204253 Differential Effect of Education on Infant Mortality by Nativity Status of Chinese-American Mothers in the United States, 1995-2000: An Interactive Life-Course Model

Tuesday, November 10, 2009

Qing Li, MD, DrPH , Center for Social Medicine & STDs, Department of Sociology, University of Alabama at Birmingham, University of Alabama at Birmingham, Birmingham, AL
Louis G. Keith, MD, PhD , Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, IL
Reducing disparities in infant mortality remains a public health concern in the United States. Because maternal foreign-born status has not been favorable for infant mortality of Asian sub-groups, especially Chinese Americans (Ch-A) during the 1980's, it is reasonable to ask if infant survival is influenced only by social origin of the parents or interacted upon jointly by parental achieved status. We applied a broad and interactive life-course model, and examined whether the influence of maternal achieved status (education) on infant mortality differed by maternal place of origin (nativity). We conducted a population-based cohort study of singleton live births to US-resident (150,620 foreign-born, 15,040 US-born) Ch-A mothers and a random sample of 150,620 non-Hispanic White mothers from the 1995-2000 US linked birth/infant death certificate files. Proportional hazards regressions and stratified analyses of infant mortality and cause-specific mortality analyses were performed. Infant mortality did not vary between US-born and foreign-born Ch-A by age at death or across birthweight strata but did vary by maternal educational strata. Controlling for other covariates, maternal nativity alone blurred intra-group differences in infant mortality. The protective effect of foreign-born status was seen only among mothers with 13-15 years of education, and low educational attainment was more detrimental for the US-born, whereby US-born non-college educated mothers had the highest risk among six subgroups. Our findings imply that maternal nativity and education affect infant mortality among Ch-A synergistically. Identified high-risk groups and different causes of infant death should be targeted to reduce infant mortality among Ch-A communities.

Learning Objectives:
Recognize the importance of a life-course model in investigating infant mortality in the context of maternal social origin and achieved status. Discuss the strengths and limitations of stratified analysis in testing interaction effect relating to educational status. Identify at least one application from this study for public health program planning to reduce infant mortality.

Keywords: Infant Mortality, Asian Americans

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: This student work is a part of my DrPH program at Maternal and Child Health department of University of Alabama at Birmingham.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.