Research
Obstetrics
The increasing racial disparity in infant mortality rates: Composition and contributors to recent US trends

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Objectives

We examined trends in birthweight-gestational age distributions and related infant mortality for African American and white women and calculated the estimated excess annual number of African American infant deaths.

Study Design

Live births to US-resident mothers with a maternal race of white or African American were selected from the National Center for Health Statistics’ linked live birth-infant death cohort files (1985-1988 and 1995-2000).

Results

The racial disparity in infant mortality widened despite an increasing rate of white low-birthweight infants. White preterm infants had relatively greater gains in survival and the white advantage in survival at term increased. Annually, African American women experience approximately 3300 more infant deaths than would be expected.

Conclusion

The increasing US racial disparity in infant mortality is largely influenced by changes in birthweight-gestational age–specific mortality, rather than the birthweight-gestational age distribution. Improvement in the survival of white preterm and low-birthweight infants, probably reflecting advances in and changing access to medical technology, contributed appreciably to this trend.

Section snippets

Materials and Methods

The National Center for Health Statistics’ (NCHS) linked live birth-infant death cohort files for 1985-1988 and 1995-2000 were used for this study. The files with all personal identifiers removed are public access files and the use of these files for research has been deemed as exempt research by the institutional review board at the University of Alabama at Birmingham. Singleton live births to US-resident mothers with a reported maternal race of white or AA were selected for analysis. We focus

Results

For each race group, part 1 of Table 1 presents the proportion of live births by year and BW-GA categories. The percentage of births for just BW and GA categories are provided in the table margins, labeled “total.” Both race groups exhibit increases in the percent of very LBW infants (<1500 g), with white infants increasing from 0.4-0.6% and AA infants increasing from 1.4-1.9% of all births. The proportion of moderate LBW (1500-2499 g) infants increased for white infants, but slightly declined

Comment

For this study population, IMRs declined over time for both race groups. AA women continue to have higher proportions for preterm and LBW births compared with white women. However, this disparity is decreasing as white infants exhibit greater increases in the LBW rates. At the same time, AA infants continue to experience lower risks of infant mortality for preterm and LBW infants, while having higher risks of mortality among term, postterm, normal BW, and macrosomic births. However, the AA

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      This distinction is useful because, for example, the part of infant mortality related to fitness at birth is related to the health and behavior of the mother before the child is born, but not related to factors such as medical care after birth and the ensuing home environment. Numerous studies have found that most of the black-white IMR gap is due to differences in measures of fitness at birth, rather than due to differences in IMR conditional on fitness (e.g., Carmichael and Iyasu, 1998; Schempf et al., 2007; and Alexander et al., 2008). Similarly, studies often distinguish between deaths in the neonatal period and the post-neonatal period, defined as the first 28 days after birth and the remainder of the first year, respectively.

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    Cite this article as: Alexander GR, Wingate MS, Bader D, Kogan MD: The increasing racial disparity in infant mortality rates: Composition and contributors to recent US trends. Am J Obstet Gynecol 2008;198:51.e1-51.e9.

    The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.

    Supported in part by DHHS, HRSA, MCHB grant MC00008-16 S21 (G.R.A., M.S.W., and D.B.).

    Reprints not available from the authors.

    Deceased.

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