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

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.