cox model with time-dependent covariates. Copyright (C) 2001 John Wiley & Sons, Ltd.