Racial and Ethnic Disparities in Infant Mortality in the United States: The Role of Gestational Age

Han-Yang Chen; Suneet P. Chauhan; Nicole C. Rankins; Cande V. Ananth; Danish S. Siddiqui; Anthony M. Vintzileos

doi:10.1055/s-0032-1326992

American Journal of Perinatology, Table of Contents

Am J Perinatol 2013; 30(06): 469-476
DOI: 10.1055/s-0032-1326992

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Racial and Ethnic Disparities in Infant Mortality in the United States: The Role of Gestational Age

Authors

Han-Yang Chen

¹Center for Urban Population Health, Milwaukee, Wisconsin

²School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
Suneet P. Chauhan

³Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
Nicole C. Rankins

³Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
Cande V. Ananth

⁴Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York
Danish S. Siddiqui

⁵Department of Obstetrics and Gynecology, Aurora Sinai Medical Center, Milwaukee, Wisconsin
Anthony M. Vintzileos

⁶Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York

Abstract

Objective We assessed the association among gestational age (GA) at birth, timing of death, and risk status of the pregnancy and racial/ethnic disparities in infant mortality rate in the United States.

Study Design We utilized U.S. 2000 to 2004 birth cohort–linked birth and infant death data restricted to nonanomalous singleton live births. Multivariable log-binomial regression models were fit to evaluate racial/ethnic disparities in infant mortality while adjusting for potential confounders.

Results Compared with whites, blacks had a higher adjusted infant mortality rate (IMR) (risk ratio [RR] 1.96, 95% confidence interval [CI] 1.91, 2.01), and Hispanics had a lower adjusted IMR (RR 0.79, 95% CI 0.76, 0.82). When categorized by GA, at 24 to 31 weeks, the adjusted early neonatal mortality (ENM) is significantly lower for black than whites, similar at 32 to 36 weeks, and at 37 weeks or more, blacks have significantly higher ENM.

Conclusions The racial/ethnic disparities in infant mortality in the United States persist and vary across GA. These disparities may largely be driven by the excess post-neonatal deaths among blacks.

Keywords

infant mortality - racial disparities - gestational age - high-risk pregnancy

Full Text

References

References
1 Spong CY, Iams J, Goldenberg R, Hauck FR, Willinger M. Disparities in perinatal medicine: preterm birth, stillbirth, and infant mortality. Obstet Gynecol 2011; 117: 948-955
2 MacDorman MF, Atkinson JO. Infant mortality statistics from the 1997 period linked birth/infant death data set. Natl Vital Stat Rep 1999; 47: 1-23
3 Mathews TJ, MacDorman MF. Infant mortality statistics from the 2005 period linked birth/infant death data set. Natl Vital Stat Rep 2008; 57: 1-32
4 Geronimus AT. Black/white differences in the relationship of maternal age to birthweight: a population-based test of the weathering hypothesis. Soc Sci Med 1996; 42: 589-597
5 Mathews TJ, MacDorman MF. Infant mortality statistics from the 2006 period linked birth/infant death data set. Natl Vital Stat Rep 2010; 58: 1-31
6 Papacek EM, Collins Jr JW, Schulte NF, Goergen C, Drolet A. Differing postneonatal mortality rates of African-American and white infants in Chicago: an ecologic study. Matern Child Health J 2002; 6: 99-105
7 Ananth CV, Demissie K, Kramer MS, Vintzileos AM. Small-for-gestational-age births among black and white women: temporal trends in the United States. Am J Public Health 2003; 93: 577-579
8 Bryant AS, Worjoloh A, Caughey AB, Washington AE. Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. Am J Obstet Gynecol 2010; 202: 335-343
9 MacDorman MF, Mathews TJ. Centers for Disease Control and Prevention (CDC). Infant deaths—United States, 2000–2007. MMWR Surveill Summ 2011; 60 (Suppl) 49-51
10 Singh GK, Kogan MD. Persistent socioeconomic disparities in infant, neonatal, and postneonatal mortality rates in the United States, 1969–2001. Pediatrics 2007; 119: e928-e939
11 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–e9
12 Chen HY, Chauhan SP, Ward TC, Mori N, Gass ET, Cisler RA. Aberrant fetal growth and early, late, and postneonatal mortality: an analysis of Milwaukee births, 1996–2007. Am J Obstet Gynecol 2011; 204: 261 , e1–e261, e10
13 Vintzileos A, Ananth CV, Smulian JC, Scorza WE, Knuppel RA. The impact of prenatal care on postneonatal deaths in the presence and absence of antenatal high-risk conditions. Am J Obstet Gynecol 2002; 187: 1258-1262
14 Vintzileos AM, Ananth CV, Smulian JC, Scorza WE, Knuppel RA. The impact of prenatal care on neonatal deaths in the presence and absence of antenatal high-risk conditions. Am J Obstet Gynecol 2002; 186: 1011-1016
15 Reddy UM, Bettegowda VR, Dias T, Yamada-Kushnir T, Ko CW, Willinger M. Term pregnancy: a period of heterogeneous risk for infant mortality. Obstet Gynecol 2011; 117: 1279-1287
16 Markides KS, Coreil J. The health of Hispanics in the southwestern United States: an epidemiologic paradox. Public Health Rep 1986; 101: 253-265
17 Manuck TA, Lai Y, Meis PJ , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network (MFMU). Admixture mapping to identify spontaneous preterm birth susceptibility loci in African Americans. Obstet Gynecol 2011; 117: 1078-1084
18 Hessol NA, Fuentes-Afflick E. Ethnic differences in neonatal and postneonatal mortality. Pediatrics 2005; 115: e44-e51
19 Batton B, Burnett C, Verhulst S, Batton D. Extremely preterm infant mortality rates and cesarean deliveries in the United States. Obstet Gynecol 2011; 118: 43-48
20 Hebert PL, Chassin MR, Howell EA. The contribution of geography to black/white differences in the use of low neonatal mortality hospitals in New York City. Med Care 2011; 49: 200-206
21 Fu LY, Moon RY, Hauck FR. Bed sharing among black infants and sudden infant death syndrome: interactions with other known risk factors. Acad Pediatr 2010; 10: 376-382
22 Ward TC, Mori N, Patrick TB, Madsen MK, Cisler RA. Influence of socioeconomic factors and race on birth outcomes in urban Milwaukee. WMJ 2010; 109: 254-260
23 Rangel EL, Burd RS, Falcone Jr RA. Multicenter Child Abuse Disparity Group. Socioeconomic disparities in infant mortality after nonaccidental trauma: a multicenter study. J Trauma 2010; 69: 20-25
24 Khanani I, Elam J, Hearn R, Jones C, Maseru N. The impact of prenatal WIC participation on infant mortality and racial disparities. Am J Public Health 2010; 100 (Suppl. 01) S204-S209
25 Salihu HM, Alio AP, Wilson RE, Sharma PP, Kirby RS, Alexander GR. Obesity and extreme obesity: new insights into the black-white disparity in neonatal mortality. Obstet Gynecol 2008; 111: 1410-1416
26 Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol 1996; 87: 163-168
27 Spiegelman D, Hertzmark E. Easy SAS calculations for risk or prevalence ratios and differences. Am J Epidemiol 2005; 162: 199-200
28 Heron M, Tejada-Vera B. Deaths: leading causes for 2005. Natl Vital Stat Rep 2009; 58: 1-97
29 Scribner RA. Infant mortality among Hispanics: the epidemiological paradox. JAMA 1991; 265: 2065-2066
30 Palloni A, Morenoff JD. Interpreting the paradoxical in the hispanic paradox: demographic and epidemiologic approaches. Ann N Y Acad Sci 2001; 954: 140-174
31 Howell EA, Hebert P, Chatterjee S, Kleinman LC, Chassin MR. Black/white differences in very low birth weight neonatal mortality rates among New York City hospitals. Pediatrics 2008; 121: e407-e415
32 Arias E, Eschbach K, Schauman WS, Backlund EL, Sorlie PD. The Hispanic mortality advantage and ethnic misclassification on US death certificates. Am J Public Health 2010; 100 (Suppl. 01) S171-S177
33 Mathews TJ, Menacker F, MacDorman MF. Centers for Disease Control and Prevention, National Center for Health Statistics. Infant mortality statistics from the 2002 period: linked birth/infant death data set. Natl Vital Stat Rep 2004; 53: 1-29